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American Family Children's Hospital

UW Hospital and Clinics Offers One-Stop Shopping for People Suffering from Atrial Fibrilliation

UW Hospital and Clinics is unique in that it is one of only a few medical centers in the United States to offer multiple options for treating a condition that affects millions of Americans.


"We combine the best of both worlds,'' says Dr. Lucian Lozonschi, director of minimally invasive and robotic cardiac surgery at UW Hospital and Clinics.


Many institutions offer only a single option for the treatment of atrial fibrillation. But at UW Hospital and Clinics, Lozonschi and Dr. Takushi Kohmoto collaborate closely with a team led by Dr. Douglas Kopp, a cardiologist and director of the electrophysiology fellowship program, to offer patients several options and thus better hope in the treatment of a heart condition that affects an estimated 2.2 million Americans.


Atrial fibrillation is an abnormal heart rhythm where the electrical signals from the upper chambers (the atria) are irregular and fast, creating a sort of short circuit that causes the heart to quiver instead of beating effectively. The condition is most commonly caused by high blood pressure, with symptoms including palpitations, dizziness, angina and breathlessness, and may result in stroke or congestive heart failure. Atrial fibrillation increases with age and affects 3 percent to 5 percent of people over age 65.


Atrial fibrillation can occur in several different patterns, from paroxysmal to persistent and chronic types. A combination of medications and anti-coagulants is generally used as an initial treatment. In highly selected cases, however, the most effective treatment is to block the electrical properties of the heart tissue housing the short circuit.


UW doctors specialize in treating the most severe cases, working to determine the best approach to take in treating the problem based on the patient's severity of symptoms and anatomy. Options range from catheter ablation, which is the least invasive procedure, to a modified Maze procedure, which is minimally invasive, to a combination of the two (hybrid procedure), to the most invasive option which is a sternotomy and a full Maze procedure while the heart is supported by a heart-lung machine.


However, the cure rate of these procedures is inversely proportional to their invasiveness. The full Maze procedure has a 95 percent cure rate but is the most invasive approach. The minimally invasive hybrid approach has up to 90 percent efficacy, nearly equal to the sternotomy with cardiopulmonary bypass. The hybrid approach has been used effectively at UW Hospital and Clinics and at only a few other medical centers in the country. The less invasive procedures allow for much less pain, a shorter hospital stay and a much faster recovery.


In catheter ablation, a flexible wire is inserted into a vein in the groin and threaded into the heart, where an electrode at the tip of the wire is used to destroy the tissue causing the fibrillation from inside the heart and return it to its normal rhythm. In the modified Maze procedure, the heart is accessed through small incisions made in the side of the chest (between the ribs).


Scar lines are placed around the pulmonary veins from the outside of the heart using bipolar radiofrequency, energy delivered from two electrodes that sandwich the atrial tissue and stop the pathways of abnormal electrical triggers. Both procedures are performed on the beating heart and are done very safely and with minimal pain. In the hybrid procedure, either catheter ablation or a modified Maze is first used, depending on the type of AF and the anatomy of the individual patient.


At UW Hospital and Clinics, surgeons and cardiologists continue to work together to find the best treatment for patients suffering from atrial fibrillation.