Posted by Steve Giddings on July 02, 2001 at 18:54:15:
In Reply to: To MAZE or not to MAZE posted by Roger Meyer on June 27, 2001 at 23:01:21:
Almost all of the folks who contribute to this page have gone through or are going through the same decision.
A fib causes varying degrees of disabilities in different people. My own feeling is that folks in chronic (rather than paroxysmal) AF probably do somewhat better because their heart adapts to the alternate rhythm.
Everybody agrees that sinus rhythm is better than AF. The major concerns with AF are, as you know, increased risk for stroke and decreased cardiac output, which may ultimately lead to congestive heart failure.
AF is the largest single identifiable risk factor for stroke. The risk is small in people with lone AF under the age of 50, but increases to a point where, at age 65, most cardiologoists believe that it is better to accept the bleeding risk and inconvenience of coumadin, than to continue to accept the risk for stroke. The difference in stroke risk between NSR and AF continues to increase at every age. In octagenarians with AF, the risk is about 10% per year. Coumadin decreases that risk about 2/3 of the way to normal. A daily aspirin is less than half as effective as coumadin.Second, the heart ejects less blood per contraction in AF, for 2 reasons. The atrial contraction pushes extra blood into the waiting ventricle. This becomes more important with age because the the ventricles get stiffer with age. In young folks, the atrial contribution to ventricular filling is typically less the 10-20%. In older people, the contribution is often 50%. When that coordinated atrial contraction is lost, the ventricle doesn't fill as well and so delivers less blood per contraction. This problem also gets worse with age. The beat to beat variation in heart rate in AF also decreases the ability of the ventricle to deliver blood.
But, even given all of the above, a lot of people in AF do just fine and live well into their 80's, perhaps beyond. The chances of doing so are just decreased.
In making a decision about the MAZE, major open heart surgery, you have to decide if the cure is better than the disease. It takes about 6 months on average for the heart to recover electrically. Full recovery for cardiac output probably takes about 2 years (that is most people's consensus and my own experience but hasn't been studied well). ALthough the risk is small, there is still a finite risk for death of or other major calamity with open heart surgery. There is also a concern for long term effects on mentation.
My advice would be to read all you can, but get some help from someone with first hand experience knows the facts, and whom you trust. Hopefully this would be your cardiologist.
Me? I had the MAZE two and half years ago and I'm a internist with a fair number of miles on the professional odometer. None of what I wrote above is intended as professional advice. You can never substitute for a knowledgeable and concerned physician who knows you well.