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Heart Disease (Expert Forum)
Chronic Atrial Fibrillation
Answered by
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Chronic Atrial Fibrillation
by Doug, Sep 20, 1999 12:00AM
Last year I was diagnosed with chronic atrial fibrillation during a routine physical (I am a 44 year-old male). I was unaware of any abnormality. I was first cardioverted about seven months ago after an unsuccessful attempt to control the condition with Tambocor. A follow-up exam this month indicated I had gone out of sinus rhythm (I had no sense of the condition again). Electro-cardioversion was repeated last week, but by the time the anesthesia had worn off, I was back in Afib. Does this fit the profile of a candidate for the Maze procedure?
Doctor's Answer
by Cleveland Clinic, MD, Sep 22, 1999 12:00AM
, Sep 22, 1999 12:00AM
Thank you for your question. The Maze procedure is a surgical approach to controling atrial fibrilllation. What this procedure does is create multiple blockages in the atrium (the site of atrial fibrillation) and creates a "maze" that channels the rhythm down a normal pathway. This can be done either surgically (by opening the chest, cutting up the atrium and then sewing it back together) or with a catheter through the groin and putting multiple linear burns in the atrium. There are benefits and disadvantages to both methods.
The surgical method has a higher success rate but involves opening up the chest. It is not usually done for lone atrial fibrillation. It was developed by Dr. J Cox at the University of Washington in St. Louis and I would recommend him if you are interested in this approach. The catheter procedure is less invasive but has a lower success rate. It is not done at many centers and is a long procedure lasting up to 8 hours. Only certain types of atrial fibrillation respond to these procedures and the success rate is higher with some types than others. In general however the surgical maze is only done when open heart surgery is already required - i.e. valve surgery.
I have listed some review articles below about these procedures. Your local medical library can help you obtain copies. Good luck and post a follow-up as to how things turn out.
Unique Identifier
98066875
Authors
Sundt TM 3rd. Camillo CJ. Cox JL.
Institution
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Title
The maze procedure for cure of atrial fibrillation. [Review] [25 refs]
Source
Cardiology Clinics. 15(4):739-48, 1997 Nov.
Local Messages
Abstract
Atrial fibrillation is the most common dysrhythmia encountered in clinical practice. A significant number of patients fail medical therapy because of inability to convert or control the rhythm pharmacologically, intolerance of the requisite medication, or persistent symptoms despite apparently satisfactory rate control. Based on experimental studies establishing the electrophysiologic basis of atrial fibrillation, a surgical procedure has been developed that is highly effective in restoring sinus rhythm without further requirement for medications. The evolution of this procedure, its current indications, and results are outlined. [References: 25]
Unique Identifier
98014535
Authors
Stevenson WG. Ellison KE. Lefroy DC. Friedman PL.
Institution
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Title
Ablation therapy for cardiac arrhythmias. [Review] [124 refs]
Source
American Journal of Cardiology. 80(8A):56G-66G, 1997 Oct 23.
Abstract
Ablation has become an important and, in some cases, the first-line therapy for a number of tachyarrhythmias. The feasibility of treating arrhythmias with ablation was initially demonstrated with surgical ablation techniques. Recently, catheter ablation techniques have replaced the surgical approach in nearly all cases. Catheter ablation is highly effective for the Wolff-Parkinson-White syndrome, atrioventricular nodal reentry, and atrial ectopic tachycardia. It is effective for atrial flutter, although approximately one quarter of patients treated with catheter ablation continue to require therapy for concomitant atrial fibrillation. The surgical maze procedure has proved to be feasible for preventing atrial fibrillation. The risks and long-term efficacy of catheter ablation maze procedures for atrial fibrillation need to be defined. The efficacy of ablation for ventricular tachycardia varies with the type of tachycardia. Catheter ablation is very effective for the rare idiopathic ventricular tachycardias that occur in structurally normal hearts and for bundle-branch reentry ventricular tachycardia, which occurs most frequently in patients with dilated cardiomyopathy. When performed at an experienced center, surgical ablation is an excellent option for selected patients with ventricular tachycardia due to prior myocardial infarction who have a discrete aneurysm but otherwise well-preserved ventricular function. Catheter ablation shows promise for this arrhythmia, but it can be offered only to those patients who have relatively slow tachycardias that allow catheter mapping. Substantial advances in mapping and ablation technology will continue to occur, allowing nonpharmacologic control of cardiac arrhythmias to be achieved in an ever greater number of patients. [References: 124]
The surgical method has a higher success rate but involves opening up the chest. It is not usually done for lone atrial fibrillation. It was developed by Dr. J Cox at the University of Washington in St. Louis and I would recommend him if you are interested in this approach. The catheter procedure is less invasive but has a lower success rate. It is not done at many centers and is a long procedure lasting up to 8 hours. Only certain types of atrial fibrillation respond to these procedures and the success rate is higher with some types than others. In general however the surgical maze is only done when open heart surgery is already required - i.e. valve surgery.
I have listed some review articles below about these procedures. Your local medical library can help you obtain copies. Good luck and post a follow-up as to how things turn out.
Unique Identifier
98066875
Authors
Sundt TM 3rd. Camillo CJ. Cox JL.
Institution
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Title
The maze procedure for cure of atrial fibrillation. [Review] [25 refs]
Source
Cardiology Clinics. 15(4):739-48, 1997 Nov.
Local Messages
Abstract
Atrial fibrillation is the most common dysrhythmia encountered in clinical practice. A significant number of patients fail medical therapy because of inability to convert or control the rhythm pharmacologically, intolerance of the requisite medication, or persistent symptoms despite apparently satisfactory rate control. Based on experimental studies establishing the electrophysiologic basis of atrial fibrillation, a surgical procedure has been developed that is highly effective in restoring sinus rhythm without further requirement for medications. The evolution of this procedure, its current indications, and results are outlined. [References: 25]
Unique Identifier
98014535
Authors
Stevenson WG. Ellison KE. Lefroy DC. Friedman PL.
Institution
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Title
Ablation therapy for cardiac arrhythmias. [Review] [124 refs]
Source
American Journal of Cardiology. 80(8A):56G-66G, 1997 Oct 23.
Abstract
Ablation has become an important and, in some cases, the first-line therapy for a number of tachyarrhythmias. The feasibility of treating arrhythmias with ablation was initially demonstrated with surgical ablation techniques. Recently, catheter ablation techniques have replaced the surgical approach in nearly all cases. Catheter ablation is highly effective for the Wolff-Parkinson-White syndrome, atrioventricular nodal reentry, and atrial ectopic tachycardia. It is effective for atrial flutter, although approximately one quarter of patients treated with catheter ablation continue to require therapy for concomitant atrial fibrillation. The surgical maze procedure has proved to be feasible for preventing atrial fibrillation. The risks and long-term efficacy of catheter ablation maze procedures for atrial fibrillation need to be defined. The efficacy of ablation for ventricular tachycardia varies with the type of tachycardia. Catheter ablation is very effective for the rare idiopathic ventricular tachycardias that occur in structurally normal hearts and for bundle-branch reentry ventricular tachycardia, which occurs most frequently in patients with dilated cardiomyopathy. When performed at an experienced center, surgical ablation is an excellent option for selected patients with ventricular tachycardia due to prior myocardial infarction who have a discrete aneurysm but otherwise well-preserved ventricular function. Catheter ablation shows promise for this arrhythmia, but it can be offered only to those patients who have relatively slow tachycardias that allow catheter mapping. Substantial advances in mapping and ablation technology will continue to occur, allowing nonpharmacologic control of cardiac arrhythmias to be achieved in an ever greater number of patients. [References: 124]
