Thank you, Steve! Congratulations on your 5 years.

[ Follow Ups ] [ Post Followup ] [ MAZE Alumni Forum ]

Posted by Henry Alken on January 10, 2004 at 12:41:45:

Back in April of 2002, 6 months after receiving the Maze at CC, I was still in Atrial Flutter at 150 bpm and feeling very depressed about the whole thing.

I received a LOT of support from the members of this board who encouraged me to return to CC for a "touch-up ablation". But I hesitated and dragged my feet. The idea of a long 7 hour drive each way by myself, checking into the GuestHouse and once more making my way through F15, F17, F26 and the other CC departments, along with following Dr Hammer's suggestion of injecting myself in the belly with Lovenox twice a day, combined with my doubts as to whether the ablation would really cure me, held me back.

Then, on 8 April 2002, I received an email from Steve Giddings. This email gave me the hope and encouragement I needed to make the appointment. Two months after receiving the email I had the ablation and was cured the same day.

I shall always be grateful for Steve for taking the time out of his busy day to compose this long and thoughtful email packed with information and encouragement.

I hope he won't mind if I reproduce it here since there is so much good stuff contained in it.

THANK YOU, STEVE

4-8-2002

Henry:

The flutter that occurs post op in MAZE patients is almost always caused by an electrical reentry circuit that involves the wall of the coronary sinus. This may be incompletely ablated at the time of surgery. You can read about this in Dr. Cox and Niv Ad's article in Seminars in Cardiothoracic (CT) surgery entitled The importance of complete cryoablation across the coronary sinus in the maze procedure. The abstract is posted on the maze website. Flutter is usually characterized as "usual" or "unusual" Usual flutter refers to the re entry pathway, which is in the right atrium, is amenable to ablation. This accounts for about 75% of cases of flutter. The remaining 25% have reentry pathways that occur at different sites, mostly in the left atrium, as you were told. IN post op maze patients, however, all of these pathways (the single usual pathway and all of the unusual ones are interrupted by the maze scars, and the offending pathway develops using part of the coronary sinus. The coronary sinus is the large vein that drains the blood circulating to the heart, it courses across the back of the heart, in the groove between the atria and ventricles and terminates in the right ventricle. The usual spot of failure is a t the base of the maze line that runs down from the pulmonary veins to the base of the left atrium. An EP person who is familiar with this can cannulate the coronary sinus, run an RFA catheter up to it, and interrupt the pathway from inside the vein. They don't have to cross the interatrial septum to do this, so risk of clot formation is low.

I had a similar problem with one episode of flutter about a year and a half ago, one year and 9 months post op (it was on my birthday).
The EP guy in my cardiologist's group wouldn't listen to me, (even though I had been his attending when he was a medical resident) and offered to fry my AV node and put in a pacemaker. I didn't get anything done except to be shocked out of flutter. It has never recurred, or if it has, it has aborted spontaneously. The EP person at Georgetown went through this with Dr. Cox the first time this happened, there (there had been a few cases at Washington University when Cox was still here). He actually went to the cath lab with her and the patient and guided her throughout the procedure, told her exactly where he thought the problem would be. The locus mapped to the point he predicted, and the patient was RFAd and cured. Because the location is so predictable, the RFA procedure is relatively short (unlike the 10 hour marathon I had in an attempt to cure a fib) because they don't have to go fishing for the offending site with sensing electrodes.

I am sure are familiar with this potential problem at Cleveland Clinic (or there may be another offending locus that I don;t know about). If you don't have any luck there, you might want to contact Terry Palazzo at Georgetown. She is the nurse coordinator for CT surgery there. Her phone there is: 202-784-1697.
Her email address is: palazzot@gunet.georgetown.edu.

Her address and title:

Terry Palazzo, RN, MS, CCRN
Cardiovascular Nurse Specialist
Cardiovascular and Thoracic Surgery
3800 Reservoir Road, NW
Washington, DC 20007

Good luck.

Steve Giddings

Follow Ups:


Post a Followup

Name    : 
E-Mail  : 
Subject : 

Comments:


Optional Link URL:  
Link Title:         
Optional Image URL:

[ Follow Ups ] [ Post Followup ] [ MAZE Alumni Forum ]

WWWBoard 2.0a and WWWAdmin 2.0a © 1997, All Rights Reserved.
Matt Wright and DBasics Software Company