A less invasive 'Maze' procedure curbs electrical problems in heart

Doctors affiliated with St. Mark's and Timpanogos hospitals are using a less invasive "Maze" procedure to short-circuit a dangerous and common electrical problem in the hearts of some patients.

Atrial fibrillation — a chaotic, quivering arrhythmia that affects millions of Americans — can contribute directly to stroke and heart failure. A normal heartbeat starts with an electrical signal from the heart's own internal pacemaker in the right atrium, which then moves along a specific path across the upper chambers, making them contract and send blood to the ventricles. Then it moves to those lower chambers, causing them to contract and send blood to the body and lungs. The result is the familiar lub-dub that is a normal heart rhythm.

With atrial fibrillation, the heart quivers instead of contracting properly, so blood flow is inadequate and some of it may pool in the atrial appendage, a thumb-shaped sac, where it can clot. If the clot breaks loose, it may cause stroke.

Traditional treatment has involved the use of powerful blood thinners to prevent the blood from clotting, but that carries other risks, including excessive bleeding. Doctors may also opt to perform a catheter ablation, short-circuiting the errant electrical signal's path by using heat to form scar tissue from within the heart.

A treatment deemed the "gold standard," is called a Maze, developed by a St. Louis surgeon years ago. During open-heart surgery, with the patient on a bypass machine, cuts are made then sewn up to form specific maze-like scars that redirect the heart's electrical current. It's a big but very effective operation, says Dr. David G. Affleck of MountainStar Cardiovascular Surgery.

Affleck and colleagues do the Maze, and now a "mini" version that's less invasive, using a special pen with electrodes, a guide and ablation clamp to accomplish similar results for certain patients without opening the entire chest. For patients who have other heart problems that need to be fixed, they still use the open-heart Maze.

For less-invasive surgery, they go in through two ports under each armpit (one on each side is for the camera that allows them to see what they're doing).