CC and Dr. McCarthy Update

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Posted by Ed Wehan on December 22, 2002 at 20:01:37:

I just returned from a five day trip so I have not as yet caught up on all of the postings. But, I do know that a few of you have procedures coming up so I thought that the first thing that I would do would post this update sent to me by Dr. McCarthy at the Cleveland Clinic. Dr. McCarthy did my maze as well as Carl Plaskett and many others who post here. He is one (#1 for me) of the most highly regarded cardiothoracic surgeons in the U.S. He is also generous with his time and has been willing to update us on current advances in AFib cures. What follows is his email to me. He also sent a very nice personal note which reflects his genuine interest in his patients. Happy Holidays to all of you and my very best to those who will soon be cured of their AFib with an upcoming procedure.
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From Dr. McCarthy at the Cleveland Clinic:

As per your request, I will update you on our latest thinking on surgery for atrial fibrillation. I will be happy to make some comments.

The mddietofutah Maze board may have to be changed because we are evolving into a more generic "surgery for atrial fibrillation." The Maze is a tremendous operation with great long-term results, but many surgeons found it too complex and too difficult. In addition, there are new technologies (in particular we are using a bipolar radio-frequency ablation clamp) that can simplify the procedure without compromising the results. A few years ago we did about 20 Maze operations a year. This year we have already done over 300 AF operations and about half were Maze procedures and the other half a new "simpler" procedure for atrial fibrillation. The simpler procedure is to use the radio-frequency clamp to do pulmonary vein isolation, and we also close the left atrial appendage, the source of clots that can break off and cause strokes. The Maze has a long-term success rate of 95-98% (depending upon the size of the atrium, and whether there are associated valve lesions such as from rheumatic fever). Pulmonary vein isolation (PVI) takes only about five minutes, and we expect a success rate of approximately 75%. Many of these patients, however, were too sick to undergo the more complex Maze procedure. For instance, this may be a patient in their 80's undergoing coronary bypass surgery, but who also has a history of atrial fibrillation. We may not want to do a lengthy Maze procedure in addition to the bypass for this patient, but will spend a few minutes to do PVI and ligate the left atrial appendage. 75% success in this group is better than the alternative of doing nothing. Therefore, the PVI is for patients already going through cardiac surgery who have complex heart disease, or who may be older or with weaker heart muscles to begin with. The near future holds some very minimally invasive ways to do pulmonary vein isolation, such that we expect it may be possible to do it with just a one hour procedure. This began in Europe a few months ago and so far 11 of 12 patients are in sinus rhythm. Again, I do not think it will have the same level of success as the Maze procedure, but it will be simpler and it has some advantages to catheter based pulmonary vein isolation.

The whole field of interventions for atrial fibrillation has really taken off in the past two years. I am still encountering patients who have been told by their doctors that there is nothing they can offer them and they should just learn to "live with it." We have several papers coming out that hopefully will help educate the cardiologists and other physicians so that they know that this is no longer the case. The Cleveland Clinic has done a good job putting together a website with information about atrial fibrillation.

So, this is the time of year when I receive the Christmas cards and thank you notes that keep us working towards our goal of treating as many patients as we can with this frequently disabling problem. I hope that the holiday season finds all of our patients well and in a nice regular rhythm!

Regards,

Patrick M. McCarthy, MD

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