Comprehensive procedure combines minimally invasive ablation treatments inside and outside of heart
BALTIMORE – Experts at MedStar Union Memorial Hospital are leading the region with an emerging treatment for long-standing atrial fibrillation (AFib) called convergent hybrid ablation. By combining electrophysiology and cardio-thoracic surgery techniques in a two-part approach, doctors can ablate the inside (endocardium) and the outside (epicardium) of the heart, minimally invasively, and stop the AFib.
AFib is the most common of arrythmias, or heart rhythm disorders, affecting an estimated 2.7 million Americans. Symptoms include racing heart, dizziness, breathlessness, chest pain and fatigue. If left untreated, atrial fibrillation can lead to blood clots, stroke, heart failure and weakening of heart function. Research indicates that 70% of patients with AFib, suffer from long-standing persistent AFib.
Such was the case for one Howard County man. Don Fitzgerald was in a constant state of AFib despite nearly eight years of medical treatment. A friend referred him to cardiac electrophysiologist Glenn Meininger, MD, director of Cardiac Electrophysiology Services for the Baltimore region of the MedStar Heart & Vascular Institute.
“Treating persistent AFib conservatively with medicine is not unusual,” said Dr. Meininger, “but in Don’s case, we were seeing a weakening of the heart muscle. His ejection fraction had declined to an estimated 30%. Normal is over 50%. We thought he would be a good candidate for the convergent hybrid ablation procedure.” Ejection fraction is a measurement of the percentage of blood leaving the heart each time it squeezes.
Dr. Brian Bethea, chief of Cardiac Surgery at MedStar Union Memorial Hospital and the regional chief of outreach for the Baltimore region, started the two-part procedure in the operating room. Using a scope inserted through a tiny incision under the breastbone and placed under the sternum, he accessed the four pulmonary veins at the back of Don’s heart. With a small camera, Dr. Bethea identified pulmonary landmarks and created tiny ablation lesions or scars to the tissue on the back wall of the left atrium. This scar is intentionally created to prevent abnormal electrical signals that trigger atrial fibrillation.
The second part of the procedure is done in the electrophysiology lab and performed the same day or the following day. Dr. Meininger inserted a catheter through a vein in the groin at the top of Don’s thigh and threaded it to the heart. Using real time cardiac images from fluoroscopy, as well as 3D mapping of the heart, Dr. Meininger delivered cooling energy using a cryoballoon to further consolidate the scar from the inside of the heart.
Don remained in the hospital for another day for monitoring, but went home and without pain, and without atrial fibrillation.
“The first thing that I noticed that was dramatic was the first time I went golfing again,” Don said. “It was on our 18th hole. It's a big hill going up to the green and walking it left me always out of breath. But I was walking up the hill and wasn’t breathing hard at all.”
“Usually there’s a three-month healing window where people may continue to have irregular rhythms until the scar tissue forms sufficiently,” Dr. Meininger said. “For Don, he had no recurring atrial fibrillation, and importantly, full recovery of heart function.”
Schedule an appointment to learn if you are a candidate for convergent hybrid ablation. Call: 410-554-6727.