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Atrial Fibrillation - May '08
Surgical advances are curing atrial fibrillation
Samuel Durham, MD
Until the 1990s, people with atrial fibrillation (afib or AF) were treated with medications, which likely meant they would be on them for the rest of their lives. Within the last three years, the minimally invasive MAZE procedure has become the standard of care for surgically treating the disease – and many times, curing it.
The MAZE procedure’s name comes from the maze-looking incisions that are created to block unwanted electrical impulses. When the procedure was first developed in the 1980s, it was an open, invasive surgery that was not well understood. “Although the MAZE procedure immediately proved to have the best results for curing afib, it wasn’t until the last 5 to 10 years that we truly understood why it worked,” says Samuel Durham, MD, chief of cardiothoracic surgery.
Advancing the MAZE procedure
After non-invasive ablation techniques were developed, scientists found that the MAZE procedure could be done using catheters and similar energy sources to create lesions that eliminate abnormal electrical signals that cause afib. “This minimally invasive MAZE procedure has gained popularity because patients don’t need to have an open, invasive procedure,” says Dr. Durham. “Rather, the procedure requires small, keyhole incisions in the chest and patients aren’t required to be on the heart and lung machine.” Smaller incisions mean less pain, less blood loss and quicker recovery.
Eliminating the need for blood thinners
“Most afib is instigated by special tissues located on the pulmonary veins of the left atrium,” says Dr. Durham. “Although everyone has these tissues, they trigger afib in some people.” There are two groups of afib patients: those who have proximal afib, which means it comes and goes, and those with chronic or persistent afib.
Those with proximal afib only have problems with the tissue on the pulmonary veins of the left atrium and require lesion sets around the pulmonary vein. The longer someone is in proximal afib, the higher their risk for persistent afib, which is the reason doctors urge patients to get treatment right away.
Persistent afib causes problems with the tissue on the pulmonary veins and the left atrium slowly transforms. When the left atrium dilates and grows in size, it causes afib. To cure persistent afib, additional lesions are needed in the left atrium and sometimes even in the right atrium.
Because patients with afib are at such high risk for stroke, surgeons block off the left atrium appendage to prevent stroke and eliminate the need for patients to be on blood thinners for the rest of their lives. “Blood is dumped to the left atrium, and when the heart goes into afib, the blood stops moving, like a stagnant pond,” says Dr. Durham. “The atrial appendage has the least movement and becomes the resting spot where blood pools and clots, which can cause a stroke. Stapling the atrial appendage prevents the pooling and clotting.”
Depending on the type of afib, a patient may undergo varied techniques of the MAZE procedure. With up to a 90 percent success rate, the MAZE procedure is curing patients from the debilitating effects of afib without the subsequent need for blood thinners. At UT Medical Center, patients have access to highly skilled, specially trained surgeons who provide this advanced, minimally invasive technique.
For more information on atrial fibrillation or get an appointment
at the UT Center for Atrial Fibrillation Ablation within 24 hours,
call 877-451-2299.
