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Mostafa Salem's Patient Story

Rhythm Restored

After MiniMaze surgery, man returns to his hummingbird garden

Mostafa Salem of Framingham had felt his heart flip-flopping in his chest from time to time. A business analyst then in his 60s, he chalked the uncomfortable, quivering sensation up to stress and never suspected a medical condition.

On a vacation trip to London in 2005, Mr. Salem spent two hours in the sun on a double-decker sightseeing bus, sweltering in 96-degree heat. Back in his hotel room, he rose from lying on the bed to turn on the television, fainted and hit the floor. Although his wife reported that he was unconscious for less than a minute, she motivated him to finally connect the dots.

Diagnosis: Atrial Fibrillation

Upon returning to the United States, the Egyptian-American met with his primary care physician. She suspected that the fainting spell had been caused not by the hot sun but by a cardiac condition. When his heart started beating erratically right in her office, she called an ambulance that whisked him to the Beth Israel Deaconess Medical Center (BIDMC) emergency room. Diagnosis confirmed: Mr. Salem had atrial fibrillation.

This abnormal heart rhythm (or "arrhythmia") originates in the top two chambers of the heart (the atria). A faulty electrical impulse causes the atria beat to beat chaotically so that it is out of synch with the lower two chambers (the ventricles). In medical terms, Mr. Salem's heart was "out of sinus rhythm." For this reason, it did not pump blood efficiently to the rest of his body, depriving it of normal oxygen levels and causing him to faint. Even more ominously, the inefficient pumping posed a risk that blood could pool and clot in his atria, increasing by five times the likelihood of a stroke should a clot fragment break lose and travel to his brain.

Atrial fibrillation is the most common type of arrhythmia, afflicting 2.2 million Americans and as many as 5 percent of senior citizens. This number is rising as the baby boom ages and as new treatments allow more people to survive other heart diseases that can cause atrial fibrillation as a byproduct. About 15 percent of people who have strokes have atrial fibrillation, and 1.1 to 3.6 percent of people with atrial fibrillation have strokes, depending on risk factors like age.
Although atrial fibrillation in itself is not life-threatening, Mr. Salem recognized its potential to threaten the active lifestyle he enjoys - working, gardening, cooking, walking with his wife and working up a sweat on the treadmill.

Treatment Options

Peter J. Zimetbaum, MD, Mr. Salem's cardiologist at BIDMC's CardioVascular Institute, outlined his treatment options. Most atrial fibrillation is managed medically with a combination of antiarrhythmia drugs and the blood-thinner warfarin (known by its trade name, Coumadin). However, Mr. Salem was apprehensive about warfarin because he is prone to excessive bleeding. In addition, successful warfarin therapy requires frequent blood tests and dietary precautions. He also rejected the options of catheter ablation and pacemaker implantation.

Ultimately, Mr. Salem chose to address his atrial fibrillation with MiniMaze surgery after learning that Robert Hagberg, MD, a cardiac surgeon at the CardioVascular Institute at Beth Israel Deaconess Medical Center, is the only doctor in Boston who performs this operation.
Successful MiniMaze surgery eliminates atrial fibrillations and allows some patients to forego spending the rest of their lives on warfarin. Mr. Salem says MiniMaze appealed to him because it is an "open and close" approach.

Multidisciplinary Team

The minimally invasive surgical procedure requires a multidisciplinary team - a cardiac surgeon and an electrophysiologist (a cardiologist who specializes in the electrical activity of the heart). Working through two small incisions, the team applies radio frequency energy to the atria to create a pattern of scars. The scars shepherd the heart's electrical impulses along a prescribed pathway that keeps the atrial beating in synch with the ventricles. The procedure typically lasts three to six hours and requires the patient to remain in the hospital for three or four days.

"Mr. Salem was a good candidate for MiniMaze because of his particular form of atrial fibrillation, paroxysmal fibrillation," says Dr. Hagberg. "This means that Mr. Salem's condition was intermittent. In these patients, we have a success rate of more than 90 percent, and the patient's chest usually feels back to normal within three or four weeks."
After his successful MiniMaze procedure in 2007, Mr. Salem's heart clicked right back into sinus rhythm, but he had more conditions to address. He had surgery to repair a hole in the lining of his lung caused by a broken rib, and to repair a herniated disc in his back. His recuperation from all three surgeries has been steady, and he has experienced no recurring symptoms of atrial fibrillation.

Back to Living Fully

Last summer, Mr. Salem began a gradual return to work, to cooking, to walking with his wife, to working up a sweat on the treadmill, and to caring for the hummingbird garden he has created in his yard. The beauty of the tiny, vibrating birds and the brilliant red blossoms with which he entices them were two of the many reasons he wanted to not just treat but actually to cure his atrial fibrillation.

"Now I am back in the garden," he says with evident pleasure. "I put on my hat and do what I need to do."

Contact Information

Cardiovascular Medicine
Division of the CardioVascular Institute
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215