February 12, 2010

VHVI uses novel approach to treat atrial fibrillation

VHVI uses novel approach to treat atrial fibrillation

Vanderbilt Heart & Vascular Institute physicians are taking a tag-team approach to treating, and ultimately curing, atrial fibrillation (AF), the most common form of irregular heart rhythm.

The team was the first in Tennessee to perform the “hybrid” procedure a few weeks ago on a 43-year-old patient from Jackson, Tenn., who suffered from continuous AF.

In Vanderbilt's hybrid operating room, cardiac surgeon Steven Hoff, M.D., performed ablation on the surface of the heart — the epicardium — while electrophysiologist Patrick Whalen, M.D., used a catheter to do the same thing on the inside of the heart — the endocardium.

The procedure is called simultaneous endo-epi ablation and has been performed on five patients at Vanderbilt.

Steven Hoff, M.D.

Steven Hoff, M.D.

Ablation applies various energy sources to the inside and outside of the heart to disrupt the electrical pathways responsible for AF.

These energy sources range from cold (cryoablation) to heat (radiofrequency, high-frequency ultrasound, and microwave).

“The concept is the best of both worlds,” Hoff said. “The cardiac surgeon treats AF surgically on the surface of the heart, and the electrophysiologist, who is knowledgeable on the electrical activities of the heart, comes into the hybrid OR and treats the problem from within the heart,” Hoff said.

Since VHVI developed its Center for Atrial Fibrillation a few years ago, physicians have been interested in developing surgical options for AF, which is typically treated with medicine and catheter-based techniques.

Until recently, the only viable surgical option was the Cox-Maze procedure, a complex operation that involved opening up the chest and placing the patient on a heart-lung machine.

“Although the results were great — as high as 90 percent cure rate — not a lot of surgeons wanted to do the Cox-Maze, and not a lot of patients wanted to have it done,” Hoff said.

Electrophysiologists began mimicking those ablation lines with catheters about 15 years ago.

VHVI electrophysiologists were among the first in the country to develop a robust ablation strategy for treating AF with catheters. Using radiofrequency, he and others made ablation lines to create electrical blocks in the atrium. It was reasonably successful, Hoff said.

Creating those blocks through minimally invasive endoscopic surgery provides another option to patients whose lives are impacted by chronic, continuous irregular heart rhythm.

“Surgical ablation on the surface of the heart has advanced over the last couple of years to the point of doing it all through scopes. The approach is even better tolerated by patients, and the results are equally as good,” Hoff said, adding that Vanderbilt is one of only three centers performing this procedure.

“We think this is going to be the most robust treatment we can offer for AF, and potentially the most curative.”