Atrial fibrillation
A new, minimally invasive procedure could be a relief for those who suffer
By Divyakant B. Gandhi, MD FACS FRCS
The heart has four chambers. Two atria at the top collect blood, and the two ventricles at the bottom of the heart pump the blood. Atrial fibrillation is a condition where the top chambers of the heart will beat rapidly and in a disorderly fashion. This disorder affects about 2 percent of the adult population in the United States, and unfortunately the incidence increases with age.
Atrial fibrillation is usually associated with other heart conditions such as problems with the valves or blood vessels of the heart; however in up to 30 percent of patients, this condition may be present by itself and is referred to as lone atrial fibrillation. Although some patients may not have any symptoms, most patients experience a number of symptoms such as palpitations, shortness of breath, fatigue, chest pains and fainting episodes.
Atrial fibrillation was thought to be harmless for a long period of time and, until recently, was treated only with medications. We now know that atrial fibrillation causes a five-fold increase in the risk of stroke and a two-fold increase in the risk of death. Furthermore, this condition reduces the pumping efficiency of the ventricles of the heart.
In the late 80’s, a cardiothoracic surgeon by the name of Dr. James Cox, along with his colleagues at Washington University in Missouri, pioneered an operation to treat atrial fibrillation, termed the “The Maze Procedure.” The operation consists of creating well-defined cuts in the top chambers (atria) of the heart through an open chest while the patient is on a cardiopulmonary bypass machine.
This ground-breaking procedure results in a blockade of the irregular beats in the atria, thus preventing the atrial fibrillation. More importantly it continues to allow conduction of normal electrical impulses, generated in the natural pacemaker of the heart (SA Node), from the atria to the ventricles, referred to as the Normal Sinus Rhythm.
This operation has led to freedom from a disabling and debilitating irregular heartbeat in up to 95 percent of patients, in large series, with long-term follow up. Further research and understanding of the cause of this condition, and technological innovations has led to modifications and development of less-invasive procedures through small incisions in the chest. The new minimally-invasive procedure does not require the chest to be opened nor does it necessitate placing the patient on a bypass machine, thus reducing risks for the patient.
The application of this new procedure requires careful selection of patients and rigorous testing during the operation, with careful follow-up postoperatively to document success. We, at the Ingham Regional Medical Center, have undertaken the responsibility of coordinating efforts with other physicians and cardiologists to provide this service and procedure in the Mid-Michigan area.
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