Surgical treatment for atrial fibrillation

What is atrial fibrillation and why should it be treated?

Atrial fibrillation is a heart rhythm disorder caused by a large number of circuits in the corridors of the heart. These circuits cause irregular contractions of the ventricles and a lack of effective contraction of the atria. Lack of effective contractions in the atrium can cause the formation of blood clots in the atrium, which could lead to cerebral embolism. In such cases the patient would need to receive anticoagulant therapy, such as Coumadin. Cardiac output is decreased and this causes a feeling of discomfort and fear in the patient. Atrial fibrillation is a significant risk factor for morbidity and mortality. A large number of articles have been published in the medical literature about atrial fibrillation, and have shown that it independently increases the rate of brain events to up to several hundred percent, thereby doubling mortality rates. Patients with various heart diseases can also suffer from atrial fibrillation.

The Cox Maze procedure

Atrial fibrillation can be treated by medication or catheterization. If these treatments fail, surgical options do exist. The surgical treatment for atrial fibrillation was developed in the late eighties and called the Maze procedure. According to this method a number of incisions are made in the right and left atrial which are then sewn together. Two months after surgery, connective scar tissue along the incisions lines appears in the shape of a maze. Consequently, irregular electrical circuits in the atria are stopped due to electrical high resistance of the connective tissue, and stimulation from the timer stimuli (sino-atrial node) are transferred between the scar lines to the ventricles, thus restoring regular heart rhythm, known as sinus rhythm. Maze surgery can stop atrial fibrillation in over 90% of cases. The disadvantage of this type of surgery lies in its complexity, and therefore it has not gained high popularity among cardiac surgeons throughout the world.

In recent years more limited and simplified operational techniques have been invented based on the Maze technique. Modern medical equipment and technology has been invented that allows the surgeon to operate and obtain the required connective tissue needed by freezing the tissue with liquid nitrogen, or burning it with radiofrequency radio waves, and other measures.

Cardiologists and heart surgeons today recommend the addition of surgical treatment for atrial fibrillation during “routine” open heart surgery, should the patient suffer from atrial fibrillation.

Today, the accepted surgical method combines both the classic Maze procedure, which provides the highest success rates, with liquid nitrogen freezing and burning radio waves. This combination allows for more effective surgery and is safer for the patient. The operating room at Assuta is equipped with state-of-the-art equipment which allows each patient who undergoes open heart surgery, and in addition suffers from atrial fibrillation attacks (fixed or paroxysmal), to have this procedure incorporated into open heart surgery.

A patient who arrives for treatment at the early stage of diagnosis, before it is too late to intervene surgically, can expect to return to a regular life style, including full physical exercise, sports, trips abroad and a normal way of life. The patient will be placed under long-term follow-up by the Cardioheal cardiologists, and will be able to schedule private consultations whenever necessary.

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