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July 15, 1992

Cardiothoracic Surgery

Author Affiliations

University of Colorado Health Sciences Center, Denver; Harvard Medical School, Boston, Mass

JAMA. 1992;268(3):337-338. doi:10.1001/jama.1992.03490030049023

The most common sustained cardiac rhythm, other than sinus rhythm, is atrial fibrillation. Atrial fibrillation results in both hemodynamic compromise and an increased risk of thromboembolism. Cox and associates1 have pioneered a surgical procedure that is capable of interrupting all the potential macroreentrant circuits that could occur in the atrium.

Surgical incisions are placed in such a way that it is impossible for an electrical impulse to emanate from any point in the atrium and return to the same point without crossing a suture line, which functions to interrupt conduction. Of critical importance is that the procedure provides a route by which an impulse generated by the sinoatrial node can access the atrioventricular node to drive the ventricles. Several blind alleys along this main conduction route are also created to synchronously activate the atria, thus preserving atrial transport function. The procedure, termed the maze procedure, creates a single entrance