Atrial fibrillation, a type of abnormal heartbeat, affects approximately 180,000 Chicagoans and upwards of 6 million people in the United States. While this condition can be managed with medication, the only way to cure atrial fibrillation is through surgical intervention, which until recently required a large incision in the chest, putting the heart on bypass and an average six - eight week recovery time. Thanks to a new approach that combines techniques from two existing procedures, experts at Northwestern Memorial’s Bluhm Cardiovascular Institute have pioneered a way to offer patients a minimally invasive treatment for atrial fibrillation called Hybrid Maze. Northwestern Memorial is currently the only center in the United States and one of only a handful worldwide with the capabilities to offer the Hybrid Maze procedure to patients.
During atrial fibrillation, the heart's two small upper chambers, called the atria, quiver instead of beating effectively. As a result, blood isn't pumped completely out of the atria and may pool and clot, which can transfer to the brain and become lodged, resulting in a stroke. Atrial fibrillation is the second leading cause of stroke, and the likelihood of developing atrial fibrillation increases with age. Due to the risk associated between atrial fibrillation and stroke, it’s very important for individuals suffering from atrial fibrillation to treat the condition.
Dr. Richard Lee, surgical director of Northwestern Memorial’s Center for Atrial Fibrillation, has been investigating less invasive ways to treat atrial fibrillation for years. “The Maze procedure with its high cure rate of atrial fibrillation is well known to patients, but they wanted a less invasive surgical option,” commented Dr. Lee. Minimally invasive procedures allow for a faster recovery, shorter length of stay in the hospital, lower infection rates, and less trauma than traditional cardiac surgery. Together with Jeffrey J. Goldberger, MD, director of Cardiac Electrophysiology and medical director of the Center for Atrial Fibrillation, Dr. Lee has pioneered a minimally invasive Hybrid Maze procedure which is done in two stages.
“It is through the strength of each procedure and a multidisciplinary team of outstanding clinicians that we offer a two-tiered approach to our patients,” states Dr. Goldberger. “The electrophysiologists and cardiac surgeons at the Bluhm Cardiovascular Institute spend time getting to know each patient and understand the specific characteristics of their atrial fibrillation.”
Stage I
Abnormal electrical signals around the pulmonary veins and in the heart are thought to be the cause atrial fibrillation. During Stage I of the Hybrid Maze, small incisions are made on the sides of the chest to access and place scar lines around the pulmonary veins. A tiny camera is inserted through one of the small incisions which gives the cardiac surgeon a clear view of the veins and eliminates the need for the large incision in the traditional Maze procedure. The heart is beating during the procedure, as opposed to the traditional Maze where the heart would be on bypass. The scar lines, made via an energy source such as radiofrequency, cryo, laser, ultrasound, and microwave, isolate abnormal electrical signals that cause atrial fibrillation and re-route the path of the electrical signals. After Stage I, the patient returns home and is monitored for approximately one month to see if the atrial fibrillation returns. Stage I can be up to 90 percent effective for certain types of atrial fibrillation. Patients with other types of atrial fibrillation may require Stage II.
Stage II
For Stage II patients undergo catheter ablation, which is a non-surgical and minimally invasive treatment that involves inserting several catheters, or tubes, into the heart and locating the abnormal electrical signals causing the atrial fibrillation. Once found, the pathway is destroyed with energy sources similar to those used in Stage I of the Hybrid Maze. Stage II targets areas of the heart that cannot be reached from the outside of the heart. For more information on the Bluhm Cardiovascular Institute, visit www.nmh.org/heart.
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