Dr. McCarthy Posting for Our Board

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Posted by Ed Wehan on December 17, 2001 at 17:04:03:

The following was sent to me to post to this board by Dr. Patrick McCarthy of the Cleveland Clinic:

I have been asked to make a cameo appearance in the chat room. It has been amazing to all of us how much impact the internet, and this chat room, have had on patients, their families, and (sometimes) their doctors regarding the Maze procedure. I know that there are a lot of chat rooms associated with different medical problems, this one seems to really work. When I meet the patients before surgery they almost always seem to be well informed with a good perception of the process and long-term outcomes. Also, it sounds as if it is great support for patients who are wondering whether their problems are unique, or whether this is typical for patients with atrial fibrillation.

Now onto a few updates with our Cleveland Clinic experience. Currently, we are seeing about two new patients per week so I expect to do about 100 Maze operations in 2001. Our total experience now is approximately 300 patients. Results continue to be excellent and this is very gratifying. We still receive a lot of cards (especially this time of year around the holidays) from patients telling us how much better they feel after surgery. We have several manuscripts that we are working on for publication. One paper will review the patients who underwent the Maze procedure for "lone" atrial fibrillation. As we expected, the results are quite good. Everyone has survived (we always consider risks associated with heart surgery), and in late follow-up only three patients "failed" so that late freedom from atrial fibrillation (beyond six months) is 97%. Also there haven't been any failures since 1993, although one patient sounds to have an occasional burst of atrial fibrillation for a few seconds, and he is less than a year after surgery. From our reports it sounds as if his episodes are decreasing and we are cautiously optimistic that these will stop as the inflammatory response to the surgery decreases. Beyond 3-6 months we try to have everyone taken off of anti-arrhythmics, and coumadin (except when it is needed for other reasons such as mechanical valve replacement patients). The freedom from stroke rate has truly been remarkable, and is at 0.3% with many patients over ten years out from surgery.

Internally we are trying to organize a better system for consistent evaluation and follow-up for the patients. I have discussed this with Terry Palazzo, RN (unfortunately we were not able to recruit her to come to Cleveland!), who used to work with Dr. Cox. The atrial fibrillation nurse should become invaluable for questions after surgery, and to help answer questions before surgery about the Maze procedure and alternatives. Also, there are some new tools that are just being released that may make the operation a little simpler, and therefore it will probably become more wide spread. A new radio frequency clamp can be used to create some of the lines that we use in the Maze procedure that is very encouraging.

I hope that this update has been helpful for all of my former patients (and probably a few future patients). I hope that the holidays find you all healthy and happy and in sinus rhythm.

Warm regards,
Patrick M. McCarthy, MD

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