CorVasc MD's - Microwave Ablation (MAZE) to Treat Atrial Fibrillation

Atrial Fibrillation
What is Atrial Fibrillation? Atrial fibrillation or AF is a common disturbance of the heart’s regular rhythm. AF is a condition in which the heart quivers, or fibrillates, instead of beating normally. There are 2.4 million people suffering from AF in the United States alone. AF becomes more common with age. About 2.3% of people over age 40, 6% people over age 65, and 10% of people in their 80’s have atrial fibrillation. Experts predict the number of people with AF will double over the next 20 years. How the Heart Works To better understand AF, it is helpful to know how a normal heart works. The human heart is made up of four chambers: two chambers on top (the atria) and two chambers below (the ventricles). The left and right sides of the heart perform different function: the left side pumps blood rich in oxygen to supply all parts of the body, while the right side of the heart pumps blood back to the lungs to pick up more oxygen. The chambers of the heart are separated by four valves that open and close to direct the flow of blood. During a normal heartbeat, an electrical impulse begins in the right atrium and travels throughout electrical pathways in the heart. This organized electrical stimulation results in a single smooth wave of contraction that allows the heart to pump blood at a regular rate and with a regular rhythm. Abnormal Heart Rhythms in Atrial Fibrillation Normally, the electrical signal that tells your heart to beat comes from the sinoatrial node or SA node, in the right atrium. During AF, signals start irregularly from several areas of the atria, making the heartbeat abnormal. When AF occurs, the electrical signals become disorganized and rapid, and as a result, the upper chambers of the heart quiver (fibrillate) instead of beating normally. This keeps the upper and lower chambers of the heart from working together properly, which can decrease the heart’s ability to pump blood. Symptoms of AF Although AF can occur without symptoms, most people with AF experience one or both of the following: Heart palpitations – a sudden pounding, fluttering, or racing feeling in the chest Lack of energy or feeling tired AF patients may also have a poor overall quality of life. Many patients feel weak because their hearts are not able to pump blood efficiently. A rapid or irregular heartbeat may also cause some patients to feel anxious. When a patient has AF symptoms, it may mean the heart is not pumping blood properly to the body.
Normal Conduction	Atrial Fibrillation
Health Risks of AF Because the atria are beating rapidly and irregularly, blood does not flow through them normally. This abnormal blood flow can cause blood to form clots. If a clot is pumped out of the heart, it can travel to the brain, resulting in a stroke. People with AF are 5-7 times more likely to have a stroke than those without AF. The American Heart Association estimates that in the United States, AF causes more than 70,000 strokes each year. AF combined with a fast heart rate, may also result in heart failure. AF is associated with an increased risk of death. Treatment options for AF Your cardiologist, internal medicine specialist or family physician will help you choose a treatment based on your heart’s rhythm, your symptoms, and any other medical conditions you may have. The goals of treatment for AF usually include maintaining a normal heart rate (pulse), preventing blood clots, and regaining normal heart rhythm. Medications: to help restore normal heart rhythm and prevent AF, your doctor may prescribe one or more drugs. These medicines may relieve some of the symptoms of AF, but they may not prevent an AF episode. This means there is still a risk of stroke or heart failure. Electrical Cardioversion: A procedure in which electrical current is passed across the chest with the goal of stopping fibrillation and allowing the return of a normal heart rhythm. Devices: Implantable cardioverter-defibrillator (ICD) and pacemaker devices provide another option for patients with AF. These implantable devices deliver therapy that may restore a normal heart rhythm. Surgery: Patients with AF that has not been successfully controlled by medication or procedures, or those with other conditions requiring heart surgery, may be candidates for surgical treatment of AF. For more information about Atrial Fibrillation: www.americanheart.org. Source: Guidant Corporation, a Boston Scientific Company www.bostonscientific.com.

Microwave Ablation Used to Treat Atrial Fibrillation Dr. Peter Walts, Corvasc MD's cardiothoracic surgeon, has a special interest in electrophysiology. Dr. Scott Hanan also performs this procedure.
Ablation probe positioned around pulmonary veins for cardiac tissue ablation.	Lesion created after cardiac tissue ablation.
The advantages of the surgery include reduced length of hospital stay averaging 1.5 days, less post-operative discomfort due to small incisions and sternal-sparring technique and quicker recovery time for the patient. In addition, microwave ablation eliminates the need for the patient to take medication to control heart rhythm.

For more information, please contact Dr. Peter Walts or Dr. Scott Hanan at info@corvascmds.com.

About the Maze Procedure Your cardiologist has referred you to a cardiothoracic surgeon for an evaluation for a surgical procedure to treat an abnormal rhythm of the heart called atrial flutter or atrial fibrillation. The surgery is done totally thoracoscopically with minimal trauma during the surgery, minimal post-operative recovery time and less post-operative discomfort. The hospital stay is shorter being less than three days compared to the open surgical Maze procedure For more information regarding the minimally invasive Maze procedure, contact Dr. Scott Hanan at info@corvascmds.com About the Heart The heart is made up of four chambers. The two chambers on the top are called atria. The two chambers on the bottom are called ventricles. The heart's own pacemaker is called the sinoatrial node (SA node). The SA node is found in the right atrium. During a normal heartbeat, the SA node triggers an electrical impulse. This impulse travels through the tissue that make up the atrium. The electrical impulse causes the atria to contract. Next, the impulse is captured by the atrioventricular node (AV node). The AV node slows the rate and focuses the impulse to the walls of the heart between the ventricles. The ventricles contract. Then, blood is pushed out of the heart and into the aorta and the body. Atrial Flutter and Fibrillation Atrial fibrillation is the most common abnormal heart rhythm. The number of people affected by atrial fibrillation increases with age. Atrial fibrillation is associated with hypertension (high blood pressure), heart valve disease and ischemic heart disease. Atrial flutter is caused by signals within the heart muscle that circle around and around inside the tissues. These signals cause the atria to beat as many as 200 300 times a minute. Atrial fibrillation is caused by extra signals that are produced by different areas of the heart along with signals from the SA node. These extra signals cause the heart to beat so fast (400 to 500 times a minute) that the atria don't beat evenly and just quiver instead of contracting or squeezing. When the atria don't contract, blood isn't moved into the ventricles. The blood can pool in the atria and clots can form and eventually move out into other parts of the body. This is the reason that you may be taking medicines to help keep clots from forming. The Maze Procedure The Maze procedure is a surgical procedure on the non-beating atria of your heart. The surgeon makes a series of incisions and/or ablations in the atria. The signals then have to travel through the "maze" to trigger the atria. The incisions or ablations stop the signals from circling, or stop the extra signals from triggering the atria to contract. These signals cannot travel through the scar tissue that results from the incisions or ablations. There are risks involved with every surgery. Your doctor will discuss the risks and benefits of surgery before scheduling your hospital admission. Some risks that are associated with this type of surgery are: bleeding, blood clot formation, infection, heart attack or stroke, breathing problems, nerve injury, or need for pacemaker implant. About the Surgery Before surgery starts, the anesthesiologist will ask questions about: Past problems or conditions Any surgeries Medicines you are taking or have taken When surgery is ready to begin, the anesthesiologist will give you medicines that will help you go to sleep. After you are asleep, he/she will insert a tube through your mouth into your throat and attach it to a ventilator, which is a machine that will help you breathe during surgery and for awhile afterward. The anesthesiologist will also insert an IV catheter into your neck, an IV catheter into an artery in your wrist, and a urinary catheter into your bladder. These multiple lines and devices are normal for this type of surgery. The cardiothoracic surgeon will begin by making an incision starting at the top of your breastbone and extending down to the bottom of the bone. To allow your doctor to perform surgery on the atria, your heart will be stopped and you will be placed on the cardiopulmonary bypass pump (heart-lung machine). While your heart is quiet, your blood will be passed through this machine, supplied with oxygen and pumped through your body. Your Stay in the Critical Care Immediately after your surgery, you will go to the Critical Care Unit. You will wake up with the multiple IV and monitoring lines that were put in before surgery, and also drainage tubes that will be inserted at the bottom of your breastbone. You will spend several days in this unit and your recovery will be constantly monitored. You will be given drugs to control your pain and any nausea you might have. Do not allow your pain and/or nausea to go untreated for extended periods of time. Ask your nurse for medicines. Your Move to the Cardiovascular Surgery Unit Most of the lines and drainage tubes may be removed before your transfer out of the Critical Care Unit. You will transfer to the Cardiovascular Surgery Unit for a few more days of recuperation and monitoring. While on that unit, you will be asked to: Sit in a chair for longer periods of time each day Walk in the hall several times a day Participate in your daily personal care Use your personal incentive spirometer (IS) The use of IS, deep breathing and coughing may lower the risk of pneumonia. For more information Please direct your inquiry to Dr. Peter Walts or Dr. Scott Hanan at: info@corvascmds.com.