A-Maze-ing Heart Care
Innovative Procedure Offers Surgical Approach to Treat Atrial Fibrillation

healthy heart
Healthy Heart: In a healthy heart, electrical impulses are generated in the sinus node (A) of the atrium and travel along regular pathways to the lower chambers, or ventricles, of the muscle. The ventricles are stimulated to contract and force blood into the body in a coordinated rhythm.

A growing number of people around the world have atrial fibrillation (AF), an irregular
heart rhythm, which can lead to stroke, heart attack and death.
In addition to a rapidly beating heart, ongoing problems, such as shortness of breath, fatigue and lack of stamina are symptoms of AF.
There are a number of approaches to treating AF. One is to prescribe medications that help the heart beat normally, along with blood thinners that help prevent clots
that can cause stroke. Another is
a catheter-based procedure.
Inova Heart and Vascular
Institute at Inova Fairfax Hospital
also offers a third option — an
innovative, well-established but
relatively unknown heart surgery
known as the Maze procedure.

Cardiologists and electrophysiologists around the world look to Niv Ad, MD, Chief of Cardiac Surgery and Medical Director of Cardiac Surgery Research at the Institute, to train and consult with surgeons to perform minimally invasive Maze procedures that speed up recovery of patients with AF. The Maze procedure performed for patients with lone atrial fibrillation has a success rate at over 90 percent.

Maze procedure
Maze procedure: The Maze procedure
can correct the fibrillation and restore a normal heartbeat. During the procedure, the surgeon intentionallycreates a 3-D maze of scar lines (B) to redirect the disjointed electrical impulses. It may
take several months for the process to completely restore a normal heart
rhythm, but the procedure has been
shown to be effective in terminating
atrial fibrillation in around 90 percent
of patients.

Redirection of Electrical Current

AF is a breakdown in the electrical circuitry of the heart. In effect, the Maze procedure repairs the wiring of the heart by building a route or maze (thus the name) that allowsit to beat normally. The Maze procedure applies extreme cold to the heart, a process called cryoablation, to create scar tissuein the heart. Cryoablation allows scar tissue to form a pathway that forces the heart's electrical currents in the right direction. The Maze procedure also blocks irregular electrical signals and returns the heart to a normalsinus rhythm.

Dr. Ad has dramaticallyimproved upon and developed new surgical approaches, including a minimally invasive one. Different approaches are used depending on a patient's condition and special needs. "We offer a much quicker operation with less trauma to the heart tissue," explains Dr. Ad, who studied under James Cox, MD, whoperformed the first Maze procedure in 1987 at what is now Barnes-Jewish Hospital in St. Louis.

A large percentage of Dr. Ad's AF patients are eligible for his minimally invasive approach. "The procedure time for the Maze procedure is now 90 minutes, so the total surgery time is down to
3 hours. Therefore, the operation goes much more smoothly," says Dr. Ad. "Patients are going home on the third postoperative day in most cases."

healthy heart Atrial Fibrillation: During fibrillation, the electrical output from the upper chambers is disjointed, leading to an irregular eruption of blood from the ventricles. Under these conditions, blood can pool and clot in the heart's chambers, increasing the risk of stroke and ischemia.

Learn more about Inova Heart and Vascular Institute.

Keeping an Eye on You

One unique aspect of the Maze surgery is the hospital's long-term follow-up program, explains Linda Henry, PhD, Research Investigator. Patients are asked to fill out surveys at various time points after their surgery.

They also receive heart rhythm monitors at six and 24 months to wear for five days. This cardiac outpatient telemetry allows doctors to go online and check patients' heart rhythms, which helps to further direct patient care. For example, it may allow a patient to stop taking blood-thinning medication if he or she is found to be in sinus rhythm over the monitoring period of time. "The surgery has made a difference for a lot of people," says Henry, who oversees the data gathering.

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