New surgical and catheter-based modifications of the Maze procedure.

There is currently an intense interest in applying the principles of the Maze procedure in a less invasive manner so that a wider group of patients with atrial fibrillation can be treated safely and effectively. These efforts have centered around surgical attempts to curtail the number of lesions placed in the atria at the time of valve surgery and catheter-based attempts to re-create a part or all of the Maze procedure with radiofrequency ablation. Thus far, these techniques remain highly experimental and largely without merit. Many of the problems that we encountered several years ago in developing the surgical Maze procedure are now being repeated in patients undergoing these highly experimental and inadequately evaluated procedures. Nevertheless, there are occasional flashes of promise with some of these approaches. Moreover, it is clear that only a miniscule percentage of the patients with atrial fibrillation will ever become candidates for the open-heart Maze procedure as it is now performed. Therefore, the continuing struggle to relieve the invasive downside of the Maze procedure is warranted but with the caveat, especially to our cardiologist colleagues, to proceed with caution.