BIDMC Is First To Offer Mini-Maze in MA

An innovative procedure called the Mini-Maze, provides a new way to improve quality of life for many who suffer from atrial fibrillation (AFib). Beth Israel Deaconess Medical Center (BIDMC) is currently the only hospital in Massachusetts offering this procedure, which is gaining momentum across the country.

AFib is typically not life-threatening, but it can be life-changing. A common form of abnormal heart rhythm, AFib can cause heart palpitations, fainting and shortness of breath, which may interfere with daily activity and raise the risk of blood clots and stroke.
Caused by abnormal electrical impulses that start in the pulmonary veins carrying oxygenated blood from the lungs to the left atrium of the heart, AFib can cause an irregular heartbeat and decreased blood flow in the heart.

AFib is most often treated with anticoagulant medication, which thins the blood and lowers the risk of blood clots without addressing the abnormal heartbeat. Anti-arrhythmic medications can also be used to help the heart return to its normal rhythm.

"The need for AFib medications is lifelong, however, and these drugs may have significant side effects," says Dr. Robert C. Hagberg, a cardiac surgeon at Beth Israel Deaconess Medical Center's CardioVascular Institute. "More importantly, some patients find that the medication no longer works to control AFib and find themselves at a greater risk for stroke."

In recent years, doctors have discovered that the abnormal electrical impulses seen in AFib often start in the pulmonary veins that drain into the heart. Through surgery, the electrical activity between the pulmonary veins and the heart can be halted, which reduces or eliminates AFib.

Nonsurgical catheter ablation of the heart tissue is another therapeutic option for controlling AFib. This procedure involves inserting a catheter is into a specific area of the heart. Energy is directed through the catheter to areas of the heart that create the abnormal heart rhythms to prevent them from reoccurring.

A standard Maze procedure, developed more than 20 years ago, involves open-heart surgery in which a cardiac surgeon makes small cuts or burns in the heart's atria to reduce chaotic electrical activity.

Unlike other surgical options for AFib, the newer Mini-Maze procedure is minimally invasive, with a shorter hospital stay and quicker recovery. The procedure involves making three-inch incisions on either side of the rib cage and using a small camera to find the spot where the pulmonary veins drain into the heart. CVI physicians typically suggest this procedure when both the surgeon and the electrophysiologist think that AFib in a particular patient can be controlled with Mini-Maze.

"We clamp the heart where the veins come in from the lungs and use radiofrequency energy to create lesions (scar tissue) that isolate the pulmonary veins and keep AFib away from the heart," says Hagberg.

The surgeon then removes the left atrial appendage, where most blood clots form in AFib patients.

The Mini-Maze procedure lasts from three to six hours and is followed by three to four weeks of mild recovery at home.

"Usually patients are in the hospital for two to three days," said Hagberg. "When they go home there are no real limitations; they can do pretty much whatever they want after the initial surgery recovery period."

Bruce McDonald No one knows this better than Bruce McDonald, age 58. Once an avid biker, McDonald found himself trapped in a body that was letting him down because of AFib. "A game of catch would be too strenuous," he says.

McDonald had taken medication for AFib, but this treatment was no longer effective. Then he had a stroke, a frightening experience that made him investigate surgical options.

The cardiac team at BIDMC found McDonald to be a candidate for the Mini-Maze procedure.

"The doctors leveled with me. They just explained exactly what they'd be doing and let me make the decisions. And they were right."

Today, Bruce is back on his bike and has even completed a 755-mile post-surgery bike ride.

The Mini-Maze procedure can have success rates of greater than 90 percent in appropriate patients with AFib. If you are an AFib patient, please ask your cardiologist if you are a candidate for Mini-Maze.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

February 2011

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