Surgery For arrythmias

Surgical implanatation of a heart pacemaker : usually used in treatment of sick sinus syndrome (which is a disease of the sinoatrial (SA) node, the heart’s natural pacemaker) and heart block, which occurs when the upper chambers (atria) and lower chambers (ventricles) are not coordinated, resulting in atrioventricular (AV) block (also commonly called heart block).

Surgical implantation of Implantable Cardioverter Defibrillator : This is used to terminate life threatening episodes of Ventricular Tachycardia or Ventricular fibrillation.

Surgical treatment of Atrial fibrillation:

Many times, atrial fibrillation can be successfully treated with drugs and/or an electrical shock to the heart called cardioversion . Unfortunately, the drugs and cardioversion don’t always work.

1. Maze Operation:

DR. Cox and colleagues developed an open-heart surgical procedure, called the “Maze” procedure. “Maze” refers to the series of incisions made in the upper chambers of the heart, which are arranged in a “maze-like” pattern. These incisions were intended to stop atrial fibrillation by interrupting or blocking the irregular electrical activity by the scars formed as a result of these incisions. It has long been considered the “gold standard” for treatment of atrial fibrillation. When performed by an experienced surgeon, the operation eliminates atrial fibrillation in about 90% of patients. The duration of hospitalization is usually about 1 week, and most patients can return to work within 1-2 months. Patients undergoing this operation are exposed to the risks and discomfort of open-heart surgery. Because of these drawbacks, the operation is most suitable for patients who already require open heart surgery for another type of problem, such as a leaky heart valve.

2. The Mini-Maze procedures

A series of procedures have been developed based on the Maze procedure, which were intended to be less invasive or complex. There are now at least four procedures in use, all of which have been called “mini-maze” or similar. They are suitable for patients whose only problem is atrial fibrillation. In this type of operation, the chest incisions are small and the surgeon uses special tools to destroy the areas of the heart generating the atrial fibrillation. The long-term success rate of the Mini-Maze operations has not yet been clearly established.

3.Thoracoscopic Maze for Atrial Fibrillation

This is a minimally invasive surgery for treating atrial fibrillation. The doctor works with special tools and a camera through very small openings in the chest.

Three or 4 small cuts or openings are made on each side of the chest. Each cut is about ¼ inch or 1 centimeter long. The doctor places surgical tools through these small openings. These tools are hooked to robotic arms that the doctor controls while using a camera to see the heart. With this type of heart surgery, there is not a large chest incision, no heart pump is needed, and the heart does not need to be stopped.

The doctor locates the areas that cause atrial fibrillation. These are in tissue and nerves on the outside of the heart. The doctor uses an instrument that form scars on these areas of the heart. The scars block the irregular electrical signals that cause atrial fibrillation. Part of the atria, where blood clots can form, is also removed to reduce the risk of stroke.