Heart Surgeon And Cardiologist At Moore Regional Hospital Perform Nation's First Convergent Ex-Maze Procedure To Treat Atrial Fibrillation
A heart surgeon and a cardiologist specializing in electrophysiology have collaborated to perform the nation's first-ever Convergent Ex-Maze procedure to correct atrial fibrillation at FirstHealth Moore Regional Hospital. Atrial fibrillation, or afib, is an often debilitating heart disorder that... affects an estimated five million Americans.
Cardiothoracic surgeon Andy C. Kiser, M.D., who led the development of the Ex-Maze procedure for atrial fibrillation, and electrophysiologist Mark Landers, M.D., combined their expertise to perform the groundbreaking Convergent Ex-Maze on Jan. 23, 2009. Each physician had performed his specialty (the Ex-Maze by Dr. Kiser and the percutaneous endocardial catheter ablation by Dr. Landers) separately numerous times before, but never together until the January collaboration.
"This case is significant because we can now treat atrial fibrillation without chest incisions and because by working with the electrophysiologist during the procedure, we can do a complete atrial fibrillation treatment," Dr. Kiser says.
"The power of this new procedure is that we have heart surgeons and cardiologists taking tried-and-true technologies and working together to provide the best option for the treatment of atrial fibrillation," says Dr. Landers.
Atrial fibrillation (afib), which affects an estimated five million people, is the most common type of heart rhythm disturbance. It is the rapid, uncoordinated beating of the atria in the two upper chambers of the heart. With afib, the atria quiver instead of beating in rhythm when the electrical impulses that cause them to contract travel through the heart in chaotic fashion.
There are three types of atrial fibrillation: paroxysmal, persistent and long-standing persistent. Paroxysmal afib occurs when the abnormal electrical signals and rapid heart rate begin suddenly and then stop on their own. Symptoms can be mild or severe and last for seconds, minutes, hours or days. With persistent afib, the abnormal heart rhythm continues until it is stopped with treatment. Long-standing persistent afib lasts for more than one year. Both paroxysmal and persistent atrial fibrillation may become more frequent and eventually result in a long-standing or permanent afib.
Some people with afib are severely debilitated by weakness, shortness of breath or pain while others have no symptoms at all.
The union of the Ex-Maze procedure and catheter ablation provides many benefits to the patient including:
Elimination of chest incisions
Quicker recovery time
Shorter hospital stay
Minimal scarring
Ablation testing at the time of the Ex-Maze to confirm appropriate treatment endpoints
During the Convergent Ex-Maze procedure, the Ex-Maze portion is performed through a small incision in the abdomen while a small catheter is inserted in the large vein in the groin for the catheter ablation.
"This eliminates the need for sometimes painful incisions in the chest and allows instantaneous confirmation of the success of the procedure," says Dr. Kiser. "This approach allows the patient to have a quicker recovery and also allows us to add new lesions to parts of the heart that we couldn't reach before. In addition, it allows patients who travel from great distances for the treatment to be able to fly to the area instead of having to drive."
Dr. Kiser recently traveled to the Texas Cardiac Arrhythmia Institute at St. David's Medical Center in Austin, Texas, to observe Rodney Horton, M.D., an electrophysiologist, and Andrew Hume, M.D., a cardiac surgeon, perform the second procedure in the United States. Andrea Natale, M.D., medical director of the heart arrhythmia program at St. David's and an internationally known heart arrhythmia specialist, was also on hand for the procedure.
Various improvements to the traditional open-heart surgery technique have been developed to block the stray electrical impulses of atrial fibrillation and guide electricity onto the correct pathways through the heart. Other traditional treatments include medication, pacemaker implantation and electrical shock, all of which are offered at Moore Regional Hospital.
For many years, the "gold standard" for afib treatment has been a surgical procedure called the Cox Maze, which requires opening the chest, stopping the heart and cutting it into sections before it is sewn back together. Dr. Kiser's Ex-Maze procedure, a novel improvement to the Cox Maze that he developed in collaboration with other surgeons, creates an extensive pattern of scar tissue on the heart's surface and controls the heart's abnormal electrical impulses without the complexity of similar procedures.
"A major advantage of the Ex-Maze is that the procedure is done while the heart is beating, so the patient doesn't have to be on a heart-lung machine," Dr. Kiser says.
Initially, Dr. Kiser performed the Ex-Maze only on patients who were having some other type of open-chest procedure, such as a coronary artery bypass. In 2007, he was invited to Krakow, Poland, where he performed the world's first minimally invasive Ex-Maze procedure using Paracardioscopy, which allows surgeons to look at and operate on the heart by using ports and small cameras. He began offering the Paracardioscopic Ex-Maze as a treatment option at Moore Regional in January 2008.
Catheter ablation, a common medical procedure to treat atrial fibrillation, uses a long, thin, flexible tube (called an ablation catheter) that is typically put into a blood vessel in the arm, groin (upper thigh) or neck. The tube is guided to the heart through the blood vessel, and a special machine sends energy through the catheter to the heart. This energy finds and destroys small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start. During the Convergent Ex-Maze procedure, the ablation catheter is inserted into the heart through the groin.
The Convergent Ex-Maze can be used to treat all three types of atrial fibrillation, but focuses on those patients who have been difficult to treat with traditional methods.
"Those difficult-to-treat patients, who have had atrial fibrillation for a long time, are the patients we are now treating with this procedure," says Dr. Kiser.
Dr. Kiser is a member of the Cardiovascular and Thoracic Center and chief of Thoracic Surgery at Moore Regional Hospital. Also, the medical director of FirstHealth's Chest Center of the Carolinas and Arrhythmia Center, he has been performing heart and lung surgeries at Moore Regional since 2000 and has performed more than 150 minimally invasive Ex-Maze procedures.
Dr. Landers is affiliated with Pinehurst Cardiology Consultants, a comprehensive cardiology practice in Pinehurst.
For more information on the Convergent Ex-Maze atrial fibrillation procedure developed by Dr. Andy Kiser and Dr. Mark Landers, please contact FirstHealth Moore Regional Hospital at (800) 213-3284 or visit http://www.firsthealth.org/afib. Additional information is also available on the Ex-Maze Web site at http://www.exmaze.com.
CUTLINE
A team of American and Polish physicians performed the world's first Convergent Ex-Maze procedure in Krakow, Poland, in January 2009. Members of that team are (front from left) Rodney Horton, M.D., an electrophysiologist with St. David's Medical Center in Austin, Texas; Andy Kiser, M.D., the Moore Regional Hospital cardiac surgeon who developed the groundbreaking procedure; and Andrew Hume, M.D., a cardiac surgeon with St. David's Medical Center in Austin, Texas; and (back from left) David Haines, M.D., a cardiologist with William Beaumont Hospital in Michigan; and cardiac surgeon Krzysztof Bartus, M.D., of Poland. Source medical update
Cardiothoracic surgeon Andy C. Kiser, M.D., who led the development of the Ex-Maze procedure for atrial fibrillation, and electrophysiologist Mark Landers, M.D., combined their expertise to perform the groundbreaking Convergent Ex-Maze on Jan. 23, 2009. Each physician had performed his specialty (the Ex-Maze by Dr. Kiser and the percutaneous endocardial catheter ablation by Dr. Landers) separately numerous times before, but never together until the January collaboration.
"This case is significant because we can now treat atrial fibrillation without chest incisions and because by working with the electrophysiologist during the procedure, we can do a complete atrial fibrillation treatment," Dr. Kiser says.
"The power of this new procedure is that we have heart surgeons and cardiologists taking tried-and-true technologies and working together to provide the best option for the treatment of atrial fibrillation," says Dr. Landers.
Atrial fibrillation (afib), which affects an estimated five million people, is the most common type of heart rhythm disturbance. It is the rapid, uncoordinated beating of the atria in the two upper chambers of the heart. With afib, the atria quiver instead of beating in rhythm when the electrical impulses that cause them to contract travel through the heart in chaotic fashion.
There are three types of atrial fibrillation: paroxysmal, persistent and long-standing persistent. Paroxysmal afib occurs when the abnormal electrical signals and rapid heart rate begin suddenly and then stop on their own. Symptoms can be mild or severe and last for seconds, minutes, hours or days. With persistent afib, the abnormal heart rhythm continues until it is stopped with treatment. Long-standing persistent afib lasts for more than one year. Both paroxysmal and persistent atrial fibrillation may become more frequent and eventually result in a long-standing or permanent afib.
Some people with afib are severely debilitated by weakness, shortness of breath or pain while others have no symptoms at all.
The union of the Ex-Maze procedure and catheter ablation provides many benefits to the patient including:
Elimination of chest incisions
Quicker recovery time
Shorter hospital stay
Minimal scarring
Ablation testing at the time of the Ex-Maze to confirm appropriate treatment endpoints
During the Convergent Ex-Maze procedure, the Ex-Maze portion is performed through a small incision in the abdomen while a small catheter is inserted in the large vein in the groin for the catheter ablation.
"This eliminates the need for sometimes painful incisions in the chest and allows instantaneous confirmation of the success of the procedure," says Dr. Kiser. "This approach allows the patient to have a quicker recovery and also allows us to add new lesions to parts of the heart that we couldn't reach before. In addition, it allows patients who travel from great distances for the treatment to be able to fly to the area instead of having to drive."
Dr. Kiser recently traveled to the Texas Cardiac Arrhythmia Institute at St. David's Medical Center in Austin, Texas, to observe Rodney Horton, M.D., an electrophysiologist, and Andrew Hume, M.D., a cardiac surgeon, perform the second procedure in the United States. Andrea Natale, M.D., medical director of the heart arrhythmia program at St. David's and an internationally known heart arrhythmia specialist, was also on hand for the procedure.
Various improvements to the traditional open-heart surgery technique have been developed to block the stray electrical impulses of atrial fibrillation and guide electricity onto the correct pathways through the heart. Other traditional treatments include medication, pacemaker implantation and electrical shock, all of which are offered at Moore Regional Hospital.
For many years, the "gold standard" for afib treatment has been a surgical procedure called the Cox Maze, which requires opening the chest, stopping the heart and cutting it into sections before it is sewn back together. Dr. Kiser's Ex-Maze procedure, a novel improvement to the Cox Maze that he developed in collaboration with other surgeons, creates an extensive pattern of scar tissue on the heart's surface and controls the heart's abnormal electrical impulses without the complexity of similar procedures.
"A major advantage of the Ex-Maze is that the procedure is done while the heart is beating, so the patient doesn't have to be on a heart-lung machine," Dr. Kiser says.
Initially, Dr. Kiser performed the Ex-Maze only on patients who were having some other type of open-chest procedure, such as a coronary artery bypass. In 2007, he was invited to Krakow, Poland, where he performed the world's first minimally invasive Ex-Maze procedure using Paracardioscopy, which allows surgeons to look at and operate on the heart by using ports and small cameras. He began offering the Paracardioscopic Ex-Maze as a treatment option at Moore Regional in January 2008.
Catheter ablation, a common medical procedure to treat atrial fibrillation, uses a long, thin, flexible tube (called an ablation catheter) that is typically put into a blood vessel in the arm, groin (upper thigh) or neck. The tube is guided to the heart through the blood vessel, and a special machine sends energy through the catheter to the heart. This energy finds and destroys small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start. During the Convergent Ex-Maze procedure, the ablation catheter is inserted into the heart through the groin.
The Convergent Ex-Maze can be used to treat all three types of atrial fibrillation, but focuses on those patients who have been difficult to treat with traditional methods.
"Those difficult-to-treat patients, who have had atrial fibrillation for a long time, are the patients we are now treating with this procedure," says Dr. Kiser.
Dr. Kiser is a member of the Cardiovascular and Thoracic Center and chief of Thoracic Surgery at Moore Regional Hospital. Also, the medical director of FirstHealth's Chest Center of the Carolinas and Arrhythmia Center, he has been performing heart and lung surgeries at Moore Regional since 2000 and has performed more than 150 minimally invasive Ex-Maze procedures.
Dr. Landers is affiliated with Pinehurst Cardiology Consultants, a comprehensive cardiology practice in Pinehurst.
For more information on the Convergent Ex-Maze atrial fibrillation procedure developed by Dr. Andy Kiser and Dr. Mark Landers, please contact FirstHealth Moore Regional Hospital at (800) 213-3284 or visit http://www.firsthealth.org/afib. Additional information is also available on the Ex-Maze Web site at http://www.exmaze.com.
CUTLINE
A team of American and Polish physicians performed the world's first Convergent Ex-Maze procedure in Krakow, Poland, in January 2009. Members of that team are (front from left) Rodney Horton, M.D., an electrophysiologist with St. David's Medical Center in Austin, Texas; Andy Kiser, M.D., the Moore Regional Hospital cardiac surgeon who developed the groundbreaking procedure; and Andrew Hume, M.D., a cardiac surgeon with St. David's Medical Center in Austin, Texas; and (back from left) David Haines, M.D., a cardiologist with William Beaumont Hospital in Michigan; and cardiac surgeon Krzysztof Bartus, M.D., of Poland. Source medical update