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Department of Surgery Referrals Patient Clinician Researcher

Procedures & Innovations Atrial Fibrillation Surgery


Atrial fibrillation (AF) is a form of arrhythmia, or irregular heartbeat, in which the atria (the two small upper chambers of the heart) quiver instead of beating effectively. It is one of the most common forms of cardiac arrhythmia, affecting 0.4% of the general population and 5 to 10% of persons over 65 years of age. In addition, AF occurs in as many as 50% of patients undergoing cardiac operations.

Abnormalities in the heart's electrical impulses in patients with AF cause blood to be pumped improperly, resulting in pooling or clotting. If a blood clot moves to an artery in the brain, AF can lead to stroke. AF is also associated with increased risk of congestive heart failure and cardiomyopathy (heart muscle disease). These risks warrant medical attention for patients with AF even if symptoms are mild. While nonsurgical treatment options, such as electrical cardioversion, often help restore a normal rhythm initially, recurrence rates as high as 75% have been reported.

Columbia's surgical atrial fibrillation program is led by Michael Argenziano, MD, Director of Arrhythmia Surgery, and the AF management team includes Mehmet C. Oz, MD, Yoshifumi Naka, MD and Mathew Williams, MD, who are trained in the most innovative treatment options for atrial fibrillation. The Columbia team has performed surgical atrial fibrillation ablation (SAFA) in more than 300 patients, with a success rate (normal rhythm) at 6-12 months of 76%. The majority of these operations have been performed in conjunction with other cardiac procedures (such as valve repair or coronary bypass), but the procedure can also been used for atrial fibrillation as the sole indication.

A brief overview of the treatment options for AF follows.

Treatment Options

The MAZE Procedure

The MAZE Procedure is a surgical approach that treats atrial fibrillation by interrupting the electrical impulses that cause abnormal heart rhythm. The surgery typically involves the placement of incisions in both atria, however can be modified to suit a given patient's condition. When the incisions heal, scar tissue forms and prevents abnormal electrical impulses from passing through the heart. This technique is highly effective in curing atrial fibrillation. However, potential complications of the procedure include fluid retention and other risks associated with open heart surgery such as bleeding, infection, stroke, and pneumonia. For these reasons, and because the classical MAZE procedure requires a breastbone splitting incision, use of the heart-lung machine, and multiple incisions in the heart, this procedure has not been embraced by many patients and physicians.

Surgical Atrial Fibrillation Ablation (SAFA)

To reduce the risks and trauma associated with the classic MAZE operation, surgeons at Columbia University Medical Center Heart Institute have developed modification of the MAZE, known as Surgical Atrial Fibrillation Ablation (SAFA). In these procedures, a variety of energy sources such as radiofrequency, microwave, or laser, are used to create a limited number of scars in the left atrium, avoiding the need for many incisions in the heart. Furthermore, our surgeons have developed minimally invasive versions of SAFA, in which left atrial lesions can be made without opening the breastbone or using the heartlung machine.

Totally endoscopic, beating heart atrial fibrillation ablation.

Totally Endoscopic Beating Heart Atrial Fibrillation Ablation

The Columbia team has developed a totally endoscopic, beating heart version of surgical atrial fibrillation ablation. In this minimally invasive, robotic operation, the ablation is performed through small puncture wounds in the chest and without stopping the heart or using the heart-lung machine. We performed our first such closed chest, off-pump atrial fibrillation operation in February 2003, and we now offer this approach as a clinical option for treatment of lone atrial fibrillation.

Postoperative photos taken 10 days after totally endoscopic, beating heart atrial fibrillation surgery.

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