What is Atrial Fibrillation

Atrial fibrillation (AF or AFib) is the most common abnormal heart rhythm. Atrial fibrillation is an irregular, frequently rapid heart rhythm originating in the atria (top chambers of the heart). Instead of the normal situation (normal sinus rhythm) in which a single impulse travels in an orderly fashion through the heart, in AF many impulses begin simultaneously and spread through the atria, causing a rapid and disorganized heartbeat.

At one time, atrial fibrillation was thought to be a harmless annoyance. However, atrial fibrillation is now recognized as a dangerous condition. Atrial fibrillation doubles the risk of death. It also increases the risk of stroke five to seven times compared to a person without atrial fibrillation. In addition, atrial fibrillation may cause congestive heart failure and uncomfortable symptoms related to a rapid heart rate. Advances in ablation (both minimal invasive surgical and catheter) offer the possibility of cure to a large number of patients.

 

Treatment Options

The MAZE Procedure
The MAZE Procedure is a surgical approach that treats atrial fibrillation by interrupting the electrical impulses that cause abnormal heart rhythm. The surgery typically involves the placement of incisions in both atria, however can be modified to suit a given patient's condition. When the incisions heal, scar tissue forms and prevents abnormal electrical impulses from passing through the heart. This technique is highly effective in curing atrial fibrillation. However, potential complications of the procedure include fluid retention and other risks associated with open heart surgery such as bleeding, infection, stroke, and pneumonia. For these reasons, and because the classical MAZE procedure requires a breastbone splitting incision, use of the heart-lung machine, and multiple incisions in the heart, this procedure has not been embraced by many patients and physicians.
Radiofrequency Ablation for Atrial Fibrillation: Modified Maze Procedure
Surgical ablation, also called a modified Maze procedure or Mini Maze procedure, involves the use of radiofrequency waves (modified electrical energy) to create precise scar lines on the heart's surface. These scars redirect the erratic electrical impulses of atrial fibrillation to follow a normal electrical pathway through the heart. Our surgeons use specially designed instruments to deliver the radiofrequency waves to the abnormal heart tissue.

This operation is frequently performed in conjunction with other heart surgeries, such as mitral valve repair or coronary artery bypass, but is also performed as a stand-alone procedure for patients with atrial fibrillation. This procedure can be performed through one or two very small incisions (minimally invasive). The minimally invasive approach is performed with the use of a videoscope. Like many other heart surgeries performed here, surgical radiofrequency ablation can be done on a beating heart and does not require use of a heart-lung machine.

How is surgical ablation different from catheter ablation?
Catheter ablation is similar to surgical ablation in the sense that both procedures are performed for the same purpose and they both use radiofrequency waves to treat abnormal heart rhythms. Catheter ablation involves the use of a catheter that is threaded through the leg and into the heart. The catheter is equipped with a device that delivers radiofrequency waves to the source of the arrhythmia. An electrophysiologist performs this procedure in a catheterization lab.
Who is a candidate for surgical treatment of atrial fibrillation?

    Radiofrequency ablation for atrial fibrillation is an option if:

  • You have chronic atrial fibrillation
  • Your atrial fibrillation is not well controlled by medication
  • You have intermittent atrial fibrillation that is disabling
  • You require another type of heart surgery procedure, such as mitral valve surgery or coronary artery bypass surgery
  • You have a history of stroke or cannot take Coumadinne