UPLAND, Pa. - Atrial fibrillation (AFib) is the most common irregular heart rhythm in the United States, affecting more than two million people annually. Once considered a harmless nuisance, AFib is now recognized as a dangerous condition that doubles the risk of death. Complications of AFib include stroke, congestive heart failure and cardiomyopathy.
Now, physicians at Crozer-Chester Medical Center in Upland can offer patients with atrial fibrillation more treatment options thanks to the availability of two advanced procedures: pulmonary vein isolation ablation and a surgical intervention called the Maze procedure.
Atrial fibrillation occurs when the electrical impulses that enable the heart to pump become disordered. Instead of one impulse traveling in an orderly manner through the heart, many impulses begin at once and spread, causing a rapid and disorganized heartbeat.
Pulmonary Vein Isolation Ablation
The pulmonary vein has been found to be the source of about 90 percent of the initiating beats of atrial fibrillation. Pulmonary vein isolation ablation involves electrically isolating the atrial tissue in the pulmonary vein. This is done with radiofrequency energy delivered to the heart through catheters inserted in the veins of the leg. The radiofrequency energy is used to heat up and destroy the atrial tissue in the pulmonary vein, turning it into a scar which can not conduct electricity.
“It’s like a first-degree burn on the inside of the heart,” says Scott Hessen, M.D., an electrophysiologist in the Section of Cardiology at Crozer who performs the procedure. “Once the scar is created, any impulses that would have started in the atrial tissue in the pulmonary vein become isolated from the rest of the heart, so the impulse can’t drag the rest of the heart into AFib.”
This minimally invasive, four-hour procedure has been performed in the Electrophysiology Lab at Crozer for about a year by Hessen and David Kleinman, M.D. Crozer’s recent acquisition of an advanced computerized electroanatomical mapping system was key to making pulmonary vein isolation ablation available at the hospital.
“This system allows for very precise placement of the catheter and creation of the lesions in each patient, enhancing the safety and efficacy of the procedure,” says Hessen.
Candidates for this procedure are patients who are significantly symptomatic in AFib and have failed one or two medications. The procedure is most successful for patients with paroxysmal AFib in which the arrhythmia starts and stops spontaneously and lasts short periods of time, from a few seconds to a day, according to Hessen.
“Our success rate is 60 to 70 percent for paroxysmal patients, and 50 percent for those with chronic AFib,” he says.
Maze Procedure
Patients with atrial fibrillation may also be candidates for the Maze procedure, a surgical intervention most often performed when a patient needs open heart surgery for another problem such as coronary artery disease.
The Maze procedure involves creating scar tissue in the heart which disrupts the path of abnormal electrical impulses. This keeps the heart’s electrical rhythm in a more ordered form. The Maze procedure may be done by making incisions, by freezing or burning the atrial tissue, or by disrupting the tissue with ultrasonic waves. All of these methods result in a scar that the abnormal electrical impulse can’t penetrate.
Karl Grunewald, M.D., a cardiothoracic surgeon at Crozer who performs the Maze procedure, uses a radiofrequency device. “This device enables me to perform a very controlled burn of the tissue, forming a linear scar that won’t allow any conduction of electrical impulses,” he says.
For most patients, atrial fibrillation subsides after they recover from the stress of the surgery, usually two to three months later. The Maze procedure has a success rate of 80 to 90 percent.
Grunewald says, “We expect the demand for such procedures to rise as the population grows older and an increasing number of people develop atrial fibrillation.”
To find a Crozer-Keystone physician who’s right for you, call 1-800-CK-HEALTH (1-800-254-3258). To learn more about Crozer-Keystone cardiology services, visit http://ckheart.crozer.org.