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[Rodney__0]

  First of all I am glad this site is available.  I am a 49 Yr. Old firefighter and I am still working though it is very difficult.  I am Suffering from paroxysmal atrial fibrillation,(this means the A-Fib. comes and goes every 5 or 6 days).  Since this started on Feb. 7, 1995 my stamina and strength have gone down and now it is to the point where almost every time I have to work hard at a fire I go into Atrial Fibrillation and it takes between 8 and 10 hours for it to convert to normal sinus rythum.  I have had every test and have tried every medication with no solution.  I have heard that the ablation proceedure (may) cure this problem.  If this is true I would be interested in further investigation.  My cardiologist does not perform this proceedure and does not know of any that do.  I would appreciate the answers to the following guestions.
  1.   Does anyone know of a specialist in the Houston or Dallas Texas area?
  2.   If I have this proceedure what are the possible complications?
  3.   What is the recovery time before I can go back to work?
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Dear  Rodney,
Topic Area: Palpitation
Thank you for your question.  Atrial fibrillation is a difficult condition to control and you have my commendation for continuing on in your job.  The treatment you are referring to is called the "Maze procedure".  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.  
Q: Does anyone know of a specialist in the Houston or Dallas Texas area?
A: I don’t know of anyone who does the procedure in these areas.  Dr. Chris Wyndam at Presbyterian Hospital of Dallas is a specialist in the area of atrial fibrillation and may be able to direct you to someone locally.  There is a doctor in Tulsa, OK that does the catheter procedure.  I am not sure of his name (Dr. Black?) but he works out of St. Francis or Hillcrest Hospitals.  Another doctor that has done some of the catheter procedures is Dr. Morady at the University of Michigan.
Q:  If I have this proceedure what are the possible complications?
Q:  What is the recovery time before I can go back to work?
A: Both of these questions would have to be addressed by the doctor performing the procedure.  Obviously the catheter based procedure has a shorter recovery time than the surgical procedure.
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]
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