Improved Afib Surgery

Millions of people across the United States suffer from irregular heartbeat, a condition known as atrial fibrillation, or afib. It occurs when the upper and lower chambers of the heartbeat are out of sync with each other. In itself, afib is not necessarily life-threatening, but complications caused by the condition can be. Although medical science in this field is relatively new, recent innovations in corrective surgery are less invasive, safer, and require shorter recovery times.

An irregular heartbeat can be a chronic condition, or a person can experience it in sporadic episodes. Heart disease and high blood pressure often are behind the damage leading to irregular heart rhythms. Symptoms associated with afib can include fatigue, light-headedness, and shortness of breath, but the real danger is it has been linked to blood clots and strokes. In fact, between 15 percent and 30 percent of all strokes are caused by afib, and in comparison to strokes caused by other factors, these strokes are often devastating.

Medication can significantly reduce the risk of stroke, but some patients can continue to incur heart damage caused by a slight but chronic rapid heartbeat, even if they no longer have symptoms. Dr. Michael Brothers, a cardiothoracic surgeon with East Jefferson General Hospital, says, “Asymptomatic patients with satisfactory rhythm or rate control, without warning, may also experience serious and sometimes life-threatening complications from antiarrhythmic and anticoagulant drugs used to treat afib.”

Surgery is the most effective way to treat atrial fibrillation. Although it is a relatively modern procedure (the first successful surgery for cardiac arrhythmia was performed in 1968), vast improvements in the practice have been accomplished over the years. The Cox MAZE III procedure, pioneered by Dr. James Cox at the Washington University School of Medicine in 1988, has been considered the most successful open-heart surgery for more than a decade. According to Dr. Brothers, “Ten- and 15-year studies for this complex gold-standard open-heart procedure resulted in 93 percent cure rates. More impressive, the freedom from stroke is 99.3 percent, even in those who failed to maintain a normal heart rhythm.”

Since then, Dr. Ralph Damiano, who trained at Duke and went on to work with Washington State University, further refined the surgery. Damiano created the Cox MAZE IV, which uses rapidly applied radiofrequency energy to destroy the damaged tissue causing a patient’s arrhythmia. Because the Cox-Maze IV can be performed in less than an hour, it reduces the risk of surgery-related complications but is just as effective as MAZE III. “I regularly recommend the full Cox MAZE IV to young patients with persistent or longstanding atrial fibrillation. This operation can also be added concomitantly to other cardiac surgical procedures such as coronary bypass or valve repair,” Brothers says.

Now, a state-of-the-art, minimally invasive procedure called the mini-MAZE is being performed by Brothers at East Jefferson General Hospital. The mini-MAZE effectively eliminates the need to crack and divide the patient’s sternum or to use a heart-lung pump to facilitate organ function during the surgery. Brothers can attain results comparable to that of a much more invasive surgery by creating three to four holes, each about the size of a pencil, on each side of the chest and using video-assisted thoracic surgery (VATS) techniques. The heart continues to beat on its own during the procedure, and through radio frequencies, high-frequency stimulation, ablation, and video-assisted surgery, patients’ heart rhythms can be expected to return to normal over time as the heart continues to heal.

After spending one night in ICU, patients should be able to begin moving around, and within a few days, they can be released from the hospital. Many patients who have had the surgery eventually can quit taking medication for afib altogether.

Success rates post-mini-MAZE are high, with a cessation of symptoms one year after surgery for about 91 percent of those suffering from occasional bouts of afib, 70 percent to 75 percent for persistent afib, and 60 percent for long-standing persistent afib. Even those who experience atrial fibrillation again after surgery are not considered failures. They often need less medication to control their arrhythmia and, according to Brothers, “It is unlikely that a patient will ever have an embolic stroke in the absence of Coumadin therapy [medication prescribed for irregular heartbeat] if the left atrial appendage has been satisfactorily excluded or resected.”

All of these procedures, as well as hybrid MAZE techniques that involve collaboration between cardiac surgeons and cardiologists, are highly effective in treating atrial fibrillation, so the question for doctors and patients becomes a matter of which procedure will answer the patient’s needs with the least amount of risk involved. An assessment of age, health, and medical history usually can help to determine the safest, most beneficial treatment plan.