Summer 2006
An Up-Beat Story: Pioneering Surgery in the Heart Institute

Stratford resident David Thorne didn't even know he had a heart problem until ten years ago, when he went mano a mano with a chainsaw and cut his hand. Not badly, fortunately, but he went to an urgent care center to have it looked at. When the doctor put a stethoscope to David's chest, he found a heartbeat that was fast and erratic—even for a man who just had a run-in with a man-eating garden implement. The physician recommended that David follow up with his own doctor.

David's primary physician, Bridgeport Hospital–affiliated Sheldon Weicholz, MD, promptly sent him to a cardiologist, who diagnosed atrial fibrillation (a-fib for short).

Diagnosed in about 2.2 million Americans, a-fib is a glitch in the electrical impulses that regulate the heartbeat. A normal impulse begins at a specific place in the right atrium (one of the two top chambers of the heart) and travels down to the two lower chambers (ventricles). This makes all four chambers contract in an orderly way to push blood through the heart and out into the body. A-fib occurs when extra impulses start out from the wrong place at the wrong time. Instead of traveling straight along the highway through the heart, they branch out along byways, detouring to nowhere. This causes a rapid and disorganized heartbeat.

A-fib may be episodic, coming and going (think: occasional potholes in the highway)—but it can also become chronic and permanent (think: bumpy back road). And even though David didn't notice any symptoms, a-fib is dangerous. It increases the risk of stroke, may cause congestive heart failure, and can cause dizziness and fainting. A-fib can be controlled by medication to slow the heartbeat, but it may take several drugs, it may take time to find the right dosages, and the medications can have side effects such as nausea, drowsiness and blurry vision. And if the medications become ineffective, it might be necessary to undergo cardioversion (shocking the heart)—as David did.

For a-fib patients like David, cardioversion is done as a non-emergency procedure. David came to the electrophysiology laboratory in the Heart Institute at Bridgeport Hospital, where the procedure was done under sedation by Craig McPherson, MD, Director of Electrophysiology. Paddles were placed on David's chest, and a modest dose of electricity was given in sync with his heartbeat. The goal was to shock the heart into behaving itself.

Cardioversion usually works well, but like medications, it can have undesirable side effects. "Some day, maybe by 2010," Dr. McPherson once promised David, "there will be a better, more permanent solution to atrial fibrillation."

Fast-forward a few years: David has been taking up to five different pills a day, while his doctors fine-tune his medications to find the combination that would work for him. He has undergone cardioversion several times. Bottom line: he's tired of it.

"It was a lifestyle thing," he says. "I was just fed up with all the pills. So in February '06, when Dr. McPherson told me about a new kind of surgery being done at Bridgeport Hospital that might cure my a-fib, I said, 'Yay, we're four years ahead of schedule!'"

M. Clive Robinson, MD, introduced the new procedure to Bridgeport Hospital. An internationally recognized pioneer in minimally invasive heart surgery, he is one of the very few physicians in the nation who perform the surgery, called "mini-maze" (for reasons that will become clear). Dr. Robinson determined that David was the ideal candidate. "He had episodic atrial fibrillation, which is most suitable for mini-maze; he wasn't responding well to the medications; and he had an athletic background so I felt he had the stamina to go through the procedure," Dr. Robinson explains.

"Mini-maze is effective in returning the heart to a normal rhythm in selected patients," says Bridgeport Hospital Chief of Cardiothoracic Surgery Juan Sanchez, MD, who is known for his expertise in mitral valve repair. "It was developed because current treatments with medications for this group of patients are sometimes ineffective and may have significant side effects," Dr. Sanchez adds.

So in May 2006, David came to the Heart Institute for pioneering mini-maze surgery.

David's procedure required two specialists. Dr. McPherson, the electrophysiologist, used a computer in the operating room to map out the electrical impulses in David's heart and demonstrate where the impulses were coming from. Dr. Robinson, the cardiothoracic surgeon, used radiofrequency waves to ablate, or burn away, the areas of heart muscle that were sending impulses in the wrong directions. "Scar tissue will form where the heart muscle was ablated," Dr. Robinson explains. "That scar tissue won't conduct electricity. Instead, it will create a maze that blocks the impulses from going the wrong way." (Hence the term "maze.")

As part of the operation, Dr. Robinson also closed off the atrial appendage, a small sac-like structure on the outside of the heart, in which blood collects. This pooled blood forms clots that can travel to the brain, causing a stroke. Reducing the risk of a stroke in this way is one of the advantages of mini-maze.

What David's mini-maze did not require was a heart-lung machine—because, remarkably, the entire procedure was performed without opening David's chest or stopping his heart. Instead, Dr. Robinson made a one-and-a-half-inch mini-incision between the ribs on each side of David's chest, and two one-centimeter incisions for the camera and miniature instruments. (Hence the term "mini!") A tiny camera, placed into the chest cavity, let him visualize the heart on a video monitor, while through the incisions between the ribs, he could also see with his own eyes exactly what he was working on. "It's kind of like having two sets of eyes," he comments. This direct view allowed great accuracy in positioning his small ablation devices.

Once the surgical procedures were completed, Dr. McPherson again mapped the electrical impulses to be sure that the detours had been blocked by the maze of scar tissue.

The entire procedure took about 31⁄2 hours; David spent just three days in the Heart Institute at Bridgeport Hospital recovering from his procedure before going home; and he was back at his job as Senior Vice President of Independent Mortgage in Fairfield in about three weeks!

David feels completely up-beat about an active future without pills, cardioversion, or dizzy spells. "I'm just glad I live in Fairfield County, where there are experts who can perform this specialized procedure," he says.