MAZE
A Surgical Treatment for An Irregular Heartbeat at the McLeod Heart & Vascular Institute
Arrhythmias or abnormal heart beats result from atypical electrical impulses in the heart. Atrial fibrillation or an irregular heart rhythm is the most common arrhythmia in the United States affecting between 2.7 and 6.1 million Americans. The incidence of atrial fibrillation is increasing as the population ages - doubling in prevalence every ten years for those over age 55. The American Heart Association estimates that as many as 12 million people will have this condition by the year 2050.
Atrial fibrillation was long considered a relatively benign condition. But, in fact, it can be quite serious. Irregular beating of the upper chambers of the heart (the atria) can lead to pooling or clotting of the blood. This clotted blood can cause a stroke or other complications. Atrial fibrillation patients have a five times greater stroke risk than the general population. One third of atrial fibrillation patients will suffer a stroke at some point in their lives.
The symptoms of atrial fibrillation range from very minimal to quite severe. Many patients report shortness of breath, chest pain, heart palpitations, and easy fatigability. Other symptoms can include light headedness, swelling of the legs and anxiety. It is not uncommon for patients to be asymptomatic. A number of patients are completely without symptoms and are even unaware that they have atrial fibrillation.
Patients with other types of heart disease, such as, valve disease or coronary artery disease have a greater risk of developing atrial fibrillation. Also, patients with hypertension, thyroid disease, and Chronic Obstructive Pulmonary Disease (COPD) are at an increased risk. Recently, a strong association has been found between sleep apnea and atrial fibrillation.
Once a diagnosis of atrial fibrillation has been made most patients are referred to a cardiologist. Diagnostic testing requested by the cardiologist would include an echocardiogram, holter monitor, and possibly a heart catheterization to rule out any other types of heart disease.
Initial therapy has traditionally been with medications to control the heart rate. A significant number of patients do not respond to the medications or become intolerant of their side effects. These patients may be cardioverted or medically “shocked” back into a normal rhythm. Cardioversion is an electrical procedure where the heart is given low-energy shocks to trigger a normal rhythm. This type of cardioversion is performed in a hospital as an outpatient procedure.
Patients who fail or decline medical therapy may be candidates for medical or surgical ablation. Medical ablations are performed by an electrophysiologist, a cardiologist with specialized training in arrhythmia management. The electrophysiologist will insert a catheter, through a blood vessel in the leg or arm, guide the catheter up to the heart via X-ray imaging and freeze or burn out the abnormal electrical connection.
Dr. S. Cary Huber McLeod Cardiothoracic Surgeon
Patients who are not a candidate for this method or who have developed recurrent atrial fibrillation may be a candidate for a more invasive surgical ablation called MAZE. This procedure, performed by a cardiothoracic surgeon, would also be suitable for those patients who are undergoing open-heart surgery for other reasons. MAZE cures atrial fibrillation by interrupting the electrical patterns that are responsible for the irregular heartbeat.
With the MAZE procedure, a probe is used to make lesions in the heart tissue without damaging the muscle. These lesions, placed in strategic areas of the upper chambers of the heart, redirect the electrical pattern.
The scar tissue generated by the lesions permanently blocks the electrical travel route and aids in the redirection of the electrical flow. This surgery helps the heart pump in a normal way. Also, the MAZE operation surgical eliminates the leſt atrial appendage - a part of the heart that is responsible for ninety percent of the clots that cause strokes.
Recovery from the procedure is a full four to six weeks and most patients can anticipate a return to full activity.
Dr. S. Cary Huber is a board-certified cardiothoracic surgeon with McLeod Cardiothoracic Surgical Associates. He has more than 20 years of cardiac surgical experience. Dr. Huber’s areas of expertise include heart valve replacement, surgical treatment of arrhythmias, and video assisted lung surgery, a procedure involving a video scope through a small incision in the skin.
42
February 2014
shemagazine.com
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