A-maze-ing procedure creates scars on the heart to stop erratic heart beats

Troy and Beth Jones

A typical resting heart rate for an adult is 60 to 100 beats per minute. Beth Jones’ heart rate would soar to 180 beats per minute and stay that high for hours, even while just sitting on the couch. The school administrator from St. Charles was suffering from atrial fibrillation. A tag-team approach by a cardiac surgeon and a cardiac electrophysiologist at the Northwestern Medicine Bluhm Cardiovascular Institute created scars on her heart to return it to a normal rhythm.

During atrial fibrillation (Afib) the upper chambers of the heart, the atria, are not contracting normally due to irregular signals in the conduction system. Instead, the atria quiver, decreasing the amount of blood ejected from the heart with each heartbeat.

“One of the major concerns addressed when a patient is initially diagnosed with atrial fibrillation is the five-fold increased risk of stroke, particularly debilitating strokes,” said Jessica Delaney, MD, cardiac electrophysiology at Northwestern Medicine Central DuPage Hospital and Northwestern Medicine Delnor Hospital. “In addition, if a patient’s heart rate remains elevated, over time this can increase the risk for developing congestive heart failure.”

Many people with Afib never have symptoms. But others may experience a frightening mix of rapid, pounding heartbeat, along with dizziness, fatigue, trouble breathing and tightness in the chest.

“I was working out on a treadmill and my heart rate hit 236. I switched to another machine thinking it was broken, and it showed the same high heart rate,” said Jones. “I thought I was going to die right there at the fitness center.”

Jones was treated with medications, often the first line of defense in Afib. However, drugs are not a cure and some patients, like Jones, need additional treatment. Jones first underwent a catheter ablation at Northwestern Medicine Central DuPage Hospital.

During treatment, a small, flexible tube is inserted through veins in the groin, and directed to the area of the heart generating the abnormal signals. The tissue can be burned using radiofrequency or frozen with cryoablation.

“For some patients, ablation on the inside wall of the heart is not enough to control the atrial fibrillation and further ablation is needed on the outer side,” said Dr. Delaney. “The most common reasons for this are thickened heart muscle, anatomy limiting completeness of the inside ablation, or a prolonged duration of atrial fibrillation prior to the ablation.”

To fully disrupt the pathways, Jones needed the expertise of both a cardiac electrophysiologist and a cardiac surgeon.  The team at Northwestern Medicine Bluhm Cardiovascular Institute is collaborating on a “one-two punch” to eliminate her atrial fibrillation.

In November, Jones underwent a total thoracoscopic modified maze (TT-maze) procedure at Northwestern Medicine Palos Hospital. Unlike the classic maze, which is an open-heart procedure, the TT-maze is done minimally invasively through small incisions.

“We deflate one lung at a time to access the heart through three incisions on each side,” said Andrei Churyla, MD, cardiac surgeon, Northwestern Medicine Bluhm Cardiovascular Institute at Palos Hospital. “Using radiofrequency instruments, we create a special maze pattern on the surface of the heart to disrupt the irregular flow of electricity.”

The left atrial appendage, a pocket-like section in the left atrium, is also closed to reduce a common source of blood clot formation that increases stroke risk. A few months after the TT-maze, Dr. Delaney performed a catheter ablation inside the heart to complete the connection with the surface scars.

“With the minimally invasive approach, we don’t make a big incision in the chest, we avoid a heart lung machine, and patients can return to their lives much sooner,” said Dr. Churyla.

Jones says she could feel the difference immediately.

“The Afib was really depressing. I felt like I was working out for 15 hours a day. I was constantly exhausted and afraid because my father had a stroke and passed away in his 60s,” said Jones. “Dr. Delaney and Dr. Churlya gave me my life back. I’m exercising, traveling and back at work.”