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Note: This article contains reference to Saqib Masroor, MD, MHS, FACC, who is no longer with Froedtert & The Medical College of Wisconsin.
Heart of Ice
New minimally invasive heart surgery offers freedom from atrial fibrillation… at 256 degrees below zero.
More than 3 million Americans suffer from atrial fibrillation, a heart rhythm disorder. A new procedure available at Froedtert & The Medical College of Wisconsin offers patients the strong possibility of a cure without open heart surgery.
Randy Hoth of Shorewood experienced the first disturbing symptoms of a heart rhythm problem in 2005, when he was 56 years old. “The first couple episodes took place at night,” he said. “I felt short of breath and couldn’t sleep. It was not painful, but I could tell something wasn’t right.”
A visit to the doctor led to a diagnosis of atrial fibrillation, the most common heart arrhythmia. Randy was hospitalized immediately and started on anti-arrhythmic medications. It was 36 hours before his heartbeat returned to normal.
Over the next three years, Randy worked with cardiologist Marcie Berger, MD, FACC, a board certified cardiac electrophysiologist who specializes in atrial fibrillation, to control his condition. Unfortunately, he was among the sizable group of atrial fibrillation patients who do not respond well to standard therapies. He eventually underwent two separate procedures to eliminate the source of his irregular rhythm. Both helped, but neither led to a cure.
In 2008, Dr. Berger joined the The Medical College of Wisconsin faculty. At Randy’s next appointment, she had a new option to discuss.
“She told me that since moving to Froedtert & The Medical College of Wisconsin she had met a cardiothoracic surgeon who was getting remarkable results using a different procedure,” Randy said. She briefly described a laparoscopic surgery called CryoMaze.
Randy didn’t think twice. “I quickly said, ‘no.’”
He was not interested in going through another operation. Besides, he was beginning to feel arrhythmia was something he could live with. “I was getting by,” he said. “My condition was not optimal, but it could have been a lot worse.”
What Randy didn’t realize is that “living with” atrial fibrillation was not as simple as he thought — and that minimally invasive CryoMaze offered real potential for a complete cure.
Serious Health ProblemSaqib Masroor, MD, MHS, FACC, a Medical College of Wisconsin physician, began practicing at Froedtert Hospital at about the same time as Dr. Berger. He is a fellowship-trained cardiac surgeon with special expertise in heart rhythm disorders.
Every heartbeat, he explained, begins with an electrical impulse generated by a special group of neurons in the right atrium — the right upper chamber of the heart. Normally, these impulses spread through the heart along well defined pathways, causing the heart muscles to contract in an orderly pattern.
Atrial fibrillation occurs when electrical impulses bypass these regular pathways and race around the atria in an irregular fashion. “This leads to two problems,” Dr. Masroor said. “First, the upper chambers do not contract in an organized way. Second, the lower chambers receive many impulses instead of just one at a time, so they beat faster.”
Not everybody with atrial fibrillation knows it. “Many patients don’t feel anything unusual. When they do, typical symptoms include palpitations, shortness of breath and fatigue.”
Twenty years ago, atrial fibrillation was considered a minor problem. Now, physicians understand that it can lead to heart failure and worse.
“The most devastating complication is stroke,” Dr. Masroor said. Because the heart muscles squeeze inefficiently, blood tends to pool in a pouch-like structure called the left atrial appendage. This can lead to blood clots. “Blood thinners can decrease the risk of stroke, but not completely remove it.”
Traditionally, there have not been many easy options for treating atrial fibrillation. The simplest intervention — drug therapy — is not effective for many patients.
For years, the gold standard for treating atrial fibrillation has been the “Cox maze” surgery. In this procedure, the upper chambers of the heart are cut along carefully demarcated lines and then sutured back together. This produces a “maze” of scar tissue that interrupts irregular electric flow.
“The ’cut and sew’ procedure has excellent results, but it is a major operation involving a big incision in the chest,” Dr. Masroor said. “Because it is so invasive, it has always been reserved for patients with very bad symptoms.”
Physicians have investigated many ways to produce the Cox maze pattern using less invasive methods. One option is radiofrequency (RF) ablation, a procedure that uses a special heat energy probe to create scar lines in the heart. The problem with RF ablation, Dr. Masroor said, is that it cannot create the complete maze pattern. “It is less invasive, but the success rate is relatively low.”
“The Rest of My Life?”Randy began to focus on improving his health. He had always exercised, but now he began to work out in earnest. He also began to watch his diet very carefully. At the same time, he continued to deal with the side effects of his medications — bruising and clotting problems caused by his blood thinner, and heart rate issues caused by his beta blocker.
“I was as healthy as I had ever been, and I lost a lot of weight. Primarily, my condition was just frustrating,” he said. “Was this what the rest of my life was going to be like?”
It was at about this time that Dr. Berger suggested the CryoMaze procedure. Although Randy initially wasn’t interested, she kept encouraging him to think about it.
“One thing that brought me around was her explanation that my medications also posed long-term risks,” Randy said. “That shook me up. It made me realize that the status quo was not an option.”
The other thing that caught his attention was the success rate of the CryoMaze procedure — more than 90 percent of patients achieve complete freedom from symptoms without medications.
“I looked up Dr. Masroor online and the first thing that popped up was research he had published about CryoMaze and its very high success rate,” he said. “To me, it began to look like more than just a glimmer of hope. It looked like a real possibility.”
Small Incisions“The entire CryoMaze procedure is performed through a two-inch incision at the right side of the chest,” Dr. Masroor explained. “There are no cut bones.”
What makes the procedure possible is a special argon probe that can be cooled to 256 degrees below zero. Working from inside the heart, the surgeon uses the probe to create the Cox maze lesion pattern. “We just freeze the heart along the same lines,” Dr. Masroor said.
During the procedure, the surgeon also ties off the left atrial appendage, permanently removing the risk of stroke.
According to Dr. Masroor, the CryoMaze procedure can be performed using standard laparoscopic techniques or robotically with the da Vinci® Surgical System. “It depends on the patient’s choice.”
Dr. Masroor has performed hundreds of CryoMaze surgeries. “The great thing about this procedure is that there is minimal risk,” he said. “You get the best possible outcomes with minimally invasive access and faster recovery.”
Immediate ReliefRandy met with Dr. Masroor in early 2009. “He explained the procedure and reaffirmed what I had learned about success rates,” Randy said.
Following their meeting, Randy scheduled his surgery for that summer. He then notched up his exercise program even further. “I never trained with as much focus for anything in my life.”
Randy’s CryoMaze procedure took place at Froedtert & The Medical College in July 2009. His arrhythmia stopped immediately, and he got off medications within days. “I came out of the hospital and have not had a spell since.”
One surprising outcome for Randy was the relief he felt afterwards. “Looking back, I think I was in denial about my risk of stroke,” he said. “But once it was over, it felt like a huge weight had been lifted off me.”
Even by CryoMaze standards, Randy’s recovery was rapid. He completed cardiac rehabilitation and returned to his job at a bank on a part-time basis within three weeks. He was back full-time in about one month. Many of his coworkers were astonished to learn he had heart surgery.
Randy didn’t just look healthy. He quickly got his exercise regime back on track and by November was able to take part in a challenging fundraising event — climbing the stairs of the 42-story U.S. Bank Center in downtown Milwaukee. Not only did he participate, but Randy took first place in his age category.
Teamwork and ExpertiseToday, Randy feels he is in the best shape ever. He cycles, lifts weights and takes part in group stationary biking workouts at the Wisconsin Athletic Club. “A week with 10, 12 or 14 hours of exercise is normal.”
Looking back at his experience at Froedtert & The Medical College, he said the service was outstanding. “The nursing staff just knocked my socks off. And I liked the way the nursing cycle rotated — I was in the hospital from Thursday to Monday and I had the same three nurses until the day I went home.”
Randy believes choosing Froedtert & The Medical College of Wisconsin was important, because it put him in touch with physicians who could provide the latest treatments. “If you want access to the people who are doing the research and making the advances, you need to go where they are — an academic medical center.”
For Randy, advanced care made a huge difference.
“I have been cured for over a year now,” he said. “The CryoMaze procedure changed my life.”
As part of an academic medical center, Medical College of Wisconsin physicians in the Heart and Vascular Center are up-to-date on the latest research findings and treatment techniques. To make an appointment, call Froedtert & The Medical College at 414-805-3666.
Source: Froedtert Today Date: September 2010 |
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