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August 11, 2006
New procedure at Marquette
General can cure atrial fibrillation
“Mini-Maze” performed at only a few hospitals nationwide
Patients have described it as a “racing
heart.” It’s something most people experience at some
time in their lives. But when your heart races all the time, it
can herald a serious heart condition known as atrial fibrillation
(AF). AF is the most common form of arrhythmia, an irregularity
in the normal rhythm of the heartbeat.
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New
procedure at MGH can cure atrial fibrillation The zigzag lines
in the first illustration represent abnormal electrical impulses
that begin in one of the upper chambers (atria) of the heart.
These impulses create the “racing heart rate”
known as atrial fibrillation. |
When atrial fibrillation persists, patients are at high risk for
stroke or congestive heart failure. Many must also take a life-long
course of anticoagulant medications to prevent blood clots that
could cause a stroke.
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During
Mini-Maze surgery, a precise instrument encircles the atrium
and uses radiofrequency energy to destroy a small ring of
tissue where the irregular heart impulses start. |
A new surgical procedure, called a “Mini-Maze,” can
permanently stop AF for eight out of every 10 patients. The minimally
invasive Mini-Maze is being done in the Heart Institute at Marquette
General Hospital by cardiothoracic surgeon Dr.
Doug Baldwin.
Dr.
Doug Baldwin
The Mini-Maze is done thoracoscopically (using an endoscope in
the chest cavity), with three small incisions between the patient’s
ribs. With the guidance of a miniature camera inside one of the
incisions, Dr. Baldwin applies radiofrequency energy to destroy
a small area of heart tissue. In doing so, he shuts off an electrical
circuit in the heart that causes the irregular rhythm.
“This procedure can be life-changing for AF patients,”
said Dr. Baldwin. “It offers them a cure. It also means
that patients may be able to taper off and eliminate their clot-preventing
medications, so they no longer need weekly lab work.
“The Mini-Maze can provide significant improvement in the
patient’s energy level, while improving their overall quality
of life,” Baldwin said.
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The
ring represents the damaged tissue that shuts off transmission
of the irregular impulses. |
According to Baldwin, who is a partner at Upper Michigan Cardiovascular
Associates in the Peninsula Medical Center, AF is an irregular
heart rhythm that reduces the heart’s ability to pump blood.
As a result, blood pools in one of the atria (upper chambers)
of the heart, allowing clots to form. When clots travel to the
brain, there is a high risk of stroke.
The rhythm is determined by electrical signals that travel through
heart muscle tissue from the atria at the top of the heart to
the ventricles at the bottom. When these electrical signals are
irregular, the atria can begin to fibrillate (contract at a very
rapid rate). The Mini-Maze procedure stops fibrillation and allows
the heart’s normal rhythm to resume. Not only does the heart
pump more efficiently, but the pooling of blood also diminishes,
and the risk of stroke is significantly reduced.
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With the irregular impulses
stopped, the heart resumes its normal rhythm, and the atrial
fibrillation is cured.
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Patients can return to normal activity after the procedure more
quickly and with less pain than with conventional heart surgery.
In fact, hospital stays with the Mini-Maze are usually only two
to three days.
Most patients who undergo the procedure have a 70-90 percent chance
for a complete cure, but physicians state that it takes six months
for the full effects of the procedure to stabilize.
The Mini-Maze technique can also be used as part of more commonly
performed “open heart” surgeries such as heart valve
replacement or coronary artery bypass. The options provide greater
flexibility to treat larger numbers of patients with atrial fibrillation.
According to the American Heart Association, approximately 2.2
million people in the United States suffer from AF and more than
300,000 new cases are diagnosed each year. The condition carries
serious consequences. AF increases the risk of stroke fivefold,
and is a major contributor to the development of congestive heart
failure.
AF has traditionally been treated with anticoagulant drugs, which
do not treat the abnormal heartbeat, but instead prevent the formation
of blood clots. These clots account for the high risk of stroke
in patients with AF. Lifelong anticoagulant therapy is necessary,
but these drugs increase the risk of bleeding and require frequent
blood tests to ensure that the level of medication is the right
range.
“Until now, the options available to AF patients have been
limited. They could be on anticoagulant therapy for life, have
a permanent pacemaker or undergo a very complex surgery,”
Baldwin said. “With Mini-Maze, we can offer patients a much
better choice.”
For more information on the Mini-Maze procedure, please call the
Upper Michigan Heart
Institute at 1-800-MGH-HRTS, or Upper Michigan Cardiovascular
Associates at 906-225-3870 or
1-800-628-3333, ext 3870.
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