Winter 2012
Tandem Treatment Tames Troubled Ticker
Tandem Treatment Tames Troubled Ticker

Just four days after having a hybrid ablation procedure to correct his a-fib, Geoff Smith of Woodbury felt strong enough to take his dog, Finnie, for a walk.

For decades, Geoff Smith of Woodbury lived life at a rapid pace—when it came to his daily routine. As an information technology consultant in Manhattan, his weekdays often began hours before the sun came up so he could catch the early morning train from the Metro- North Fairfield station to Grand Central Terminal. By the time his head hit the pillow, it was often nearly midnight.

Then, in 2010, Geoff’s energy abruptly plummeted. He thought it was due to his hectic work schedule and “getting older,” or possibly an undiagnosed sleep disorder. ”I was suddenly so tired—all the time. Everything took so much effort,” Geoff remembers. “On the mornings I drove my son to school, I would have to pull into a parking lot on the way home to take a 45—60 minute nap. It wasn’t ‘normal’ for me to feel this way.” He spoke to his primary care physician, Monica Jain, MD, who recommended a sleep study. The sleep study results surprised everyone. Geoff didn’t have sleep apnea or another sleep disorder. Geoff had atrial fibrillation.

…everyone needs to learn how to take their pulse, do it regularly and tell their doctor about any skipped beats. See insert; Ring for Your Rhythm.

What is Atrial Fibrillation?

Atrial fibrillation (a-fib) is the most common heart rhythm disorder among adults in the United States. “People with a-fib have abnormal electrical signals in their heart’s upper chambers that cause the heart to flutter, quiver or shake, rather than beat steadily,” says Chief of Cardiology Stuart Zarich, MD. “This irregular beating causes blood to pool in the heart’s chambers, which can lead to the formation of blood clots. These clots can travel to the brain and trigger a stroke.” Symptoms of a-fib also include chest palpitations, fatigue (feeling tired), dizziness and trouble breathing. What’s worse, about half the people who have a-fib experience no symptoms. “They are at risk and don’t even know it,” says Dr. Zarich. “Therefore, everyone needs to learn how to take their pulse, do it regularly and tell their doctor about any skipped beats.”

Primary care physician Paris Spanolios, MD, tested Ronnie’s heartbeat in the office. The painless electrocardiogram took just a few minutes. (An electrocardiogram— ECG or EKG—measures the patterns or rhythms of the heart. A doctor can interpret the patterns to diagnose various heart conditions.)

Getting Back into Rhythm

The sleep specialists recommended that Geoff make an appointment with an atrial fibrillation expert. Geoff met with Bridgeport Hospital cardiologist Linda Casale, MD, and cardiac electrophysiologist (a cardiologist who specializes in heart rhythm disorders) Murali Chiravuri, MD, PhD. They discussed the various options to restore his heart rhythm and opted for cardioversion (electric shock), which is done in the Electrophysiology Lab at Bridgeport Hospital. Dr. Chiravuri also prescribed a blood thinning medication to reduce Geoff’s risk of stroke.

Hybrid Ablation Likely to Make Mini-Maze Obsolete

Until now, non-surgical and surgical approaches to ablation have been performed separately. Hybrid ablation combines the catheter and surgical methods to maximize the advantages of each and minimize the risks. “Hybrid ablation has significant benefits to the patient, all of which make it a distinctly improved alternative for early and advanced forms of a-fib,” says Chief of Cardiothoracic Surgery M. Clive Robinson, MD. “These benefits will likely make other approaches, including the Mini-Maze, obsolete.”

  • First, hybrid ablation is truly minimally invasive. “Other surgical techniques, including the Mini-Maze, require access through the ribs and collapsing of the lung, or breastbone incisions. These are avoided with hybrid ablation,” says Dr. Robinson. In the ne w procedure, physicians reach the heart through tiny incisions in the soft tissues of the upper abdomen and the diaphragm.
  • Second, the ablations that block the faulty electrical pathways are more comprehensive. “In hybrid ablation, we can target the specific areas of the heart where par ticularly advanced forms of a-fib occur,” Dr. Robinson continues.
  • Third, hybrid ablation allows the physicians to reach areas of the heart not accessible using other techniques
  • Fourth, “hybrid ablation allows testing of the effectiveness of the procedure,” explains Dr. Robinson.

The cardioversion worked—at first. But Geoff’s heart would not sustain a steady rhythm for more than a few weeks. He needed another cardioversion. And another one. And another one. After four cardioversions in six months, Dr. Chiravuri became concerned about the side effects of so many electric shock procedures in such a short amount of time. He sat down with Geoff to talk about a new breakthrough option: hybrid ablation.

Hybrid Ablation Dr. Chiravuri told Geoff

Dr. Chiravuri told Geoff that he and fellow Connecticut Cardiac Arrhythmia Center electrophysiologists and Chief of Cardiothoracic Surgery M. Clive Robinson, MD, were about to bring hybrid ablation to New England, and that Bridgeport Hospital would be the first and only regional facility able to offer hybrid ablation to a-fib patients. Dr. Chiravuri was confident that Geoff would be the ideal candidate for the procedure.

Geoff was intrigued—and excited. “My family joked about me wanting to be the guinea pig,” he says, “but I felt completely relieved. I knew I was in the right place at the right time for this.”

“Ablation” refers to creating scar tissue to block faulty electrical pathways in the heart. When these wrong-turn pathways are blocked, the heart’s electrical impulses are forced to take the right paths, and the heart is able to beat rhythmically. These ablation scars can be created using three different methods: threading a very thin tube into the heart (catheter ablation), minimally invasive surgery (Mini-Maze) or open-heart surgery (Maze). “In each case, a scar is created to block abnormal electrical signals from spreading through the heart chambers,” says Dr. Robinson, a pioneer of minmally invasive heart surgery who also has extensive experience with heart rhythm procedures, including the Mini-Maze.

Hybrid ablation is a combination of the catheter and surgical approaches, designed to maximize the advantages of each and minimize their risks. The two are performed together in a single, significantly less invasive procedure that results in a more comprehensive ablation. The electrophysiologist and heart surgeon work side by side–the surgeon first from outside the heart inward and then the electrophysiologist from inside the heart out. “This combined approach is entirely new and truly minimally invasive,” says Dr. Robinson. (See sidebar: Hybrid Ablation Likely to Make Mini-Maze Obsolete.)

Dr. Robinson went over the procedure with Geoff, step-bystep. “Using a model kit, he showed me the tools and exactly what he was going to do,” remembers Geoff. “I liked that he took the time to demystify the procedure for me.” On Friday, June 3, the day of the hybrid ablation, Dr. Chiravuri and Dr. Robinson again met with Geoff to discuss the procedure and introduce him to his operating team, which included the dedicated cardiac anesthesia team. The physician anesthesiologist and certified registered nurse anesthetist were responsible for Geoff’s sedation during surgery and also controlled the lung machines (ventilators) and breathing tubes. The anesthesia team would also manage Geoff’s pain after surgery and determine when he was ready to leave the recovery room. “Everyone in the operating room was handpicked just for me. I knew I was in good hands with a top-notch group,” says Geoff. Then he kissed his wife, JJ, and became the first patient in New England to undergo hybrid ablation for a-fib.

Picking Up the Pace

The next morning in the hospital, Geoff was up and walking. On the fourth day after the procedure, he was feeling strong and well enough to go home. He looked forward to walking his dog, Finnie. And that afternoon, he did.

Since having hybrid ablation, Geoff has felt like a new person. His energy is back and he has a new outlook on life. Even better, his heart has stayed in sync. Geoff still takes his pulse every day. “I never did that before, but now I can’t imagine going through a day without checking,” he says. “It takes less than a minute and it’s so important to my heart health.” He is back to commuting into New York City every morning and doesn’t feel like he’s dragging at the end of the day. “A year ago, I never would have had the energy to do this,” he says. “I’m so grateful to Dr. Chiravuri and Dr. Robinson and the entire team that solved my problem—and gave me my life back!”

When choosing a cardiologist or cardiothoracic surgeon, be sure to select an expert physician affiliated with Bridgeport Hospital’s Joel E. Smilow Heart Institute:


If you would like more information about, or a referral to, any of these expert physicians, please visit www.bridgeporthospital.org/FindPhysician or call 1-800-794-5013, toll free, 24/7.