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Video-assisted surgery treats atrial fibrillation

Photo Mike Ichikawa/El Camino Hospital Dr. Gan Dunnington, from left, Dr. Ramin Beygui and surgical technician Robert Wright perform video-assisted thorascopic surgery to correct atrial fibrillation. The procedure avoids open-heart surgery, minimizing complications and hastening recovery.

Chronic atrial fibrillation (AFib), a rapid or irregular heartbeat that triggers fatigue, dizziness and a racing heart, affects 5.1 million Americans, according to the Mayo Clinic.

The intense quivering leaves some victims exhausted and nauseous, while others may experience a feeling of impending doom or anxiety. Heart attacks and strokes pose graver risks down the road.

Traditionally, doctors have treated AFib with drugs to control the heart rate or by performing open-heart surgery to control the heart rhythm. Although open-heart surgery stops AFib completely, it requires cardiopulmonary bypass and weeks of recovery.


VATS Maze short-circuits

electrical currents

To correct the arrhythmia with smaller incisions and less downtime, doctors in El Camino Hospital’s cardiothoracic surgery program now recommend a minimally invasive procedure – video-assisted thoracic surgery (VATS).

Atrial fibrillation causes blood to pool in the atria – the upper chambers of the heart – leading to blood clots in the brain, which can cause strokes. Such strokes bring additional distress and devastation to patients over 80, according to Gan Dunnington, M.D., cardiothoracic surgeon and assistant medical director of cardiothoracic surgery at El Camino Hospital’s Heart and Vascular Institute.

A Los Altos resident and graduate of Duke University and the Medical College of Virginia, Dunnington runs a similar program at Stanford University Medical Center’s Falk Institute.

Dunnington said “the ability to do the surgical procedure

totally thoracoscopically and off the heart-lung bypass machine is relatively new.”

He also labeled the multidisciplinary cooperation between cardiology and surgery as “unusual” and “most innovative.”


What causes AFib?

Patients may already have a somewhat weak heart due to heart attacks or damaged valves, high blood pressure, congenital heart defects, medications or other stimulants.

In the past, doctors treated AFib in one of three ways. Heart-rate control requires strong anticoagulants like Coumadin to prevent atrial fibrillation. They can be quite toxic, according to Dunnington, who noted that Coumadin (Warfarin) is used as a rodent poison and can produce thromboembolisms. A second option is catheter radiofrequency ablation, which “has a better safety profile,” he said. In this method, the doctor inserts a catheter through a vein in the arm or groin, then directs radiofrequency energy to burn spots on the heart, scarring tissue and normalizing the chaotic electrical currents. The third alternative, surgery, gets the job done.

For patients well enough to withstand it, doctors perform open-heart surgery to maintain rhythm control. Candidates for surgery tend to be younger patients who want to avoid the side effects of anticoagulants or who don’t qualify for other treatments.

“Nobody wants surgery,” Dunnington said. “On the other hand, nobody wants to struggle, suffer and die, either.”

The downside is that opening the chest means long incisions, cardiopulmonary bypass, hours on the operating table and weeks of recovery.

Conceding that his colleagues often promote surgical dogma such as “nothing heals like cold, hard steel,” Dunnington noted that surgery “persists because of the results, not despite them.”


Cox Maze technique

becomes VATS Maze

VATS “is a fancy way of saying that we put a camera inside the patient,” Dunnington said. After inserting the catheter containing a camera, doctors burn a maze of lines on the left atrium of the heart, essentially short-circuiting the electrical currents.

Named after Dr. James Cox, the maze technique burns heart lesions instead of cutting and sewing.

“It’s just advanced quilting,” Dunnington said, but called it “a genius technique to allow us to isolate part of the heart.”

When Cox developed the original procedure, it involved open-heart surgery through a sternotomy on cardiopulmonary bypass – it involved cutting and sewing the heart back together to create scar lines, he said.

Following the procedure, patients often realize an improved quality of life, Dunnington said, even though they may not have been aware of the degree of their impairment before.

To view a video on the procedure, visit www.elcaminoinnovates.org and select “Fixing Irregular Heartbeats – El Camino Innovates.”

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