VCU news

By Malorie Burkett

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RICHMOND, Va. (July 17, 2006) – Doctors at the Virginia Commonwealth University Medical Center are performing a new procedure that may eliminate atrial fibrillation, a common rhythm abnormality in the heart's upper chambers and a major cause of stroke.

The technique, called a modified Mini-Maze, offers hope to patients who previously have had limited treatment options.

During the procedure, surgeons insert instruments into the chest through several keyhole-size incisions between the ribs. With the aid of a tiny video camera, a specially designed instrument is placed around the top of one of the atria and energy is delivered to destroy the tissue near the origin of the irregular impulses.

The damaged tissue disrupts the abnormal signaling pathways, stopping the irregular impulses.

"This is a significant advance in the management of atrial fibrillation," said Vigneshwar Kasirajan, M.D., chairman of cardiothoracic surgery at the VCU Medical Center's Pauley Heart Center. "We've known for sometime this could be an effective strategy for treating the abnormal rhythm, but until now we haven't had the tools to do it efficiently."

Atrial fibrillation, or a-fib, is an irregular heart rhythm caused by abnormal electrical impulses that begin at the top of the heart and travel down the upper chambers, or atria, causing them to contract erratically. The irregular rhythm interferes with the heart's ability to efficiently pump blood. As a result, blood can pool in the atria, which can lead to the formation of clots and the possibility of a stroke.

For years, doctors have used catheters to ablate or burn sites inside the atria and ventricles – the heart's lower pumping chambers – that cause arrhythmias. Many a-fib patients are treated with anti-arrhythmic medications and anticoagulant drugs to prevent clots from forming.

"We carefully evaluate patients before recommending them for the Mini-Maze procedure," said Kenneth Ellenbogen, M.D., director of the cardiac electrophysiology lab at VCU. "It is primarily for patients who are too old for catheter ablation, had a previous, unsuccessful ablation or are unable to tolerate blood thinners."

Unlike catheter ablation, which treats the inside of the heart, the Mini-Maze technique is performed on the heart's surface which may offer a "more complete ablation of the abnormal impulses that trigger arrhythmias," according to Kasirajan.

Kasirajan trained for a year before performing the first Mini-Maze procedure in June.

According to the American Heart Association, more than 2 million people in the United States suffer from atrial fibrillation, and about 300,000 cases are diagnosed each year. In addition to an increased risk for stroke, a-fib is a major contributor in the development of congestive heart failure as well as more serious, life threatening arrhythmias. 

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