Bridgeport Hospital:Pioneering Heart Surgery

In some people it causes constant fatigue, severe shortness of breath, chest pain, palpitations, light-headedness and exercise intolerance. Other people dont have any symptoms at all. But all who have this condition are in danger of stroke or heart failure.

What is it? An abnormal heart rhythm called atrial fibrillation (a-fib for short) that affects about four out of every 100 adults.

In a normal rhythm, the heart beats a steady and regular 60100 times per minute, but in a-fib, the heart beats irregularly and can race at 180 beats or more per minute.

The Problem

Normally the two small upper chambers in the heart, the atria, receive a strong electrical signal from one single source. It then travels down through the heart, causing the atria to contract in unison. 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 side roads, detouring to nowhere. This causes the atria to quiver like a bowl of Jell-O, which prevents the blood from being completely pumped out of the atria into the ventriclesthe lower chambers of the heart.

People with atrial fibrillation are at increased risk of developing a stroke or going into heart failure. In fact, the American Heart Association says that about 15 percent of all strokes occur in people who have atrial fibrillation. A-fib is the second most frequent cause of cardiac hospital admissions in both men and women. From three to five percent of people over age 65 have atrial fibrillation.

If you have an overactive thyroid, high blood pressure, a history of heart attacks, congestive heart failure or valve disease, you are at greater risk of developing atrial fibrillation. (Your cardiologist can refer you to an electrophysiologist a physician specializing in the electrical pathways of the heartfor a definitive diagnosis.)

The Solutions

The primary goals of a-fib treatment are to improve symptoms and decrease the risk of stroke. These goals can be accomplished by

1. slowing down the heart rate 2. reducing the risk of clots that can cause a stroke, using anticoagulation medications (blood thinners) 3. restoring the heart to its normal rhythm A-fib can be controlled with 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.

If medication cant keep the atrial fibrillation in check, the next step is often cardioversion. This is an electric shock that can quiet the heart so that the normal heart rhythm is restored. Other treatment options are atrial pacemakers implanted under the skin to help regulate the heart rhythm and implantable defibrillators that can restart the heart if the ventricles stop beating.

Surgery is also an option. The goal is to use a laser to burn certain areas of heart muscle. This creates scar tissue, which will not conduct electricity. Thus the impulse is guided into the proper electrical pathway. Until recently, catheter ablation (inserting a thin laser-tipped catheter through a vein and up to the heart to burn away unwanted tissue) and the Cox Maze procedure have been the only types of surgery available.

However, they have drawbacks: The catheter ablation does not work for everyone, and the Cox Maze surgery is a five-to-six hour openchest operation during which the heart is stopped and the patient is connected to a heart lung machine.

The Possibility of a Cure

Today, the Wolf Mini-Mazethe newest and most promising surgeryoffers many patients the possibility of a cure for a-fib. Bridgeport Hospital cardiothoracic surgeons M. Clive Robinson, MD, and Juan Sanchez, MD, Chief of Cardiothoracic Surgery, are among the very few surgeons in the nation with the special training to perform this surgery. It is a minimally invasive procedure (meaning that it does not require the opening of the chest or the stopping of the heart) and takes about three hours. Through small incisions on each side of the chest cavity, the surgeon uses a laser to create the maze of scar tissue to guide the misguided electrical signals along the proper route. This allows the atria to function normally, producing a steady, regular, strong heartbeat. Patients generally go home in about three days, and they can be back at work in three weeks.

With more than 40 years of experience, Bridgeport Hospital offers a comprehensive range of cardiovascular services that includes open-heart surgery, angioplasty, and cardiac rehabilitation and wellness programs.