Re: Some maze questions

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Posted by Carl Plaskett on February 26, 2003 at 08:02:55:

In Reply to: Some maze questions posted by Jim Matthews on February 25, 2003 at 23:15:52:

Jim: Prior to the question posted a few days ago, I had never seen the term "atrial kick". I might GUESS that it refers to the force of an atrial contraction, which may be lower after cutting of the muscle tissue in the atria until it heals and regains flexibility. That is my GUESS! So many mazers are now performing at or better than their pre-afib levels, that there must not be too much concern about this change. Even Brian, who posted the question, ran a half-marathon at 6 months post maze. Not TOO shabby! I have asked Dr. Cox to comment on this term, but have not heard back from him.

Atrial flutter is a faster arrhythmia, the origin of which is in a different area of the heart. In my case, my EP thought that flutter was my primary arrhythmia, which was putting me into afib. Since the location of the origin of flutter is realitively easy to ablate, many of us have had flutter ablations before the Maze, usually without much success. Anecdotally, my HR during afib went down from a max of 260+ to about 165 after the flutter ablation, so I did get some benefit from the ablation. Two years later, I had the Maze, and have had no afib since. I DID have 2 short bouts of a-flutter at about 3 months and at 19 months, for which I was cardioverted. Some of us have had to go back for flutter ablations post maze because the flutter was undiscovered until after the Maze. The cure rate of 98.5 to 99% at the CC includes those people.

I BELEIVE most heart/lung surgery patients have some fluid retention problems for a few weeks post surgery. Some of us end up with fluid in the pericardial sac surrounding the heart, some accumulate fluid in or around the lungs, hence the need for chest tubes, which I believe we all experienced post-Maze, for at least a short period.

As for anti-arrhythmic drugs post-maze, I think that is a personal choice by the surgeon/attending cardiologist. Some mazers have reported taking no drugs post-Maze. I didn't until I had afib for a few hours on day four. I was released from the CC on Rythmol, but 3-4 days later, my EP halved that small dosage, and 2-3 weeks later, eliminated it altogether.

I have never heard of afib orginating in the "posterior
portion" of the atrium, but exactly where is this location? Afib seems to originate at or very close to the pulmonary vein openings in just about all cases of which I am aware. Any other input...Steve?

We were ALL nervous, Jim. Just keep asking questions. The more answers you get, the better you will feel about your decision. They WON'T try to talk you into anything at the CC. If you get Dr. Hammer, you WILL make the decision on your own, as he will answer every question to your satisfaction before you get to have the Maze.

Not having junctional rythm, I cannot comment. With the Cox Maze III, the atrial appendages, where blood tends to "pool" and coagulate, are REMOVED, hence reducing the possibility of stroke being caused by insufficient pumping/arrythmias in the future, since there is no longer these little "pockets" in which blood can "pool".

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