The Maze procedure - surgical ablation for atrial fibrillation.
A Cox-Maze IV by a consultant cardiothoracic surgeon - concomitant with cardiac surgery, or as a standalone thoracoscopic mini-maze. Rhythm restoration, LAA exclusion, and a plan for what happens next.
Indicative pricing
What a private Maze procedure costs in the UK.
Indicative ranges across our cardiothoracic network. Fundable on the NHS per BHRS and SCTS criteria - private figures below.
In short
Standalone thoracoscopic mini-maze: £30,000–£50,000, home in 2–3 nights.
| Procedure | Indicative range | Typical duration | Stay |
|---|---|---|---|
| Standalone thoracoscopic mini-maze (Wolf / Ex-Maze) | £30,000–£50,000 | 4–6 hours | 2–3 nights |
| Concomitant Maze during cardiac surgery (add-on) | £5,000–£10,000 | +20–30 min | With primary op |
| Hybrid convergent (staged endo + epicardial) | £35,000–£55,000 | 2 stages | 3–5 nights |
| Pre-op TOE | £900–£1,600 | 30–45 min | Same visit |
| CT of the left atrium | £600–£1,200 | 20 min | 48–72 hours |
| Consultation only | £250–£500 | 45 min | Same visit |
Prices vary by centre, by which surgeon does the case, by whether a Maze is concomitant or standalone, and by which energy source (bipolar RF, cryo, HIFU) is chosen.
The problem
The right operation, the right surgeon, at the right moment.
Maze is the most under-offered AF treatment in the UK - added too late, or not at all, when a patient is already on the cardiac surgery list. We fix the timing, the surgeon and the lesion set before you commit.
-
Already booked for cardiac surgery?
Ask about a concomitant Maze. It adds 20–30 minutes and is first-line per SCTS when AF is present.
-
Catheter ablation not held?
A standalone thoracoscopic mini-maze reaches lines a catheter cannot. We compare the two, honestly.
-
Cannot take anticoagulation?
Maze plus LAA exclusion, or dedicated LAA closure - we discuss both.
When it helps
When the Maze procedure is the right step.
The situations where surgical AF ablation is the right choice - plus the one red flag that delays surgery until it is treated.
-
Symptomatic AF failing medical therapy
Palpitations, breathlessness or fatigue on rate and rhythm drugs - and catheter ablation has failed or is unlikely to work.
-
AF undergoing concomitant cardiac surgery
Mitral valve repair or replacement, CABG or aortic surgery - a Maze added at the same time is first-line per SCTS guidance.
-
Persistent AF after failed catheter ablation
Standalone thoracoscopic mini-maze for younger patients with persistent AF where one or more catheter ablations have not held.
-
Long-standing persistent AF
AF present for more than a year - surgical ablation reaches lines catheter ablation cannot, and outperforms it in the right patient.
-
Enlarged left atrium
A dilated LA lowers catheter-ablation success. Surgical lines with LAA exclusion are often the more durable option.
-
Contraindication to anticoagulation
A high-stroke-risk AF patient who cannot tolerate long-term anticoagulation - Maze plus LAA exclusion is considered alongside dedicated LAA closure.
-
Rhythm restoration priority
Patients who want the best shot at durable sinus rhythm - accepting a bigger operation for a better long-term result.
-
Red flag: LAA thrombus on TOE
A clot in the left atrial appendage delays surgery until it is treated. TOE before any Maze is non-negotiable.
Procedure options
One Maze, several ways to do it.
What each option on the table involves - concomitant vs standalone, energy source, and where LAA management fits.
-
Concomitant Cox-Maze IV
Added to mitral valve, CABG or aortic surgery. Bilateral pulmonary vein isolation plus roof, mitral, right atrial and coronary sinus lines, with LAA amputation. Adds 20–30 minutes.
-
Standalone thoracoscopic mini-maze
3-port thoracoscopic bilateral epicardial pulmonary vein isolation, LAA excision and ganglionated plexi ablation. Wolf mini-maze or Ex-Maze variants.
-
Hybrid convergent
Staged endocardial catheter ablation plus surgical epicardial ablation. The most complex option, offered by specialist centres for the hardest AF.
-
Bipolar radiofrequency (RF)
Modern energy source. Creates transmural linear scar with less bleeding and shorter clamp times than the old cut-and-sew Maze.
-
Cryoablation
Cold energy - useful near the mitral annulus and coronary sinus. Often combined with RF in the same operation.
-
HIFU (high-intensity focused ultrasound)
Used in selected epicardial cases where an off-pump lesion set is preferred.
-
LAA amputation or exclusion
Always part of a Maze. Removes the commonest source of AF-related stroke.
-
Consultation only
Safety and recovery
What to expect afterwards - honestly.
Maze is a cardiac operation with real risks and a real recovery. The things worth planning are the pacemaker chance, the anticoagulation plan, and the possibility of a top-up ablation later.
-
A cardiac operation, not a day case
Even the thoracoscopic mini-maze is done in a cardiac theatre with a cardiac team. Concomitant Maze rides on the recovery of a bigger operation.
-
Bleeding and atrial injury
Every atrial ablation carries a small bleeding risk. Modern bipolar RF and cryo have reduced this compared with cut-and-sew.
-
Atrio-oesophageal fistula (rare, catastrophic)
A rare energy-source-related injury between atrium and oesophagus. Very uncommon in modern practice - but the reason temperature and lesion depth are watched closely.
-
Phrenic nerve injury
The nerve to the diaphragm runs near the ablation lines. Injury is uncommon and usually recovers.
-
Pacemaker in 5–10%
Sinus node dysfunction after Maze needs a permanent pacemaker in 5–10% of cases.
-
Sternal wound or pneumothorax
Open Maze via sternotomy carries wound risks; thoracoscopic mini-maze carries a small pneumothorax risk from the port sites.
-
Pulmonary vein stenosis (rare)
Very uncommon with modern energy sources - the older concern with earlier RF systems.
-
Peri-operative stroke
Small but real. LAA exclusion at the same operation reduces long-term stroke risk.
-
Recurrent AF - top-up ablation
Around 15–25% will need a top-up catheter ablation within 5 years. It is planned for, not a failure.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever lesion set and energy source was used, the note the surgeon sends you keeps to the same shape.
A quiet reminder
Cardiac surgery language is precise and can read coldly - ask your care team to explain anything that is unclear.
Ask your care team to explain anything that is unclear.
- 01 Header
AF type and operation performed
Paroxysmal, persistent or long-standing persistent - and whether the Maze was concomitant, standalone thoracoscopic or hybrid convergent.
- 02 Technique
Lesion set and energy source
Which lines were placed (bilateral PVI, roof, mitral, right atrial, SVC-IVC, coronary sinus), which energy source (bipolar RF, cryo, HIFU), and whether the LAA was amputated or excluded.
- 03 Findings
LAA, valve and intra-op rhythm
Notes on the LAA (thrombus, morphology), any valve findings, and the rhythm coming off bypass.
- 04 Impression
Anticoagulation, rhythm plan, review
Read this first: anticoagulation duration (many still need long-term per CHA₂DS₂-VASc / HAS-BLED), Holter schedule at 3/6/12 months, and when to consider a top-up.
Recognised by major UK insurers
Cover for the Maze procedure varies by insurer, by AF pattern and by whether the operation is concomitant or standalone.
Frequently asked
Everything we get asked about the Maze procedure.
Quick answers on when Maze beats catheter ablation, cost, success rates, pacemaker risk and recovery.
-
What is the Maze procedure?
A surgical treatment for atrial fibrillation. The surgeon creates a set of scar lines in the atrial tissue - the Cox-Maze IV lesion set - that block the abnormal electrical circuits driving AF. Modern Maze uses bipolar radiofrequency or cryoablation to make the lines, rather than the old cut-and-sew technique.
-
When is Maze recommended over catheter ablation?
When catheter ablation has failed, when AF is long-standing persistent, when the left atrium is very dilated, or when the patient is already having other cardiac surgery (mitral valve, CABG, aortic) - a concomitant Maze is first-line per SCTS guidance in that setting.
-
What is the difference between concomitant Maze and standalone mini-maze?
Concomitant Maze is added to another cardiac operation and adds only 20–30 minutes. Standalone mini-maze (Wolf mini-maze, Ex-Maze) is a 4–6 hour thoracoscopic operation done just for AF, through 3 small ports on each side of the chest.
-
How much does a private Maze procedure cost in the UK?
Standalone thoracoscopic mini-maze is roughly £30,000–£50,000. Concomitant Maze added to a cardiac operation is an extra £5,000–£10,000 on top of the primary surgery. Hybrid convergent runs £35,000–£55,000. NHS-funded per BHRS and SCTS criteria.
-
What are the success rates?
Freedom from AF at 5 years is 75–90% overall - best in paroxysmal AF undergoing mitral surgery, and lower in long-standing persistent AF with a very enlarged left atrium. Standalone mini-maze reports 75–85% at 3–5 years.
-
Will I still need anticoagulation after a Maze?
Often yes. Even in sinus rhythm, many patients are advised to continue long-term anticoagulation based on CHA₂DS₂-VASc and HAS-BLED scores. LAA exclusion at surgery reduces - but does not eliminate - the case for anticoagulation.
-
What are the main risks?
Bleeding, atrial injury, a rare atrio-oesophageal fistula, phrenic nerve injury, a 5–10% chance of needing a pacemaker for sinus node dysfunction, sternal wound issues after open surgery, pneumothorax after thoracoscopic surgery, and peri-operative stroke. Around 15–25% need a top-up catheter ablation within 5 years.
-
How long does recovery take?
Standalone thoracoscopic mini-maze: 2–3 nights in hospital, back to office work at 4–6 weeks, no gym for 6–8 weeks. Concomitant Maze follows the recovery of the primary cardiac operation - usually 6–12 weeks off work.
Related treatments
Looking for something else?
-
Catheter ablation for AF
The less-invasive first-line ablation option.
Learn more -
Left atrial appendage closure
Stroke prevention when anticoagulation is not an option.
Learn more -
All tests & procedures
Every test and procedure guide.
Learn more