Atrial Fibrillation Q & A
Q & A with Dr. Robert Hagberg, Cardiothoracic Surgeon in the Cardiovascular Institute at Beth Israel Deaconess Medical Center.
Q: What is Atrial Fibrillation?
Dr. Robert Hagberg: Atrial Fibrillation (AF) is an abnormal heart rhythm. According to the American Heart Association, some 2.2 million Americans have AF. During atrial fibrillation, the heart's two small upper chambers quiver instead of beating effectively. Blood isn't pumped completely out of them so it may pool or clot. Some people don't feel AF at all, while others are aware their hearts are not beating normally.
Q: What is the risk?
Dr. Robert Hagberg: The big risk for AF is stroke. If a clot forms in the left atrial appendage - on the left side of the atrial chamber, it can break off and travel to other parts of the body including the brain. About 15 percent of all strokes occur as a result of AF.
Q: What are the treatments?
Dr. Robert Hagberg: Some people can do well with taking medications to help control AF. These may include blood thinners like Coumadin which will help prevent a clot from forming, or beta blockers to slow the heart rate during AF. There are also anti-arrhythmia drugs which try to convert the patient back to normal heart rhythm. Some patients have symptoms like shortness of breath, fatigue, and the inability to do the things they are used to doing which may change management of the condition. While some patients are more prone to strokes, there is no way to predict if or when a stroke will occur, even in patients on medications. That's the danger of AF. Only Coumadin has been proven to reduce this risk.
Other treatments try to stop AF from happening by isolating the place they begin - the veins of the lung - from the rest of heart. The catheter approach involves feeding a catheter up through the groin and into the heart under X-ray guidance. Radiofrequency energy is used to create scars or lesions to isolate the pulmonary veins from within the heart. When that doesn't work, a repeat catheter procedure or surgery may be needed.
Q: What is the Maze procedure?
Dr. Robert Hagberg: Traditionally, the Maze procedure involves isolating the pulmonary veins via an incision that divides the breastbone. Patients are placed on a heart/lung machine and surgeons cut up the heart into a specific pattern designed to stop AF and then sew it back together. This is major surgery with a lengthy recovery and some risk.
A newer form of the procedure, called the minimally invasive Maze, does not require the heart/lung machine. Surgeons make small (4-5 cm) incisions between the ribs on both sides, exposing the heart. A clamp is used to isolate the part of the heart where the veins come in from the lungs and radiofrequency energy is again used to create scarring between the two sides of the clamp. Unlike the catheter approach, surgeons also remove the left atrial appendage, where most blood clots form, hopefully reducing the risk of stroke. So far, data suggests the minimally invasive form of this procedure leads to a faster recovery, less chance of bleeding, infection and other complications compared to traditional open heart surgery. After a minimally invasive Maze procedure, patients are usually in the hospital two or three days and have few limitations when discharged home. Therefore, they can get back to their normal routines very quickly.
Q: Who is appropriate for the minimally invasive Maze procedure?
Dr. Robert Hagberg: The perfect patient for this procedure is someone who doesn't have structural heart disease - meaning artery blockages or valve problems - and they need to have a specific type of AF. We are working now to expand the application of the procedure to patients with other types of AF.
Q: What is the success rate?
Dr. Robert Hagberg: The success rate for this procedure in patients with no structural heart disease and the right type of AF is in the range of 85 percent. We still don't know if it's going to be 100 percent successful in preventing strokes - that's still being studied. In addition, most patients who have the procedure are able to reduce or discontinue their heart medications. In all, it's a good option for certain patients with AF.
Above content provided by the CardioVascular Institute at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted January 2013