The Maze that is Not Maze: It is Not Filling the Gap!

When properly performed, the true Maze procedure is highly effective to eliminate any type of atrial fibrillation or flutter. Since non-paroxysmal atrial fibrillation is sustained by macro-reentrant circuits located anywhere in both atria, a full bi-atrial lesion pattern is the best way to approach all possible causes in one single step. As we move into less invasive surgical techniques, we must more clearly maintain the scope of the Maze procedure. Difficult approaches are oftentimes the source for incomplete, unsuccessful, and frustrated forms of the Maze. The two only alternative energy sources enabling full transmural lesions in the atrial myocardium are bipolar radiofrequency as well as cryothermia. Standardization of the Maze procedure as a full bi-atrial lesion pattern as well as the proper selection in the alternative energy source is the keystone to get the best outcome.