Winter 2008
Howard’s Heart
Howard’s Heart

Why do surgeons from Long Island and Albany travel to Bridgeport Hospital? (Hint: It’s not for the palm trees!) Physicians choose to bypass dozens of other hospitals along the way for the expert training provided by Bridgeport Hospital Chief of Cardiothoracic Surgery M. Clive Robinson, MD. Dr. Robinson is one of only a handful of surgeons in the country who performs an innovative minimally invasive heart procedure called MiniMaze. Because of his expertise, Dr. Robinson is a preceptor, designated to teach other surgeons how the MiniMaze can correct a condition called atrial fibrillation.

Meet Howard

Atrial fibrillation patient Howard Chess, 59, traveled 1,400 miles from Fort Lauderdale, Florida, early last year to meet with Dr. Robinson and electrophysiologist Craig McPherson, MD. (An electrophysiologist is a cardiologist who specializes in treating heart rhythm disorders.) Howard credits them for giving him a second chance to live the life of his dreams.

He Never Suspected A Problem

Until one fateful day in November 2006, Howard never suspected he had a heart condition. He and his wife, Carol, were happy with their busy lifestyle. He loved his position as an administrator for a non-profit organization, the trips to Europe he and Carol took together, and their active social life with friends and family. Howard was at the top of his game.

Howard especially looked forward to his early morning workouts on the treadmill to jump-start his day. But one morning, his routine came to a screeching halt. Soon after starting his daily run, he suddenly felt dizzy. The treadmill heart monitor read his pulse at 160—way over the usual rate of 120, which was typical for him during a workout. "I’m not going that fast," he thought. "I’m not even breaking a sweat." Assuming the monitor was broken, he got off and reset it. But the monitor continued to measure his heart at the same accelerated rate. Thinking his dizziness might be due to low blood sugar, he decided to get off the machine and head to work, where he ate breakfast at his desk.

But the dizziness didn’t subside, and he felt a strange fluttering in his chest. Howard called his primary care physician, who recommended that someone drive him to the doctor’s office to get it checked out right away. Howard’s condition was quickly confirmed: atrial fibrillation.

Watching and Waiting

Affecting millions of people, atrial fibrillation is a serious heart condition. Abnormal electrical signals in the heart’s upper chambers cause the heart to quiver and shake, affecting its ability to pump blood. Blood then pools in the upper chambers of the heart and can form clots. Clots in the heart can travel to the brain and cause a stroke. Symptoms of atrial fibrillation can come and go, and include dizziness, shortness of breath and palpitations (an unpleasant awareness of the heart beating). Many people with atrial fibrillation also feel very tired. This is caused by the decreased amount of blood being pumped by the heart each minute, as well as the weakening of the heart, due to the constant racing of the muscle.

Howard’s doctor prescribed medication to control the heart’s rate and rhythm, and instructed him to return in the morning if symptoms continued. The doctor also prepared Howard for the possibility of a cardioversion – a procedure that delivers an electric shock to jolt the heart back to a normal rhythm.

All night long, Carol kept vigil over her husband, worrying about Howard’s heart palpitations, which continued at a frightening rate. Howard’s doctor called throughout the night to check on his condition. At daybreak, shaken from the seemingly long hours at home, Howard and Carol headed to the hospital, where the cardioversion was performed.

During the next few months, despite the medication and the cardioversion procedure, Howard’s atrial fibrillation symptoms continued. "I would feel fluttering in my chest, or my heart pulsating—beating very hard," he says. "But most of all I would feel very tired." The fluttering and pulsating sensations would last anywhere from four to 12 hours. Medications helped relieve symptoms, but didn’t stop them completely, and possible side effects of the various medications weighed on his mind.

This waiting and worrying about having a stroke at any moment didn’t allow Howard to relax and enjoy life as he used to. "Atrial fibrillation knocked me off my lifestyle," he says. "I wasn’t ready for this. I was only 59, and I wasn’t willing to throw in the towel."

What is atrial fibrillation?

Atrial fibrillation is an abnormal heart rhythm. The upper chambers (right and left atria) are stimulated so rapidly that they stop pumping blood and simply quiver (fibrillate). The condition can come and go and is brought on by various triggers.

  • Risk Factors: Previous heart attack; additional heart conditions; high blood pressure; diabetes; overactive thyroid; lung disease; high levels of caffeine, stimulants or the body’s own adrenaline. In many patients, there is no obvious sign of heart disease or other risk factors. Some patients have an inherited tendency for atrial fibrillation.
  • Signs: Dizziness, extreme fatigue, shortness of breath, a fluttering sensation in the chest.
  • Risks if Untreated: Blood clots leading to stroke; enlargement of the heart leading to congestive heart failure (when the heart cannot pump enough blood to the body’s other organs).
  • Treatments (individualized, based on a patient’s unique condition):
    • medication to control the heart’s rhythm and/or rate
    • cardioversion – electrical shock using paddles
    • catheter ablation – catheter inserted into the veins of the groin, shoulder and/or neck and guided to the malfunctioning area of the heart to ablate or destroy misdirected electrical pathways
    • traditional open-heart surgery
    • minimally invasive surgical ablation – MiniMaze

Exploring Treatments

Howard began to explore alternate ways to treat his atrial fibrillation. Due to other health conditions, he wasn’t a candidate for anticoagulant medication (blood thinners) or catheter ablation. (See "What is atrial fibrillation?," on previous page.) Howard wasn’t completely comfortable with pursuing the traditional open-heart surgical option, which involves an extensive operation and stopping the heart during the procedure.

Luckily, Howard’s brother, David Chess, MD, a physician in Shelton, CT, was familiar with the successes of the team of heart experts in the Heart Institute at Bridgeport Hospital. He recommended that Howard fly up to discuss minimally invasive surgical ablation for atrial fibrillation with Drs. McPherson and Robinson. Howard was relieved to learn how much less-invasive the MiniMaze procedure is, and agreed that his health was valuable enough to make the trip north.

From the specialists, Howard found out that he had paroxysmal atrial fibrillation, meaning that he had relatively brief episodes of the palpitations and other symptoms. In addition, Howard’s heart chambers had not yet become irreversibly enlarged, so he was a good candidate for the MiniMaze procedure.

"Atrial fibrill