Patients Feel Immediately Better After Kiser Procedure For Atrial Fibrillation
Last fall at FirstHealth Moore Regional Hospital, cardiothoracic surgeon Andy Kiser, M.D., began performing the minimally invasive version of the procedure he developed to correct the erratic beating of the heart known as atrial fibrillation. On Dec. 3, 2007, Woods became only the sixth patient at Moore Regional - and the sixth in the United States - to undergo the new procedure.
"Within two weeks, the difference in the way I felt was like night and day," he says.
Atrial fibrillation (a-fib), which affects an estimated five million people, is the most common type of heart rhythm disturbance. It is the rapid, uncoordinated beating of the atria, the two upper chambers of the heart. The atria quiver instead of beating in rhythm when the electrical impulses that cause them to contract travel through the heart in chaotic fashion.
Some people with a-fib are severely debilitated by weakness, shortness of breath or pain. Others have no symptoms at all.
"It never hurt, but I would get tired and short of breath," Woods says. "It just wears you out."
Various methods have been developed to block stray electrical impulses and guide electricity onto the correct pathways through the heart. Traditional treatments for atrial fibrillation include medication, pacemaker implantation and electrical shock, all of which are offered at Moore Regional Hospital.
For many years, the "gold standard" for a-fib treatment has been a surgical procedure called the Cox Maze, which requires opening the chest, stopping the heart, cutting it into sections and sewing it back together. Dr. Kiser developed a new version of the Cox Maze in collaboration with other surgeons. Called the Ex-Maze, the procedure creates a more extensive pattern of scar tissue and controls the heart's electrical impulses more effectively.
A major advantage of the Ex-Maze is that the procedure is done while the heart is beating, so the patient doesn't have to be on a heart-lung machine. Because the heart is beating, the surgeon can also be sure that the heart has converted from a-fib to normal rhythm.
"We are finding that if we can convert patients out of atrial fibrillation in the operating room, we have a remarkable success rate," Dr. Kiser says.
Initially, Dr. Kiser performed the Ex-Maze only on patients who were having some other type of open-chest procedure such as a coronary artery bypass. Then, last June, he was invited to Krakow, Poland, where he performed the world's first minimally invasive Ex-Maze procedure.
A few months later, he began offering it as a treatment option at Moore Regional.
Jon Woods had been waiting, and taking medication to control his a-fib, for just such a development.
"It was well worth the wait, because the difference was dramatic," he says. "I had just about forgotten what it feels like to have this much energy and to feel this good."
So had 68-year-old Edward Jolly of Laurinburg.
"I've gone from someone who couldn't get excited about anything to a very happy person," he says.
Jolly had suffered from a-fib for nearly six years before Dr. Kiser performed the minimally invasive Ex-Maze procedure on his heart. He had been taking medication to control the condition and twice had undergone electric shock.
"The first time I was shocked, my heart came out of a-fib for three months," he says. "The second time, it only lasted about three days."
His wife, Carolyn, observed the condition's devastating effect on his quality of life.
"He became very lethargic, very sluggish," she says. "He had no energy to do the things he once loved."
That changed, quite literally, in a heartbeat. Jolly's heart began beating in normal rhythm during the Ex-Maze procedure and has continued to do so ever since.
Jolly was referred to Dr. Kiser by Laurinburg cardiologist Matthew Block, M.D.
"We have satisfactory treatments for the vast majority of people with a-fib, but it comes at the price of being weighed down with medications and having to see the doctor and have their blood drawn on a regular basis," Dr. Block says. "Patients who are motivated to try something different to avoid the need for all that might be candidates for the Ex-Maze procedure."
According to Dr. Block, maze-type procedures have been available for many years, but they were more invasive than the Ex-Maze and could be done only with an open chest.
"The science behind it is sound, but it has always been impractical in most cases," he says. "A-fib is generally not a painful or seriously limiting condition; it's more of a nuisance. People don't want to undergo open-heart surgery for something like that."
But Jolly was among the relatively small percentage of patients whose quality of life is seriously diminished by a-fib or the medicines used to treat it. That is why Dr. Block recommended that he consider the Ex-Maze.
"I wouldn't refer someone to a surgeon I wasn't familiar with for something like this, but I have a lot of regard for Dr. Kiser and what he is doing," Dr. Block says. "I think it's important to try to push the science ahead, because a-fib is an increasingly common problem as people live longer."
Because the Ex-Maze procedure is done through small incisions without opening the chest, patients have less pain and recover much faster. Ironically, that has caused Dr. Kiser some concern.
"The problem we're having is that patients are feeling so good so soon that they tend to forget they've had heart surgery," Dr. Kiser says. "They want to get right out and get going, so we have to slow them down a little."
Dr. Kiser has begun teaching the minimally invasive Ex-Maze procedure to heart surgeons in such places as Sacramento, Calif., and Waco, Texas.
"They have heard about it and come to Pinehurst to watch me do it," he says. "When they are ready to start doing the procedure on their own, I go to their hospital to make sure everything goes well with their first cases."
In January, Dr. Kiser was invited to make a presentation on the minimally invasive Ex-Maze at the national meeting of the American College of Cardiology in Denver.
"Cardiologists we've talked to are very excited about it," he says.
FirstHealth of the Carolinas
Pacienþii simt mai bine imediat dupã Kiser procedura de fibrilaþie atrialã - Patients Feel Immediately Better After Kiser Procedure For Atrial Fibrillation - articole medicale engleza - startsanatate