Heart Disease News:

Study: Minimally Invasive Approach of Curing Artial Fibrillation Works as Well as Traditional Method

A minimally invasive approach to curing the common heart rhythm abnormality of atrial fibrillation can be done in half the time and just as well as the traditional surgical procedure.

"This is very good news because it means more surgeons can perform the procedure and it will be applicable to virtually all patients with this irregular rhythm," said lead researcher Ralph J. Damiano, M.D., chief of cardiac surgery at Washington University School of Medicine in St. Louis.

The traditional surgical procedure is known as the Cox maze. This procedure involves the making of small, strategically placed incisions in the atria, generating scar tissue that served as barriers that trap abnormal electric signals in a maze of barricades. Only one path remains intact, guiding impulses to their correct destination.

With a success rate of more than 90 percent, the Cox maze procedure revolutionized the treatment of atrial fibrillation. However, it is not performed frequently as it is technically difficult and requires the heart to be temporarily stopped.

As reported in the October issue of the Journal of Thoracic and Cardiovascular Surgery, Damiano and his colleagues developed an alternative using two electrodes that pass a current through a section of heart tissue, heating and killing a thin band of tissue and creating scar tissue that blocks abnormal impulses responsible for atrial fibrillation.

Damiano's team replaced most of the Cox maze incisions, using their new and less invasive approach in 40 consecutive patients treated for atrial fibrillation at Barnes-Jewish Hospital in St. Louis from January 2002 to October 2003.

Overall, the success of the procedure was equivalent to the team's success using the traditional Cox maze approach. All patients survived the operation, and about 15 percent needed a pacemaker after surgery to help maintain a normal heart rhythm. A little over 90 percent of patients followed for six months still had healthy heart rhythms.

The only notable difference between the patients in this study and their predecessors who had undergone the traditional surgery was the length of the operation. Traditional Cox maze procedures took on average 93 minutes to perform, while procedures that incorporated the new approach took only 54 minutes.

"Shorter operative times are important for patient safety and outcome," says Damiano. "If we shorten the procedure, it decreases the time we need to keep patients on the heart-lung machine. We are working in the laboratory on an approach that someday will allow us to perform atrial fibrillation surgery on the beating heart."

Source: Medical Week Staff week of October 23, 2004