Ten Things Your Electrophysiologist Will Not Tell You About Lone Atrial Fibrillation

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Posted by L. Paul Teague on June 28, 2004 at 14:01:17:

This perspective reflects my bias. The Cox Maze III surgical procedure cured me of lone atrial fibrillation. It saved my life.

None of the four electrophyologists [EPs] who treated me ever suggested that I consider the Maze procedure. After considerable research, I self-referred myself to Dr. Cox for Maze surgery. After this research, I found that I, a lay person, was often more knowledgeable about the options for the treatment of AF than my EPs.

Some may disagree with some of my points. Civil and informed dissent can be helpful to those who are considering their treatment options. I hope my views are constructive and provide a basis for further discussion.

Note: An EP is a cardiologist who specializes in the treatment of heart rhythm disorders. Atrial fibrillation [AF] is a rhythm disorder. Lone AF is atrial fibrilation that has no under lying cause such as a thyroid disorder, heart valve problems, congestive heart disease, etc.

1. Lone atrial fibrillation is not a benign condition. AF greatly increases the risk of strokes for those older than 65 years. It adversely affects the quality of life, exercise tolerance, and will eventually lead to congestive heart disease.

2. None of the medicines cure AF. In fact, I don't even know if it's better to treat you for rhythm control or for heart rate control. The medicines for rhythm control are more costly than those for rate control. For those older than 65 years, coumadin should be prescsribed to lessen the chances of a stroke.

3. Lone AF never gets better. It is progressive. There may be periods when the AF episodes do not get worse - or even become less frequent with medical treatment - but ultimately the episodes become more frequent and last longer. The disease often progresses from paroxysmal [comes and goes] to chronic [always in AF]. An AF p;atient is like an annuity for an EP - because of items 1, 2 and 3.

4. The heart rhythm drugs all have seious side effects especially amiodarone - and they will not cure lone AF. Some, but not all, of the amiodarone seious side effects include vision impairment, pulmonary fibrosis, and loss of thyroid function.

5. I am a medical doctor and I will not refer you to a surgeon who can do the Cox Maze procedure. But I may refer you to a fellow EP doctor who does catheter based procedures.

6. The Cox Maze III procedure is the gold standard for the cure of AF. For lone AF, the cure rate is 96% plus. The maze procedure is major surgery, but for competent surgeons who specialize in the procedure, the mortality rate is less than for the common heart bypass operations. Several medical centers [such as the Cleveland Clinic] that specialize in the surgical treatment of AF are working on improved procedures that do not require stopping the heart.

Practice doesn't always make perfect but it sure helps when it comes to the Maze Procedure. It is a very difficult procedure requiring unusual surgical skills and knowledge. The Cleveland Clinic is an excellent facility with some great heart surgeons. There are also some other facilities, such as the one that did Jack Drum's successful furgery, that have excewllent results. The thing to do is investigate, investigate and investigate.

Problem Maze surgeries are often caused by poor surgical practices and skills.

7. Lone AF patients who are in otherwise good health, are the ideal candidates for the surgical treatment of AF. For lone AF, Dr. Cox had a 99% success rate.

8. Much of the information about the treatment of AF on the web is biased because it is from a medical [i.e., EP] perspective. For example, the web site, "AF Advisor", which is run by EP doctors devotes only two sentences to the Maze procedure including this statement, "Surgical procedures of this nature are rarely used to treat AF."

9. Catheter based ablation procedures cannot replicate the Maze procedure. There are some catheter procedures that cure certain AF conditions. Unfortunately, unsuccessful and failed catheter procedure results are not usually published so it is difficult to get accurate information about these procedures. Referral to a facility that does only catheter based procedures - and not Maze type surgeries - is like using a carpenter whose only tool is a hammer. To him, everything looks like a nail. Prefer multi-discipline facilities.

10. I will tell you about the "Maze Alumni ... web site.

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