Atrial Fibrillation Surgery
If atrial fibrillation continues unabated, it may evolve into a persistent dysrythmia with associated symptoms. A majority of patients suffering from the condition have increased episodes of shortness of breath, fatigue, and anxiety, negatively impacting their quality of life, and causing an increased risk of stroke.
At UNC, our goal is to identify patients with atrial fibrillation, evaluate their quality of life, determine the source of their condition, and provide a comprehensive treatment plan. With this strategy, we hope to improve the lives of our patients by successfully curing this prevalent, chronic, and life-impacting condition.
Medical vs. Surgical Options
Medical treatment of atrial fibrillation with anti-arrythmic agents has failed to achieve a significant therapeutic impact. The most commonly used agent, Amiodarone, is associated with an increasingly toxic profile over time. Electrical cardioversion (a brief shock administered to the heart to bring it back into normal rhythm) provides a temporary solution, but the cause of the arrhythmia (usually in the pulmonary veins) persists. Because of the increased risk of embolic stroke with atrial fibrillation, medical treatment requires lifelong therapy with Coumadin (a blood thinner which discourages clotting), with its resulting dangers.
The surgical solution for atrial fibrillation, on the other hand, is to isolate the pulmonary veins from the remainder of the left atrium, thus removing the source of the fibrillation.
Although the original surgery (Cox/Maze III) proved successful in over 90% of patients, it required that surgeons cut through and open the sternum in the middle of the chest (median sternotomy), put the patient on cardiopulmonary bypass, and perform extensive intra-cardiac reconstruction.
A new minimally-invasive approach at UNC
With technological advances, UNC now offers a safer minimally invasive treatment for lone atrial fibrillation using a thorascopic approach, which involves only small incisions in the chest, through which a tiny camera and instruments are passed. This approach can be accomplished without stopping the heart, and without cardiopulmonary bypass (placement on a heart-lung machine).
Using microwave energy, we’re now able to isolate the pulmonary veins, a frequent source of the disrhythmia, from the rest of the heart conduction system. Anticipated length of stay in the hospital at UNC is less than three days, with a success rate over 70%.
If diagnostic evaluation reveals other cardiac abnormalities such as myocardial ischemia (a painful deficiency of oxygen-rich blood to the heart), or valvular disease, we offer complete management with myocardial revascularization or valve repair, with accompanying atrial fibrillation surgery.
Andy C. Kiser, MD
Brett Sheridan, MD