COX IV Maze...my diary...my story

I was diagnosed with AF when I was 43 and have various suffered for the last 20 years. Mine is exercise induced, so vigorous exercise is out of the question. Physical exhaustion through hard labour can also be a trigger, as can lack of sleep. I do not have other Afib risk factors: high blood pressure, sleep apnoea or obesity.

If a slip into arrhythmia I can revert naturally over-night when my heart rate slows. My normal resting heart rate is a slow 50-54 bpm or so. When I first wake up in the morning, it can be 38-44 bpm. However, if I do end up in rapid AF, it can persist and require treatment.

The years1997 to 2005 were something of a lost decade, as I had various periods of extended AF.Everything was tried with different cardiologists. Anti-Arrhythic Drugs (AAD) were of limited benefit, a cardioversion was a success, and I also reverted after a course of herbs from a Chinese herbal expert. Although I cope with AF well and the impact on a quiet normal life is minimal, it prevented me from living the active life I wanted.

In 2005 I tried the third cardiologist, who referred me to my current electophysiologist. Within 72 hours I had a Catheter Ablation that resolved right atrial flutter. A year later I had a PVI cryo-ablation to resolve flutter. My AF was resolved for almost a decade...although I sensed deterioration in my capacity for hard physical work, which was leading to physical exhaustion after a couple of hours of effort.

Then in 2016 I had an event reminiscent of my very first AF attack...I was running up stairs and half-way up simply hit a wall...I could feel my heart racing and I was gasping for breath. Late 2016 I had a catheter ablation which was partially successful, requiring me to go on to Flecanide. However, I was still going into AF every few months, although I reverted after a few days. Then leading up to Xmas 2017 a persistent episode of AF started, leading up to Catheter Ablation #4 in Feb 2018.

I raised the question of a hybrid maze, and my electrophysiologist said he would discuss my case with a leading cardiac surgeon

It took less than half an hour for the actual ablation, but my electrophysiologist took an hour and a half to do a thorough mapping

Within two weeks, on my first day back at work, I have an AF episode. I revert overnight. The following day was my first appointment with the surgeon, and on the way there I start a second AF episode.

Cox IV Maze was on the table...as I would be before long.

Right mini-thoractomy. Biatrial Cox IV Cryomaze. Left Atrial Appendage Ligation.



Edited 2 time(s). Last edit at 04/13/2018 05:29PM by tiggwigg.

I had a caratoid echo and spirolmetery ahead of a second appointment with the surgeon.
I had not had a repeat AF episode since the first appointment, and the day before the second appointment I had a full ECG.
Immediately before it I bounded up stairs for 24 stories. My heart rate recovered well and the ECG came back normal.

Although feeling a little confused at this, surgery was booked in for 11 April, 2018.

I had only walked maybe 300 meters from the surgeons rooms when I felt some arrhythmia. Within 24 hours I was in full AFib.

This completely convinced and committed me to go ahead with the Cox IV Maze procedure.

10 April, the morning of my admission, I received a phone call that I had been bumped from the surgery list for someone with greater need.

This was something of a roller coaster. I had watched many videos of youtube of the procedure, which I found confronting and disturbing.

However, I found repeat watching rather cathartic. I also had the opportunity to talk through the procedure with family and friends over easter. In the end I have embraced the surgery...and was emotionally and psychologically ready for the surgery...looking forward to the outcome.

Cancellation has resulted in a bit of an emotional crash. However, I am one of those unfortunates who is positive and an optimist and am getting over it.

11 April, the original day for my surgery, I now learn I am booked in for Tuesday April 17.

I have an appointment tomorrow 12 April with the surgeon, to have answered a couple of questions on the procedure.

12 April, and my surgeon has shifted surgery to a different, larger hospital...now booked for 19 April.

As for answers, the Cox IV Cryomaze it turns out will be fairly stock standard. I will be on bypass. RF for all lesions except those close to underlying structures, in which case cryo will be used. There will be three stab punctures in the right atrium to for insertion of an Atricure RF Clamp; and an incision across the left atrium for RF and Cryo, during which my heart will be stopped.

13 April.
First thing I contact the imaging centre for a transthorasic echocardiogram and chest Xray. I manage to get the last appointment of the day...and conveniently on the way home from work stop off for these, the last of my pre-op imaging.

Two interesting things from the echo...

The first was that for much of the day I was very aware of my heart beat. I was feeling it, and I don't usually feel it if I am in sinus rhythm....so I had a sense that something was not quite right. I had to visit one of my work colleagues one floor above. I used the stairs and when I sat down she asked me why I was out out of breath and puffing. I had not noticed it, but she was right. Just that short walk to her desk had done it.

I have a hand a Heal Force hand held ECG. I had used it mid afternoon and it showed my heart rate was a steady 51-54, which is my normal resting heart rate. I mentioned to the echo operator I thought my heart rate was a little arrhythmic, but she said I was in sinus rhythm...a slow heart rate still has to pump the normal amount of blood for someone of my build, which means that each beat pumps more blood, so the the ventricle is fuller and larger...being in and out of afib these days means I am very sensitive to my heart in my chest, so maybe I was just over sensitive.

Second, I asked the operator if she found anything that might affect the surgery going ahead. She said not, but did observe the aortic root was a little large, but did say that since I was tall it was probably within normal for my height.

Maybe she was right. That has kind of happened before. My GP noticed in a blood test I had impaired kidney performance, which had dropped quite suddenly down almost a third and was quoted as 72%. As a result I saw a kidney specialist, who told me that the pathology labs that do the the blood test use a standard body weight in their calculation...as I was well above that standard body weight, this would affect the result. He calculated that the drop in kidney function was only 10-15%, and since the initial result, the kidney function had not only been stabled, but in fact had improved slightly over several months. He said that kidney function decreases a little every decade, and given my age there was nothing indicated I should be concerned about.

Now I can relax over the week-end...and work my way through a new wad of hospital admission forms.



Edited 2 time(s). Last edit at 04/14/2018 09:01AM by tiggwigg.

14 April.
Many people will liken it to DULL, but my chore for the morning was the domestic shopping, as per usual. It went as usual...including the fact that after about an hour and a half I was weary...with a tiredness that was almost febrile in my muscles. As I carried the bags to and from the car and up the stairs, my breathing was laboured...I was out of breath and puffing as my work colleague had observed the day before.

Although I can be in sinus rhythm, it only takes an hour or so of physical activity for weariness to set in...if I push beyond that my heart rate gets irregular...series of short beats start occurring, along with some overly delayed. If I push further, I am entering Afib territory.

So once I got home and unloaded, I took things easy, and filled out the hospital admission forms before snuggling under the doona for a snooze.

Later, I set to cooking. I am vegetarian. My wife is not. I prepare my meals, she prepares hers or eats mine. While recovering, I don't seem myself cooking anything, so I am preparing meals in advance.

Many people will liken it to DULL, but I am happy to eat the same dish all week, after preparing a big pot on the week-end. So, in the afternoon I prepared dishes. The first was vegetarian Strogonoff, consisting of sliced, fried mushrooms and firm, whole champignons in a Strogonoff sour cream sauce, with chick peas and creamy medium tofu marinated in sesame oil.

The second was Moroccan dish of pumpkin and cauliflower, with red kidney beans and creamy medium tofu marinated in baharat spice mix



Edited 1 time(s). Last edit at 04/14/2018 09:03AM by tiggwigg.

No wonder you are tried, your food sounds good but there isn't any good protein in your diet. For me, I have to have some good protein in the form of meat, chicken, fish or some beef, otherwise, I have no energy. I really don't know how vegetarians can do it, I have seen people on a veggie diet and they don't seem that healthy. Sorry, I do wish you well.

L

Plenty of protein.

Quote

The first was vegetarian Strogonoff, consisting of sliced, fried mushrooms and firm, whole champignons in a Strogonoff sour cream sauce, with chick peas and creamy medium tofu marinated in sesame oil.

The second was Moroccan dish of pumpkin and cauliflower, with red kidney beans and creamy medium tofu marinated in baharat spice mix

I wouldn't mind eating this way, except for tofu which a lot of vegetarians eat, but it isn't for me. Tofu is made from curdled soy milk, soy is not good for one, especially people with thyroid problems.

A protein is a pretty simple thing. It’s made up of nine essential amino acids necessary for the dietary needs of humans. There are two kinds: complete and incomplete. A complete protein has the right proportions of all nine essential amino acids; they are most easily attained from meat, poultry and dairy.

Proteins from plants, such as beans, legumes and grains, are incomplete proteins. That means that in order to get everything you need from a vegetarian protein source, you need to eat a combination of them in order to create a complete one. For example, if you eat lentils, adding bulgur to your dish would make that protein complete. And you don’t need to eat these protein sources during the same meal; so long as you consume them at some point throughout the day, your body will take care of the rest. And how much protein you need a day varies from person to person.



Edited 1 time(s). Last edit at 04/14/2018 04:07PM by Elizabeth.

I do eat yoghurt and other dairy products and the the full range of tree nuts copiously: walnuts, hazelnuts, cashews, brazil nuts, pistachios. I believe Walnuts and mushrooms provide the last of the missing amino acids...and I do adore mushrooms.

Finding a complete protein that isn't from meat or beans is simple. A peanut butter sandwich will do. There are a dozen other examples of non-meat complete protein sources.

Protein is an essential nutrient that your body needs. Your body is constantly breaking down proteins in your cells, organs and tissues. Protein from the food you eat, breaks down into amino acids that replace proteins in your body. A complete protein contains all the essential amino acids your body needs to stay healthy. While peanut butter is an excellent source of protein, it is not a complete protein.


Good for a snack not a meal, I would prefer Almond meal.

15 April
My main worry, if you can describe the nagging thought as a worry, is whether the surgery will be deferred yet again...I do not believe that would now happen...but I thought that twice before.

I have been living the surgery for almost a month, and perparing for it a month before that.

My first meeting with the surgeon resulted in a carotid echo and spirometery test to evaluate my risk. The spirometery technician weighed me in at 98.6 kg. That is well into an obese BMI for my height (187cm). In my thirties I was a vigrorous cross country skiier, and as a result of the training I ran a couple of marathons, and in those days I was a fit 85kg. 98.6 kg was clothed, however, it did put me 9.6kg above the top of normal BMI (89kg), and 13.6kg above my optimum healthy weight.

Previously, I had vigorously dieted from 98kg to 92kg over a few weeks; before starting the 5:2 diet...two days of 650 calories a week, five days eating normally. Over a year on the 5:2 diet I had managed to reduce my weight down to 87kg. Why had I not maintained it there? Blame weakness and my cross-country ski-ing. I was over the moon to resume cross-country ski-ing after my successful 2005 and 2007 catheter ablations. I had never been sporting...I have two outstanding memories from my high school sporting career. The first was after volunteering for the inter-school sports, coming last, last and last in the events I entered...the second was a friend telling me I was as co-ordinated as a beached whale.

My first experience of cross-country ski-ing was at a university camp. On the last day of camp, those who could went on a 15km day trip to a local vantage point. From there, as I gazed around the view of snow covered rolling hills and high plains, in almost a revelation, I knew that this was "it". I felt fulfilled, and that the place of snow enriched me with fulfillment. And from thereon and then on, I avidly took to the snow every winter. Then AF meant cross-country ski-ing ceased to be something I could expect to safely do.

Then around 2010, I had the confidence I could try it again...and as before I would stock up on the snacks and treats for the ski season. Except I never achieved the same count of days on snow as I had earlier: poor weather; poor snow, short seasons, unavailability of my ski buddies meant I went on fewer ski trips than planned...leaving me with a heap of chocolate and candy and biscuits...which I then ate over the summer. After getting my weight down to 87kg, each summer following I went up 2 or 3 kg as I treated myself to those sugar-laden and fat burdened treats.
By the time my 2016 and then 2017 ski plans were stymied by the return of AF, my weight was again 98kg in mid Feb 2018.

Immediately after the spirometery test I resumed the 5:2 diet, except this time five days of 650 calories and only eating normally each week-end. In around 8 weeks I have lost over 10kg. My weight this morning was 88kg, meaning my BMI is once more in the normal range for my height.

The southern hemisphere winter is almost on us. I have already had a flu vaccine. When I am in public places I wear an N95 surgical respiratory mask. Twice daily, I use an antibacterial throat gargle and a saline sinus flush. I am having preventive physiotherapy for a troublesome lower back, since AF has prevented me continuing clinical pilates for the past few months.

And of course, there is daily reading and research...and the conversations with work colleagues and family which seem to usually start or finish on the subject of that state of my surgery and my well-being...so my thoughts are rarely far from Cox IV Maze...and having got to know it so well, I can visualize the procedure in my mind's eye and (at least for the present) I am comfortable with the prospect and free of apprehension.

16 April
I have a blood test today; and then off to the physiotherapist for some acupuncture needling in the areas of tightness in my back. I am also doing back exercises around strength and flexibility. Anyway, may as get all the needling done in the one day.

A friend has come to stay. The timing was to fit in when I would have left hospital had surgery occurred on 11 April. As it is, it is a chance to catch up before I become an invalid. He will also be doing maintenance and other jobs around the place that I haven't felt able to keep up with.

I live on a hectare (2.6 acres) in a semi rural area. There are wonderful views, because the house is on the steep side of a hill. There are many trees and a continuing fall of bark and occasional limbs. About once a year a mature tree comes down. Then there are weeds: introduced ivy and blackberry are the worst. Unfortunately, an hour of light gardening is all I have been able to manage without arrhythmia setting in, so I am very thankful for my friends assistance and support.

What exactly will my surgery involve: Right mini-thoractomy. Biatrial Cox IV Cryomaze. Left Atrial Appendage Ligation?

There is an article and a video of the procedure I am having, except that the Left Atrial Appendage is sutured shut, rather than being closed off using a clamp (Atriclamp).
[www.ncbi.nlm.nih.gov]
[www.youtube.com]

I found some aspects of the orientation less than clear, but have now worked that out.
As access is from the right side through a mini-thoractomy, only the right atrium is easily reached.
Isolation of the Right Pulomary Veins (RPVI) is the first thing done. Embryonically, the tissue when the veins connect with the atrium is the same, and so may be electrically active. This means that RPVI must include a cuff of atrium that includes this connector tissue. However, the RPV connect to the left atrium right against the connect between left and right atrium, which prevents that cuff of tissue being separated.

In order to free this cuff of tissue, right atrium is lifted to access the back of the heart, then the Left and Right Atria are partially separated along the line of their join (inter atrial groove). This means that the part of the left atrium to which the RPV are connected ceases to be connected to the right atrium, and the RF clamp can be placed to include the RPV cuff of left atrium.

The right atrium is then lowered back into position, and the right atrial lesions created. The Tricuspid Valve is in the tissue between the right ventricle and right atrium, so cannot be reached with the RF clamp used for the lesions through the atrial wall.

The right atrium is then again lifted to access the left atrium from the back of the heart, for the left atrial lesion set.
The incision into the left atrium is made just beyond the cuff lesion of the RPVI, through the separation made in the interatrial groove. An atrial retractor is used to open the incision, and in the graphics the lifted right atrium is above and behind the retractor. Visually, the back wall of the left atrium is fully exposed with the RPVI cuff lesion at the bottom abutting the line of the incision. The Mitral Valve is in the tissue between the left ventricle and left atrium, so cannot be reached with the RF clamp used to for the lesions through the atrial wall. For this reason, a cryoprobe is used to complete the lesion to the Mitral Valve Anulus.

The coronary sinus is a vein that encircles the heart, returning low-oxygen blood to the right atrium. Its path takes it across the left atrial wall, close to where the atrium and ventricle join. The presence of this vital underlying structure means the RF clamp cannot be used, apart from the fact that the muscle wall here is too thick for certainty that an RF lesion would go all the way through. Cryo it seems does little damage to underlying structure while still killing the tissue completely through the thicker atrial wall (transmural), and this external epiatrial lesion completes the left atrial lesion set.

Thanks, Liz - and not only that, peanut butter has the risk of contamination by aflatoxins commonly found in peanut butter. Many people are very sensitive to that fungi (and may not realize it's the source of problems.) I agree that almond butter is a better choice as it is not as prone to that invisible mold contamination.

While acute aflatoxicosis in humans is relatively rare, but the more chronic, lower-level exposure is probably more prevalent than reports would suggest because the symptoms are difficult to recognize. Chronic exposure is a significant concern due to its insidious nature and potential long-term effects, which include immunosuppression, cirrhosis, and liver cancer. There are at least 13 different species of mold that produce 20 different aflatoxins, with aflatoxin B1 considered the most toxic. Aflatoxins affect nearly every system of the body, as the following list shows

Respiratory: Pulmonary edema, cancer
Cardiovascular: Heart inflammation
Neurological: Reduced oxygen flow, headache, neuron death, encephalopathy, impaired memory, insomnia, disorientation, loss of coordination; tumors in both central and peripheral nervous system
Gastrointestinal: Liver damage, liver cancer, vital hepatitis, parasite infestation
Urinary: Kidney damage and tumors
Reproductive and Developmental: infertility, teratogenic, abnormal growth and development in children
Endocrine: Tumors and cancer
Blood: Blood and bone cancers
Immune: Immunosuppression, autoimmune reactions and allergies
Other: Mitochondrial malfunction, interference with protein and RNA synthesis, apoptosis (cell death)

[www.intechopen.com]

I started this blog, "my story...my diary" as an account of my challenging and likely traumatic journey through my Cox IV Maze procedure...as a record of my emotional, psychological and physical highs, lows and in-betweens.

As such, I am somewhat bemused to see it having been "hijacked" by a debate on the merits or otherwise of "peanuts".
Some might say this topic is particularly appropriate, and that "peanuts" is what it deserves.

Those posts may well be put down to deflection behavior, should those posting find the actual subject of this surgery confronting; and thereby prefer posting on a neutral subject such as peanuts. Maybe, it would be more appropriate to carry on that debate in its own thread.

In this forum, people are participants and entitled to post, as they are entitled to disagree. However, specious rationalisation does need to be called out. For Elizabeth to suggest, based on the partial description of two dishes, that "there isn't good protein in my diet" is spurious. It is as spurious as describing a diet as complete based on the ingredients of a single commercial Pizza. The dishes I described are only part of my overall diet, which includes a diversity of tree nuts, pulses, grains, legumes, low-fat dairy products and a veritable cornucopia of fruit and vegetables.

I am well aware of the risks of alfatoxins, but there are risks in everything. I have little doubt that more people are harmed from motor vehicles than through eating peanuts...or for that matter through eating Pizza...while maybe more people likely die undergoing heart surgery than from eating peanuts.

It is said there are three types of lies: lies, damned lies and statistics...the use of statistics in isolation can easily lead to misinformation...similarly, challenging or lambasting a thing or concept in isolation, without discussing it in context of a fuller view of the world, can easily lead to misinformation.

Certainly, there is a risk associated with peanuts; but if everyone avoided everything that had a risk, then society would grind to a halt. The greatest risk in any of our lives is probably the motor car (at least in the country in which I live), whether it be death, injury or financial consequences, yet "authorities" in press and government are more focused on the dangers of saltwater crocodiles or sharks...or for that matter, the behavior of sport stars and celebrity chefs...than travails in our world which pose substantive or on-going risks to individuals, whether those risks affect those alive today or will affect our children and their children.

I'm waiting with baited breath to hear the rest of your surgery diary. Did you have the surgery?

I doubted the value of a considerable daily investment in daily blogging on my Cox Maze IV procedure. There was certainly a lot to discuss in the course of it, or simply to talk about.

My Cox Maze IV procedure took place on April 19, after being bumped from the surgical list. There were a couple of reviews in the vein "this man saved my life when all others failed", so it seemed he took on near impossible cases and it was only reasonable for someone in real need to take precedence.

From all I had followed, I expected a mini-thoracotomy that split the fifth rib with a hard retraction, and consequently a great deal of pain and discomfort. In fact, the procedure was far better than I had hoped. The working incision was about 6cm long and no rib was affected. Soft retraction meant damage to rib muscle was minimal. There were two very small endoscopic incisions, that provided vision for the surgeon. I would class the pain as only around 3 out of 10, and then only for two or three days.

I went into theatre just after midday, and the surgeon phoned by wife to tell her all had gone well at almost 5 pm. The anaethetist had told me I would be kept under general anaesthetic for another three hours after coming out of theatre.

So, there is not much to tell about April 19. On April 20 I awoke in Intensive Care (ICU). My wife said I looked very swollen. There were two small additional incisions in my chest (one for a drain and one for the temporary pace-maker leads). I also had small incisions in both groins for the cannulation of the femoral artery and vein for the bypass, and a very small one in my neck for cannulation of the jugular.

So surgery went fine. The temporary pacing was where I had the most concern. The ICU doctors standard pacing is at 85 beats per minute (BPM). My normal resting heart rate had been around 50 BPM. It took 3 days for me to regain my own pacing, and two more days before the doctors were comfortable enough to take the temporary pace maker down to 50 BPM. By then, my established resting bpm was around 85.

Where the difficulty lay was that at night, whenever I started transition to sleep. I was having sleep apnea episodes and stop breathing, which resulted in my heart rate slowing to below 30 bpm. So essentially, until I properly got to sleep I was having rapid cycles of micro-sleep in which I stopped breathing, which would then wake me up short of breath with a heart rate below 30.

Eventually, I resolved that by using Temazapan to get me to sleep at night...then when I awoke early morning getting up to fully break the sleep cycle.

Anyway, it may be that if that early pacing had been at 50 or 60 bpm, the rate my heart rate settled into would be around that. As it is, my resting heart rate remains around 85 bpm. I am using beta blockers to slow that. It is currently at around 70 bpm.

The hospital is a major cardiac centre. It has a large ICU, with the sort of turnover of patients that would indicate. But those patients were all coronary artery bypass or coronery valve replacement patients. I was the only Maze patient they had had; and I was simply treated as another bypass patient, who are mostly on a temporary pacemaker for 12-24 hours...if longer, it means that a permanent pacemaker if necessary. Cox Maze patients require temporary pacing for 24 to 72 hours, sometime longer. No nurse or staff doctor seemed to be familiar with what Cox Maze IV procedure was, and repeatedly nursing staff would observe how long I had been on temporary pacing, and ask me when I expected to be fitted with a permanent pacemaker...and I would have to then explain how long temporary pacing may be required in a Cox Maze patient.

Information I had sought out prior to surgery indicated I could expect to be in hospital for 7 days, then resting at home for a further 14 days before returning to work. In fact, I was in hospital for 11 days, then rested 3 weeks on medical leave and one more week on annual leave. I am still in recovery mode. Although I take walks of around 5 or 6 km in length each day, those walks are on the flat. The beta blockers are such that they strip we of much of my energy, and even a slight hill leaves me exhausted.

I guess the question for readers is whether I am glad I had the surgery, and whether I would go through it again. Firstly, the outcome has not been as good as I had hoped, but recovery may take another three months or so...fingers crossed my resting heart rate will slow and my stamina improve. I do think a maze procedure was the only option that meaningfully remained for me, whether a Cox Maze or a Wolf MiniMaze. As it was, my capacity was more like that of a 75 year old than some at 62...I did not want to spend the next 13 years living the life of a 75 year old...I have always been an active, outdoor person and wanted the life of a 62 year old, until I reached 75 years of age, and then I we would see.

As it now stands, I have not had an episode of atrial arrhythmia in two months. I have been active within limits which before surgery would have pushed me into afib...although those limits are severely reduced compared to my level of activity a few years ago. And, there remains the potential for further recovery.

My wish had been to go cross-country ski-ing and back-country snow camping this coming August or September. That now appears very unlikely for 2018 and something to wonder about for 2019.

Would I recommend someone to have a Maze procedure...I would with qualifications, depending on their circumstance...a mentor with a willingness and capacity to provide real information is necessary. My key concerns would be whether the hospital has established procedures around Cox Maze IV patients and pacing; and for accurate information on the actual procedure as done by the surgeon.

I was fortunate enough to have a brilliant cardiothorasic surgeon, who completed the procedure to a standard as high as could be expected in any leading cardiac hospital anywhere in the world. The aftercare was attentive, but less than I might have expected, but whether that affected my current high heart rate cannot be determined. Anyway, the ultimate outcome is still to be determined. And, rather than holding my breath for what that might be, I will cross my fingers instead.

Thanks for the update, it's very interesting.
Hopefully everything resolves for you!

Four months on from my last post and how do I stand now?

Most days I walk 5-10km. and am now following a hilly trail. I have spent several days cross country ski-ing, covering 8-12km per day. I am probably healthier than most men of my age (63 years). I have not identified any arrhythmia during that time. I am working fully days, and no longer left exhausted by the end of the day.

So much for the good. What about the rest.

A recent echocardiogram revealed a leaking tricuspid valve which was not there before the surgery.
The Left Atrial Appendage was closed off in the surgery, which reduces left atrial capacity by around 16%.
Above all, the large areas of atrial muscle blocked off by the surgical lesion lines no longer beat normally:
picture you are squeezing a balloon between your two hands...this is your atrium beating...in my case, I am now one hand clapping...and using only one had makes squeezing that balloon difficult.

So my atrial performance had been substantially reduced by the Maze surgery, while my right ventricular performance is compromised by the leaking tricuspid valve.

I can jog when rushing for the train, but I cannot run. Going up hill I am OK for the first twenty meters, then have to slow right down and pace myself. I am fitter now than before the surgery, but my performance is less.

The big question: am I better than before having the Cox Maze IV? By my best judgement I am not much better, not much worse. More or less as I was before. When the end of a journey is where it began, Cox Maze is a tough path to take.

Was I informed before the surgery that any of this might be the outcome. No I was not.

If in the same place as I was a year ago, would I do it again given what I know now. The answer is no, I would have waited. Given the way of my atrial arrhythmia, I expect I could have made a lifestyle change, and so live within the arrhythmia. I may have been able to do that for a few years, and who knows, some fantastic new treatment may have come along before I deteriorated to where a major intervention would be needed...

My arrhythmia was exercise induced, and usually normally returned to sinus rhythm within 24 hours...at worse after a couple of days. However, on some days when I might walk untroubled for 5-10km, just jogging 50 meters would have me arrhythmic. A couple of hours working in the garden would leave me exhausted and needing to rest to avoid an episode of arrhythmia. Yet, even then, on a good day, I could run up 24 stories, two steps at a time, and remain in sinus rhythm. But that was the knife blade I walked, never knowing if just hurrying would leave me in arrhythmia. But even when I was arrhythmic, I could still finish a normal days work at the office.

Now my arrhythmia is gone. However, my hope was that the Cox Maze IV would allow me to do all that, and not be affected by a day of vigorous gardening.

But that hope has not been realized. That said, the surgery was a success. Nevertheless, the surgery resulted in damage to my tricuspid valve and I am now worse off than before...a surgical success, but a medical failure.