Atrial Fibrillation: Surgical Treatments (cont.)

GILLINOV:
AF is common in patients with heart failure. Cure of the atrial fibrillation in heart failure patients usually does improve their clinical course.

MEMBER QUESTION:
Is minimally invasive surgery the same as cardioversion?

GILLINOV:
No. Cardioversion is the use of electrical stimulation to restore normal heart rhythm. Cardioversion is what you see on TV when somebody says, "Give me the paddles." Then they yell, "Clear." That is different from minimally invasive surgery or catheter-based ablation.

"In most people with atrial fibrillation, Coumadin is far more effective than is aspirin in preventing stroke."

MEMBER QUESTION:
In the UK, so I heard on a radio doctor's show, the primary blood thinner prescribed for AF is aspirin as opposed to Coumadin, supposedly due to the pressure of socialized medicine. What are the increased risk factors to prescribing aspirin instead of Coumadin?

GILLINOV:
In most people with atrial fibrillation, Coumadin is far more effective than is aspirin in preventing stroke. Only selected patients with atrial fibrillation should receive aspirin alone.

MEMBER QUESTION:
What are the downsides of minimally invasive approaches (if any) which are not present on open heart (Maze) procedures for AF?

GILLINOV:
The Maze procedure is the most effective curative treatment for atrial fibrillation, and we have one of the world's largest experiences with this operation. However, the Maze procedure is open heart surgery and requires use of the heart/lung machine. It takes four to six weeks to recover fully from the operation. Of course, after recovery, most patients have a lifetime of normal heart rhythm. All of the minimally invasive approaches are slightly less effective than the Maze procedure, but they are also less invasive. It is important for a person with atrial fibrillation to go to a center where all of these options are available.

MEMBER QUESTION:
How many ablations does Cleveland Clinic do each year?

GILLINOV:
Overall, at the Cleveland Clinic, we perform about 1000 ablation procedures using all available techniques. This includes people having Maze procedures, minimally invasive surgery procedures and catheter based procedures.

MODERATOR:
Can you describe what you do during a minimally invasive procedure?

GILLINOV:
Depending upon the patient, we will choose one of two minimally invasive approaches. One approach is performed completely with endoscopes, and therefore has only very small incisions. The left atrial appendage is removed with a special stapler. In the other minimally invasive approach, small keyhole incisions are made, one on each side of the chest, and the ablation performed. The left atrial appendage is removed with this technique as well. Currently only surgical approaches enable removal of the left atrial appendage. This is important because strokes in people with atrial fibrillation come from blood clots in the left atrial appendage.

"Overall, at the Cleveland Clinic, we perform about 1000 ablation procedures using all available techniques."

MEMBER QUESTION:
I have premature ventricular contractions (PVCs) and my doctor is recommending ablation and/or mexiletine. The medicine concerns me because I read where side effects could be seizure. I was concerned about the ablation because I didn't know if the scar tissue would cause any hardness on the heart. My PVCs are back to back.

  • I have had an angiogram - no blockage
  • I have had the vein Doppler - no blood clots
  • I have had an MRI - no congenital disease
Regarding the PVCs, the doctor said that the bottom part of my heart was jumping in before the top part could finish its beat.

GILLINOV:
PVCs are different from atrial fibrillation (AF). PVCs arise in the ventricles rather than the atria. If PVCs are asymptomatic or minimally symptomatic they generally require no treatment. If the PVCs are symptomatic, medical therapy is appropriate before considering ablation. Mexiletine and other drugs are appropriate options.

MODERATOR:
We are almost out of time, Dr. Gillinov. Before we wrap things up for today, do you have any final words for us?

GILLINOV:
At the Cleveland Clinic we are committed to the development and implementation of new cures for atrial fibrillation. We have a multidisciplinary team of cardiac surgeons, cardiologists and nurses that examines every patient carefully and chooses the best treatment option with that patient. For more information you can contact us at www.clevelandclinic.org/heartcenter or our toll free number is 1-866-289-6911.



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