Minimally invasive surgical techniques are advancing therapies in many areas of heart care including the treatment of atrial fibrillation — or A-fib — the most common cardiac arrhythmia. A-fib occurs when the upper chambers of the heart, the atria, beat out of rhythm with the lower chambers of the heart.
Normally, the atria contract at of 60 to 90 beats per minute. During A-fib, the atria can beat at up to 600 beats per minute. Also during A-fib, blood in the upper chambers of the heart can stagnate and blood clots can form. The increased risk of the formation of a blood clot also escalates the risk for stroke in patients with A-fib.
While A-fib is more common in older adults, it has been diagnosed in patients as young as 20. The risk for A-fib also increases with age. By some estimates, men and women over age 40 have a one in four risk of developing A-fib during their lifetime.
Patients with symptomatic A-fib experience significant fatigue, shortness of breath and can develop blood clots, despite the fact that many take prescription blood thinners.
For these patients, the goal of treatment is to get the heart rate under control, reduce symptoms and prevent blood clots.
Medications are typically the first step in managing A-fib followed by other non-surgical treatments, such as cardioversion or ablation using radiofrequency. For some patients, however, surgery may be necessary.
When surgery is needed, minimally invasive techniques, such as the mini maze procedure, can help correct A-fib without extensive scarring and long hospital stays or recovery times.
During the mini maze procedure, a cardiothoracic surgeon makes three to four small incisions on each side of the chest. The surgical instruments and a thorascope — a tiny camera — are inserted through these small incisions. A surgical ablation device is then used to create scar tissue that isolates the upper left chamber of the heart.
The scar tissue prevents abnormal electrical impulses and interrupts the transmission of the abnormal signals that cause A-fib. The impulses that regulate the heartbeat are then transmitted through the new "maze" and establish a regular rhythm.
During the procedure, the left atrial appendage, where blood clots often form, can be removed minimizing the risk of a blood clot forming that could travel to other parts of the body.
The mini maze procedure is highly successful at correcting A-fib. Most patients who undergo the procedure are able to stop taking medications to treat A-fib, some of which have negative side effects.
After a period of normal rhythm, these patients can also stop taking blood thinners. Most patients leave the hospital in two to three days following their procedure.
For the five million or so Americans affected by A-fib, continued medical advances, such as mini maze procedure, provide additional treatment options without the need for open heart surgery and offer hope for a cure without a lifetime on medications.
Dr. Hamid Mohammadzadeh is with KentuckyOne Health Cardiothoracic Surgery Associates.