Charles A. Joyner, MD, FACC, Virginia Cardiovascular Specialists
Graham M. Bundy, MD, FACS, Cardiothoracic Surgical Associates
David M. Gilligan, MD, FACC, Virginia Cardiovascular Specialists
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Afib, specifically, occurs
when rapid, disorganized electrical signals cause the heart’s two upper
chambers (the atria) to contract at a fast and irregular pace, or, fibrillate. This
can lead to blood pooling in the atria, and not passing smoothly to the heart’s
two lower chambers (the ventricles), ultimately leading to a disruption in the
heart’s normal electrical harmony.
Not only is Afib of serious
concern for affected patients, but it is also a burden to the healthcare system,
needing long-term treatment and management to address its rapidly increasing
prevalence. Afib care costs nearly $15,000 annually in incremental direct and
indirect costs per patient, an unacceptable growth trend. In order to reduce
healthcare costs, hospitalization rates, and improve quality of life,
innovative treatment solutions, such as the Hybrid Maze procedure, aim to help facilitate
the management of Afib without relying on repeat treatments such as
radiofrequency ablation therapy, cardioversions (ongoing electrical
manipulation of heart rate), or continued adjustment of medications.
Hybrid Maze, so named for
the maze-like set of incisions made on the left and right atria, is a
multidisciplinary, closed chest, minimally-invasive endoscopic procedure that
creates scar lines (lesions) on the epicardium (the outside of the heart)
without compromising the pericardium (the membrane sac enclosing the heart and
other major surrounding vessels). The lesions work to divert the abnormal
electrical impulses in the heart which cause the arrhythmia, isolating them,
and allowing the heart to return to its normal cadence.
The endoscopic approach
allows epicardial access and ablation to be accomplished without violating the
chest or deflating the lungs. It also enables a single-setting procedure to be
performed in the electrophysiology laboratory, potentially reducing
post-procedure pain, decreasing length of hospital stay, and improving patient
recovery.
During the operation, after anesthesia, the surgical team first performs
the epicardial ablation portion of the procedure, creating the lesions around
the heart. This is performed through an endoscopic incision in the diaphragm using
a radiofrequency technique, allowing the heart to continue its normal function
throughout the operation. The opening in the diaphragm is sized specifically to
facilitate the passage of the epicardial ablation device and an endoscope,
allowing the surgeon to visualize both the atrial surface and the space around
the heart during the procedure.
Upon completion of the epicardial ablation, a drain remains in place
around the heart and the abdominal access site is closed. At this point, the
electrophysiology team takes over the procedure to perform the endocardial
ablation, creating any necessary lesions on the interior walls of the heart,
using irrigated tip catheters to access the multiple sites. After the
operation, the pericardial drain is left in place for 36-48 hours, and patients
are observed for a further 24 hours post drain removal.
Patients are evaluated
after the procedure at six and twelve month follow-up intervals, and seen on an
as-needed basis thereafter. Because the Hybrid Maze procedure is performed in a
single setting and can fit within the normal practice requirements of catheter
ablation, it avoids the downfalls of complex surgical procedures, including the
pain associated with large chest incisions or ports. This demonstrates the
ability to treat persistent and longstanding Afib with minimally-invasive
techniques, better patient outcomes, and reduction of long-term recurrence.
For questions about
Afib, Hybrid Maze, or to schedule a consultation, please contact CardiothoracicSurgical Associates, the practice of Graham M. Bundy, MD, FACS, at 804-320-2751.
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