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Offering Patients a Valuable Option to treat AFib

Physicians with The Heart Institute of Doylestown Hospital were the first in Bucks County to perform a convergent maze procedure on September 25 to treat an advanced case of the most common form of arrhythmia. The minimally invasive procedure is unique because it involved both a cardiothoracic surgeon, Joseph Auteri, MD, and electrophysiologists, John Harding, MD, and Robert Sangrigoli, MD, working in tandem to cure Atrial Fibrillation, or AFib. The procedure is available only at a select few institutions in the country.

The patient, a 73-year-old man from Telford, is doing well. The convergent maze procedure is used with hard-to-treat or more permanent forms of AFib. The patient benefits from a single procedure that combines the best of both worlds when it comes to the latest proven technology used to treat AFib.

“It speaks to the quality of the collaboration of the heart team at Doylestown Hospital,” says Dr. Harding. “We are staying at the forefront offering different therapies, especially for those hard-to-treat cases.”

During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. AFIB occurs when rapid, disorganized electrical signals cause the heart's two upper chambers, called the atria, to fibrillate, or contract very fast and irregularly. AFib can lead to stroke, heart failure or chronic fatigue.

The convergent procedure is not a first-line therapy, notes Dr. Harding. It is reserved for patients with chronic, more permanent or advanced cases of AFib who have failed other therapies, including medications and other catheter-based ablation procedures. In this case, the patient had failed two ablations in 2010. He was experiencing chronic fatigue and AFib was weakening his heart.

“This treatment should improve his quality of life,” Dr. Harding says, adding the success rate is above 80%.

Basically, the surgeon focuses on the outside of the heart while the electrophysiologist focuses on the inside of the heart in a single procedure. The convergent maze procedure takes advantage of the cardiothoracic surgeon's ability to more easily reach and treat areas of the heart that can be more challenging for electrophysiologist's catheters. The surgeon reaches the heart via a 1-inch incision in the upper abdomen using a video-assisted scope. The surgeon is able to ablate, or destroy, arrhythmia-generating areas by applying radiofrequency energy on the outer surface of the heart.

The procedure is completed by the electrophysiologist using more traditional catheter procedures to reach and treat areas on the inner surface of the heart, areas that cannot be reached by the minimally invasive surgical approach. The electrophysiologists used cryoablation, or freezing technology, to destroy the faulty tissue inside the heart. Drs. Sangrigoli and Harding peformed the first cryoablation procedure in Bucks County in September 2011.

“This combined or ‘hybrid’ procedure allows us to more safely and effectively treat larger areas of the heart, which is particularly important in patients who have had atrial fibrillation for longer periods of time,” explains Dr. Sangrigoli.

While the convergent maze technique has proved effective, it is only available at relatively few institutions in the nation with the technology and expertise to perform this carefully choreographed procedure.

“We’ve been incorporating these newer technologies that are safe and appropriate for use so we can offer the full gamut of options to our patients,” says Dr. Auteri, medical director of The Heart Institute of Doylestown Hospital. “We’re trying to stay ahead of the curve and on top of what’s out there so we can treat many of these patients here without sending them elsewhere.”

The procedure was performed in the hybrid room at The Heart Institute of Doylestown Hospital. The room combines the capabilities of an operating room with those of a cath lab, including ultra-high-tech imaging.

An estimated 2.7 million American have AFib, and it is estimated that 12 million will have AFib by 2050, as the Baby Boomer generation ages.

For more information, call 215-345-6050.