Atrial fibrillation is an abnormal heart rhythm that currently affects over 2 million people in the United States. During atrial fibrillation, the heart's two upper chambers (the atria) beat erratically. The irregular and usually rapid heart rate causes poor blood flow, resulting in heart palpitations, shortness of breath and fatigue. Individuals who have this condition also are at greater risk of developing blood clots that lead to stroke, which occur in about 15 percent of people with atrial fibrillation.
Cynthia Crain, a registered nurse at East Jefferson General Hospital (EJGH), had experienced occasional, or paroxysmal, atrial fibrillation for about 15 years when something suddenly changed. Normally, the episodes would last a few days and happen only a couple of times a year. But about two years ago, the fibrillation started and didn't let up. Under the care of her cardiologist at EJGH, Dr. Fortune A. Dugan, Crain started taking medication to control her condition.
'It's exhausting," Crain says. "Your oxygen levels are just so low that you're tired and short of breath all the time. It's no fun."
After a year of trying to manage her heart rate with medication, Dugan suggested Crain talk to Dr. David W. Snyder, an electrophysiologist, a physician that specializes in dealing with abnormal heart rhythms. After running a number of tests, Snyder thought Crain might be a good candidate for a minimally invasive procedure being performed by Dr. Michael N. Brothers, a cardio-thoracic surgeon with the Heart, Lung and Vascular Institute at EJGH.
The "gold standard" for atrial fibrillation surgery is known as the Cox-Maze. "In this procedure, a series of incisions arranged in a maze-like pattern are made in the atria on the heart-lung machine," Brothers says. "The scars from these incisions block the abnormal electrical circuits that cause atrial fibrillation, returning the patient to what is referred to as a normal sinus rhythm, or a regular heartbeat."
The Cox-Maze requires the chest and heart to be opened, which affects recovery time and raises the risks associated with the surgery.
But for patients like Crain, who don't have other heart problems, open-heart surgery is no longer necessary. Instead, Brothers suggested she undergo a relatively new procedure, a biopolar radiofrequency ablation Mini-Maze, which requires only three small incisions on each side of the chest. Through these incisions, Brothers uses a camera to view inside the chest and special instruments to repair the problem.
'Instead of a scalpel, this procedure uses radiofrequency energy, delivered through a clamp, to scar the atrial tissue, stopping the irregular electrical signals that cause atrial fibrillation," Brothers says. "A special linear probe and pen are also used to connect both sides of the heart."
Crain was relieved to hear she wouldn't have to have open-heart surgery. "Nobody wants to have their chest opened up from here to here (she indicates a footlong length on her chest) if they can help it," Crain says. "The fact that the surgery was minimally invasive was wonderful."
Using his previous experience in video-assisted thoracic surgery (VATS) for lung cancer, Brothers found the transition to the Mini-Maze a natural fit. "I had done hundreds of VATS lobectomies (the removal of cancerous tissue), so I was already very comfortable doing this type of minimally invasive cardiac surgery, using only small ports on the sides of the chest."
Crain was back at work only two-and-a-half weeks after the surgery. She feels healthy again and is ready to start working out. "It's a wonderful thing," she says. "It's not widely known about and there are lots of people living with afib [atrial fibrillation] who could benefit from this. They should all have an opportunity to know about it."
Success rates for this type of surgery have been very promising. One study, completed by the University of Cincinnati, showed 91.3 percent of patients who had a radiofrequency ablation Mini-Maze and removal of the left atrial appendage were atrial fibrillation-free after six months.
'We hope this procedure will be equally effective to the classic Cox-Maze which has an almost 95 percent rate of effectiveness but will be much less invasive," Brothers says. "We are already looking at rates of 75 to 85 percent, but the technology must continue to evolve, and we must be selective in choosing our patients."