New technique may reduce recovery time in arrhythmia patients

Feb 4 2010

A surgeon and an electrophysiologist in the Methodist DeBakey Heart & Vascular Center last week worked together to perform a novel, minimally-invasive procedure to treat a common but dangerous arrhythmia in a 61-year-old lawyer from east Texas who has suffered from the condition for months. By combining their talents, the physicians could perform the procedure through two small incisions, rather than six, which is common for minimally-invasive approaches. (Video: https://www.youtube.com/watch?v=ksgFPKYlM-0)

"We're hoping that by combining the expertise of a surgeon with that of an electrophysiologist, we'll make the treatment more effective, while also making it easier on the patient in terms of recovery time," said Dr. Basel Ramlawi, cardiac surgeon who performed the surgical portion of the hybrid procedure.

Atrial fibrillation (AF) is the most common type of arrhythmia, a condition in which the top chamber of the heart quivers instead of pumping. When it quivers, blood pools in the chamber, causing blood clots that can break off, travel to the head and cause strokes. AF is caused by an abnormality in the electrical system of the heart that makes it pump effectively.

"Patients with atrial fibrillation tend to be very tired, sometimes nauseated, and they'll be able to feel the irregular heartbeats," said Dr. Miguel Valderrábano, electrophysiologist who performed the catheter-based portion of the procedure. "The majority of patients with atrial fibrillation are not being treated for the condition. Many shrug off the symptoms until the irregular heartbeat comes frequently enough to scare them."

Howard Goode, a lawyer from Texarkana experienced intermittent periods of racing heart beats, shortness of breath and disorientation for months before he saw a doctor and was diagnosed with atrial fibrillation and congestive heart failure. After a period of medical treatment, his cardiologist recommended an ablation procedure.

"When I saw that having ablation would help, and it meant I didn't have to take all the medications that made me feel bad, I wanted to give it a shot," he said. "Dr. Valderrabano described the hybrid technique, introduced me to Dr. Ramlawi, and I was in."

In the new hybrid procedure, Ramlawi made a single one-inch incision in the patent's abdomen. Through this incision, he navigated tiny instruments behind the diaphragm and into the patient's heart, where he used radio-frequency heat to burn or ablate the errant electrical currents in the heart that cause arrhythmias.

Next, Valderrábano made a puncture hole in the patient's leg and snaked a catheter into the patient's heart. In this stage of the procedure, Valderrábano tested the ablations made by Ramlawi to make sure they were complete. He then used radio-frequency to ablate the residual areas that could not be reached during the first stage using a robotically manipulated catheter made by Hansen Medical.

"This two-pronged approach has the potential to provide the patient with a more robust, more effective and lasting treatment," Valderrábano said.

The standard surgical approach to treating AF is called a MAZE procedure in which a surgeon uses ablation to isolate the place where the patient's pulmonary veins attach to the heart. This is where the errant currents that cause AF originate. Surgeons can perform the MAZE procedure during open heart surgery, or through approximately six small incisions in the patient'' sides.

The standard non-surgical approach is done in a catheterization lab by a specialized cardiologist called an electrophysiologist (EP). The EP doctor makes a small incision in the groin, maneuvers the catheter into the heart, crosses the septum or center wall of the heart, and ablates the area around the pulmonary veins from inside the heart.

Combining both approaches in one minimally invasive session allows us to potentially cure some of the most challenging patients with atrial fibrillation such as patients with large left atria or longstanding atrial fibrillation.

By combining the two standard-of-care procedures, we hope to greatly improve both effectiveness and recovery, Valderrábano said.

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