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Cox Maze IV Surgery



The Cox Maze IV procedure

The Cox Maze IV procedure, often simply referred to as the Maze procedure, is a surgical treatment for atrial fibrillation (AFib), a common heart rhythm disorder characterized by irregular and rapid heartbeats in the atria (the upper chambers of the heart). 


This procedure is designed to restore normal heart rhythm and reduce the risk of blood clots that can lead to strokes in individuals with AFib. Dr.Nikhil says,”The Cox Maze IV procedure is the most effective in restoring normal sinus rhythm and maintaining it in patients with Long Standing Persistent AFib”.

The Maze procedure is named after Dr. James H. Cox, who developed and refined this surgical technique over several iterations. The Cox Maze IV procedure is the most recent and widely used version of the Maze procedure, and it aims to create a pattern of scar tissue in the atria to block the abnormal electrical pathways responsible for AFib.

Here are the key features of the Cox Maze IV procedure:

The Cox Maze IV procedure is typically performed as part of open-heart surgery, often during other heart surgeries like coronary artery bypass grafting (CABG) or valve repair or replacement. In this procedure, the surgeon creates a series of precise incisions and scars using Radiofrequency and Cryo energy instruments, in both atria to create electrical blockages and redirect the heart’s electrical signals. These scars help direct the electrical impulses in an organized way, restoring a normal heart rhythm.

The Cox Maze IV procedure has been highly effective in restoring normal sinus rhythm and maintaining it in many patients with AFib. It can significantly improve the quality of life for individuals who have had persistent or long-standing AFib.

Concomitant Procedure:
Though the Cox Maze IV procedure is a standalone procedure, it is most commonly performed concomitantly with other heart surgeries to address multiple issues at once. Combining procedures can minimize the need for additional surgeries and provide a more comprehensive approach to heart health.

Post-Procedure Care:
After the Maze procedure, patients typically spend a few days in the hospital for recovery. Full recovery usually takes 6-8 weeks, depending on the individual and the complexity of the procedure. Cardiac rehabilitation may be recommended to help regain strength and improve cardiovascular health. The published rate of success in achieving Sinus rhythm after Cox Maze IV procedure is >90%. Dr.Nikhil says, “Though this is a commonly performed procedure in the western world, for various reasons it is not performed as indicated in India!”.