Facts About Atrial Fibrillation
Facts About Atrial Fibrillation
Northern Virginia is home to one of the world’s most respected surgeons for the treatment of atrial fibrillation. Trained by the inventor of this cardiac surgery, Dr. Niv Ad practices at Cardiac Vascular and Thoracic Surgery Associates and offers residents of Virginia, Maryland and DC access to the most sophisticated atrial fibrillation surgical options available, including minimally invasive surgery.
Atrial fibrillation is a type of arrhythmia, or irregular heart beat. With atrial fibrillation, the electrical signals in the atria (the two small chambers of the heart) are fired in a very fast, chaotic and uncontrolled manner. The atria quiver instead of contract. The electrical signals then arrive in the ventricles in an irregular fashion. When atria do not contract effectively, the blood may pool and/or clot. If a blood clot becomes lodged in an artery in the brain, a stroke (brain attack) may occur. About 15 percent of strokes occur in persons with atrial fibrillation. Aspirin, warfarin, and cardiac medications may be used to treat atrial fibrillation.
For patients who do not experience relief from medication, there are interventional and surgical options for treatment. In interventional treatments, a cardiac specialist called an electrophysiologist uses cryoabalation (cold energy) to create lesions which block the abnormal electrical impulses from occurring.
Sometimes, patients are not helped by either medication or electrophysiology procedures. For these people, there is a surgical option called the Maze Procedure.
The Maze procedure is a surgical intervention that cures atrial fibrillation (AF) by interrupting the circular electrical patterns that are responsible for this arrhythmia. By creating surgical ablation lines in both atria the conduction of the erratic electrical impulses is stopped. This channels the normal electrical impulse in one direction from the top of the heart to the bottom. Scar tissue generated by the ablation permanently blocks the travel routes of the electrical impulses that cause AF, thus eradicating the arrhythmia. The major advantage the Maze procedure offers over other less-invasive forms of therapy is that it corrects all three problems associated with AF: it restores sinus rhythm, facilitates the synchrony between the atria and the ventricles and preserves organized atrial contraction.
The Maze procedure takes about 2-3 hours to perform and cures atrial fibrillation about 95 percent of the time. The procedure can be performed in two ways, through a median sternotomy or minimally invasively.
• Median sternotomy – Surgery is performed through a midline (mid chest) incision and involves splitting the breastbone. This approach is offered to candidates for a combined procedure, such as coronary artery bypass grafting or valve surgery with indications for surgical ablation of atrial fibrillation. It is also offered to patients for a stand-alone procedure who are not eligible for the minimally invasive approach.
• Minimally invasive approach – Surgery is performed through a small, seven centimeter right anterior throracotomy. The entire Maze procedure is performed with the same high success rate as with a traditional, larger incision.
Some patients experience intermittent atrial fibrillation but still need surgical treatment. For them, pulmonary vein isolation is performed through bi-lateral (left and right) incisions in the chest wall and the left atrial appendage is disarticulated.
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