Posted by Steve Giddings on April 27, 2001 at 19:21:20:
In Reply to: To maze or not to maze posted by Lowell Rottrup on April 27, 2001 at 19:03:52:
To my thinking, there are two major considerations about undergoing the maze procedure. THe first is to decrease stroke risk. AF is the major recognized cause of stroke, accounting for about 1/3 of all cases. The risk becomes greater the older you get. Risk is reduced by about 2/3 with warfarin (coumadin) (but not completely) and somewhat, but not appreciably, with aspirin. Taking blood thinners for the rest of one's life is inconvenient, it requires periodic measurements of INR (protime,PT) and causes some increased risk for bleeding,particularly from the GI tract. The bleeding risk is not severe except if the PT becomes markedly prolonged. Some wags suggest that anticoagulation is a good thing. If you bleed on therapeutic doses of coumadin it is usually from an abnormal source, like an occult colon cancer. The bleeding provides an early warning. Chronic anticoagulation may also impact on your lifestyle if you participate in activities where there is a chance for injury (competitive bicycling, rock climbing,etc)
The second reason for doing the maze is if the a fib is disabling, causes significant symptoms, or limits activities. Folks vary tremendously in this respect as well. When you are in AF, the amount of blood your heart pumps per beat decreases. In young people with healthy hearts, the decrease isn't much because the ventricles fill largely before the atria even contract. As the heart (and the other body parts) ages, the ventricles, particularly the left ventricle, become stiffer,or less compliant, and they require the added extra filling kick the atrium provides in order to fill completely. The heart usually compensates for all this by increasing the rate at , af rates in them tend to be quitwhich it beats. Sometimes it isn't enough, or the rate is remarkably suppressed (like in supremely conditioned athletes with very low resting heart rates while in sinus, rates in af can also be very low in these folks). People in these categories tend to have more sympoms. People with intermittent (paroxysmal) af also tend to have more symptoms because the heart doesn't have the time to adjust.
Concerning the "minimally invasive" approach, it isn't just a a matter of cosmetics. If your sternum is split, it takes several weeks to heal. During that time you can't do any lifting. There is also a small risk of bone infection with the sternal approach, avoided with the minimally invasive approach. I had the latter. I am told it actually hurts more than the standard approach. I believe it.