Atrial Fibrillation

Atrial fibrillation is an irregular heart rhythm that affects at least 1% of the American population. It may be paroxysmal, persistent, or permanent. Paroxysmal atrial fibrillation appears to originate from the pulmonary veins where they interface with left atrial muscle. If atrial fibrillation continues unabated it appears to evolve into a persistent dysrythmia with associated symptoms. Clearly, the majority of patients suffering from atrial fibrillation have increased episodes of shortness of breath, fatigue, and anxiety which negatively impacting their quality of life not to mention an increased risk of stroke.

Medical treatment with a variety of antiarrythmic agents has failed to achieve a significant therapeutic impact. The most commonly used agent, Amiodarone is associated with an increasingly toxic profile over time. Electrical cardioversion provides a temporary solution but the anatomic focus (usually in the pulmonary veins) persists. Because of the increased risk of embolic stroke with atrial fibrillation, patients require lifelong coumadin therapy with its attendant morbidities.

At UNC, we take a very aggressive approach to patients with atrial fibrillation. Any patient receiving heart surgery, be it for coronary artery bypass or valve surgery, will have an adjunctive procedure in order to ablate the aberrant foci of electrical stimuli. A variety of techniques are utilized including standard “cut and sew” disruption as well as several sources of energy ablation including radiofrequency, cryothermy, and microwave. In addition, the left atrial appendage is always removed, thus removing any chance for future clot development.

Although the original surgery for atrial fibrillation, termed the Cox/Maze, proves successful in > 90% of patients, it requires median sternotomy, cardiopulmonary bypass and extensive intracardiac reconstruction. With technological advances, we can now offer safe surgical treatment for lone atrial fibrillation with a minimally invasive thorascopic approach without cardiopulmonary bypass. By utilizing microwave energy, the pulmonary veins may be isolated from the remainder of the cardiac conduction system. Anticipated length of stay is < 3 days with a > 75% success rate. If diagnostic evaluation reveals other cardiac abnormalities such as myocardial ischemia or valvular disease we offer complete management with myocardial revascularization or valve repair with concomitant atrial fibrillation surgery.