Emory
Cardiothoracic Surgeons Use Innovative Procedure During Open Heart
Surgery To Eliminate Atrial Fibrillation
For 15 years,
Arnold Bailey of Hartwell, Georgia, lived with the knowledge that a
valve in his heart was defective and would eventually need to be replaced.
Like more than two million other Americans, he also suffered from atrial
fibrillation (often called a-fib), a fast, irregular and ineffective
heart rhythm.
"I had to take several medications
to keep it under control and sometimes I experienced very rapid, irregular
heartbeats and had to go to the emergency room," Mr. Bailey says. Because
a-fib can cause blood clots, raising the risk of strokes and heart attacks,
he was also placed on the blood thinner, Coumadin - a drug which can
have adverse side effects due to bleeding.
Last spring, Mr. Bailey's
heart valve had deteriorated to the point he needed open-heart surgery.
His physician referred him to Emory Cardiothoracic surgeon Joseph M.
Craver, MD at the Emory Heart Center. Dr. Craver gave him a double dose
of good news. "He told me he might be able to repair, not replace, my
heart valve and he also said there was a procedure he could do at the
same time that would likely cure my atrial fibrillation," says Mr. Bailey,
a 62-year-old retired postal worker.
Cardiothoracic surgeons at
Emory University Hospital (EUH) and Emory Crawford Long Hospital (ECLH)
are offering this innovative procedure using new technology, the Medtronic
CardioblateTM Surgical Ablation System, that can potentially cure a-fib
in selected open-heart surgery patients, like Mr. Bailey, who have experienced
a-fib for a year or more.
"When I woke up after surgery,
I noticed my heart was beating in perfect rhythm," he says. "And it
has continued to stay in rhythm. It is wonderful to not have to worry
about it any more and to get on with my life and do things I want to
do."
The Cardioblate(TM) Surgical
Ablation System allowed Dr. Craver to perform a safer and less time
consuming version of what is known as a MAZE procedure. Widely recognized
as a potentially effective treatment to restore normal heart rhythm
in patients with chronic atrial fibrillation who do not also have structural
heart disease, the standard MAZE procedure requires numerous intra-cardiac
incisions and suturing. The lesions created with the new procedure become
electrophysiological barriers, interrupting pathways in the heart causing
abnormal heart rhythms. The result is a cure for a-fib.
Because of the added risks
posed, cardiothoracic surgeons had only reluctantly attempted the lengthy,
complicated MAZE procedure on patients with a-fib who also need open-heart
surgery. However, the new procedure using the CardioblateTM system eliminates
or greatly reduces the risks of the standard MAZE procedure - giving
many patients with both chronic a-fib and valvular disease the opportunity
to have both problems treated during the same operation.
Emory Cardiothoracic surgeons
guide the tip of the CardioblateTM pen, a radio frequency device irrigated
with a saline solution, over the endocardial surface of the heart to
heat and shrink - or ablate – targeted tissues and cells to block the
abnormal impulses. The ablation produces the same results as the original
MAZE procedure, but without any incisions, sutured edges or bleeding.
"Intraoperative radio frequency
ablation is effective and far less invasive than the original MAZE procedure.
It is also associated with fewer complications," says Dr. Craver. "The
extra operating time needed to complete the MAZE procedure using this
approach is greatly shortened. The irrigated electrode offers the additional
advantage of allowing energy to be driven further into the tissue, creating
a deeper lesion while cooling the cardiac tissue surface and minimizing
charring."
Most patients who have undergone
the procedure at Emory experience an organized heart rhythm immediately.
They are closely monitored over a three to five month period so any
recurring a-fib episodes can be promptly treated. "When normal sinus
rhythm is maintained for a significant time, anti-arrhythmic medication
and Coumadin can be discontinued. While we cannot say this is curative,
we feel optimistic that may be the case for the majority of patients."
says Dr. Craver. "Chronic a-fib not only increases the risk of strokes
due to thromboembolic events but also impairs cardiac function - so
the ability to cure it reduces a huge long time burden for patients."
In Georgia, the Emory Cardiothoracic
team is in the forefront of using and studying the procedure. "Future
therapies are also being developed whereby this methodology may be applied
to the outside of the heart without open-heart surgery through the use
of catheters," Dr. Craver says.
The Emory Heart Center
is comprised of all cardiology services and research at Emory University
Hospital (EUH), Emory Crawford Long Hospital (ECLH), the Carlyle Fraser
Heart Center, Andreas Gruentzig Cardiovascular Center of Emory University
and the Emory Clinic. Ranked in the top ten of U.S. News & World Report's
annual survey of the nation's best Heart Centers, the Emory Heart Center
has a rich history of excellence in all areas of cardiology - including
education, research and patient care. It is also internationally recognized
as one of the birthplaces of modern interventional cardiology.
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