December 10, 2010

An easier surgery for atrial fibrillation

Genesis performs first- in-Iowa procedure

Genesis Medical Center, Davenport is the first in Iowa and one of only a handful of heart centers in the

nation to perform a minimally invasive surgery for patients with the most persistent kind of atrial fibrillation.

 

The surgery is called a Totally Thorascoscopic Modified Maze procedure. Despite the complicated name, it offers a far simpler surgical solution for patients who have exhausted other treatments for atrial fibrillation.

 

“The surgery is done without a large chest incision and without stopping the heart and using a heart-lung machine,” says heart surgeon Robert Fietsam, M.D., who has performed two procedures at Genesis.  “It offers a quick recovery with minimal discomfort; and, it has been shown to have a 95 percent success.”

 

During atrial fibrillation, electrical signals fire rapidly and erratically within the atria, the heart’s upper chambers, making them unable to beat effectively.

 

Some patients with atrial fibrillation experience few or no outward symptoms. Others are so debilitated they can’t work or endure normal physical activity. They can experience heart palpitations, lack of energy, dizziness, fainting, shortness of breath, and chest discomfort.

 

“About 2.2 million Americans have atrial fibrillation,” Dr. Fietsam says. “For them, it’s like having an 8-cylinder engine with only 6 cylinders working. They lose 20-25 percent of their cardiac output whenever they are in atrial fibrillation.

 

“One of the real dangers is that atrial fibrillaiton can lead to blood clots that form in the heart and can cause a stroke.”

 

Genesis Heart Institute cardiologists, electrophysiologists and surgeons all work together to determine the best treatment for each patient.

 

A new surgical solution

The TT Maze procedure becomes an option when other therapies like medication, electrical cardioversion (shocking the heart) and catheter ablation (accessing the heart via a catheter to destroy parts of the electrical pathway causing the abnormal heart rhythm) have not worked.

 

TT Maze surgically creates a new electrical pathway or “maze” for impulses to travel within the atria. It’s minimally invasive, unlike the complex, 20-year-old Cox- Maze procedure, which requires stopping the heart, putting the patient on a heart-lung machine, cutting the atrium in different locations and sewing it back together like a jigsaw puzzle.

 

The procedure

Instead of a large chest incision, three, small incisions are made on each side of the chest. A fiberoptic camera and special tools are used to perform the entire procedure through these tiny incisions.  It takes 2-4 hours and is performed in the Operating Room, under general anesthesia.

 

“We extensively test and map the arrythmia centers on the heart,” Dr. Fietsam says. “Instead of using a scalpel to create scars that block or redirect these irregular currents, we burn or cauterize the tissue with radiofrequency ablation.This creates scar tissue, which then reduces or eliminates the electrical conduction.”

 

Radiofrequency ablation, which burns or cauterizes the tissue generating the irregular heartbeat, has been available to treat atrial fibrillation at Genesis since 2004. It is performed in the Cardiac Catheterization Lab by electrophysiologists, who reach the inside of the heart muscle by snaking thin and flexible catheter tubes through a blood vessel.

 

Ablation using a catheter works for a majority of patients. However, atrial fibrillation can continue to persist for about 30-40 percent of them.

 

 

“These patients may have undergone medical therapy and several radiofrequency ablations in the Cath Lab over a period of time but are still symptomatic,” Dr. Fietsam says. “The two patients who had the TT Maze procedure at Genesis were in their 40s. Their atrial fibrillation had progressed to the point where they couldn’t work anymore.”

 

The TT Maze procedure offers patients a more extensive ablation.

 

 “With surgery, we can get to nerve areas of the heart that are not accessible during a catheter ablation and bring patients a long-term cure,” Dr. Fietsam says. “We can go across the entire pulmonary vein system and create long lines of ablation.”

 

The procedure also removes a small area of the heart, the left atrial appendage, where most blood clots form. “This is where 90 percent of strokes occur in cases of atrial fibrillation, so we’re basically able to eliminate that stroke center of the heart.”

 

Learn the options

There are many new and improved options to treat atrial fibrillation, including the new FDA-approved drug Dabigatran, which has fewer side effects than the traditionally prescribed drugs Coumadin or Warfarin. The new drug does not require frequent blood tests or special dietary considerations.

 

 “Not only do we have a new medication to hopefully stabilize patients with atrial fibrillation, but we have techniques that can cure and eliminate it,” Dr. Fietsam said.

 

 “There are a full range of options – lifestyle changes, medications, implanted medical devices and catheter or surgical ablation to render an area of heart tissue incapable of arrhythmia. We want the public to know about all the improved treatments out there.”

                       

                         --- By Linda Barlow, Genesis