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- Maze and Mini Maze
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Buffalo General Medical Center
100 High Street
Buffalo, NY 14203
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The state-of-the-art Electrophysiology (EP) Suite offers an experienced electrophysiology team for the diagnosis and treatment of patients with abnormal heart rhythms. It is the largest facility of its kind in Western New York, with certification by the American Society of Echocardiography for adult transthoracic and transesophageal studies, and provides Electrophysiology Studies.
The following tests are performed in the Electrophysiology Suite, under the direction of specially trained doctors who read and interpret the recording of the heart's action and provide a full report to the patient's doctor, so that treatment plan can be developed. reatments may include the following:
A recording of the electrical activity of the heart. This test helps the doctor find out the cause of rhythm disturbances and the most appropriate treatment options. During the test, the doctor may safely reproduce an arrhythmia, then give the patient medications to see which one controls it best.
Internal Cardioverter Defibrillator (ICD)
An implantable electronic device can be placed under the skin of the chest or the belly to stop rapid, abnormal heart rhythms. The ICD constantly monitors the heart rate and rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle. This causes the heart to beat in a normal rhythm. An ICD effectively treats life-threatening episodes of abnormal heart rhythms, but it does not prevent them. Medication is needed to decrease how often abnormal heart rhythms occur to prevent too many shocks.
A small device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate or to stimulate the lower chambers of the heart (ventricles). A pacemaker may also be used to treat fainting spells (syncope), congestive heart failure and hypertrophic cardiomyopathy.
Radio Frequency Ablation
This procedure uses electrical energy to eliminate abnormal electrical pathways in the heart and restore normal heart rhythms. Radiofrequency ablation is similar to cardiac catheterization. Thin wires (catheters) are threaded through the groin, arms or neck into different areas of the heart. Once the abnormal pathway is found, electrical energy is applied to it through the catheter. This may need to be done several times to get rid of an abnormal heart rhythm. The procedure can be done either as an inpatient or outpatient service.
Atrial Fibrillation Ablation (AF or A Fib)
Sometimes the electrical flow of the heart gets blocked or travels the same pathways repeatedly, creating something of a “short circuit” that disturbs normal heart rhythms. Medicine can help, but often the most effective treatment is to destroy the tissue housing the short circuit. Ablation accomplishes this through a relatively non-invasive procedure that involves inserting catheters into a blood vessel and winding the wire up into the heart. The journey from entry point to heart muscle is navigated by images created by a fluoroscope that provides continuous, “live” images of the catheter and tissue.
What is “Atrial Fibrillation?”
Atrial fibrillation (AF) is a condition in which the upper chambers of the heart (atria) beat irregularly and fast (400 to 600 times every minute) because of rapid and erratic electrical activity. This ‘quivering’ of the atria reduces the efficiency of the heart and decreases its ability to pump the proper amount of blood.
AF may produce an uncomfortable sensation in the chest. The decreased pumping power of the heart can also cause dizziness, light-headedness, shortness of breath and fatigue. Some patients, however, have no sensation at all that their heart is fibrillating/quivering.
How common is AF?
A new study by the Mayo Clinic now estimates that over five million Americans have AF. That’s more than double previous estimates of 2.2 million. The odds of developing AF increase with age – it is estimated that nearly four percent of people over age 60 and nine percent of those over 80 have AF.
What causes AF?
It is very difficult to determine the exact cause of AF, but below is a list of the most common conditions that often increase the risk:
- Coronary artery disease, previous heart attack, congestive heart failure and disease of the mitral valve (a check-valve on the left side of the heart)
- Long-standing, insufficiently controlled, high blood pressure
- Sleep apnea (breathing stops during sleep)
- Heavy alcohol use
- Overactive thyroid gland
- Some medications
Top Three Consequences of AF
- Feeling of rapid heartbeats (palpitations), sometimes accompanied by shortness of breath, chest pressure or light-headedness
- Formation of blood clots due to the pooling of blood in the atria and its recesses, most commonly called the atrial appendage, which can lead to stroke.
- Heart failure, which is brought on by rapid heartbeats over a prolonged period of time.
Why treat AF?
The purpose of any medical treatment is to improve health and relieve suffering, so the consequences of AF make its proper management extremely important. Reducing symptoms alleviates disability and helps restore a feeling of well-being. Decreasing the risk of blood clots diminishes the risk of stroke and its devastating effects, and controlling rapid heartbeats can prevent heart failure and possible death.
How is AF treated?
Most patients will need some form of blood thinning to reduce the risk of stroke. For patients with a 0 or 1 "CHAD" score, aspirin is often sufficient. In higher risk patients, warfarin is often used. Controlling the heart rate is almost always used to reduce symptoms and diminish fatigue of the heart. If a patient is completely free of troublesome symptoms once the heart rate is controlled, this form of treatment, along with blood thinning, is sufficient. Sometimes a pacemaker is needed because the heart rate swings between very high and very low rhythms.
When these measures are not enough, restoration of the normal heartbeat (‘sinus rhythm’) can be achieved using antiarrhythmic drugs. However, drugs often fail to maintain the normal rhythm of the heart and can cause significant side effects.
When drugs cause unpleasant side effects or fail to help the patient, catheter ablation can be tried. During this procedure, several catheters (thin, coated wires) are inserted through blood vessels to access the heart. Metal tips (electrodes) at the end of the catheters are used to find troubled areas and deactivate them using heat, which is created by an electrical current and sent through the catheters. Catheter ablation is a complex and fairly long (2-5 hours) procedure, but its value is that it can cure AF. Patients commonly spend the night in the hospital after ablation for observation.
Today, 80 to 85 percent of patients with the intermittent (‘paroxysmal’) form of AF can be permanently cured, and a cure for persistent symptoms of AF can be achieved in 60 to 75 percent of cases. Some patients will need the procedure repeated to achieve this result. As with any invasive procedure, there is a risk of complications which should be discussed with the physician.
More than 40,000 patients have had surgical ablation, often called a Maze. It has been proven effective for a wide range of AF patients, even some with chronic AF. It is an open heart surgery during which the surgeon eliminates (ablates) the trouble spots under direct vision. The procedure is performed primarily in patients who are undergoing open-heart surgery for other reasons, such as bypass operation or valve surgery.
Minimally Invasive Surgical Ablation
Surgeons have recently developed a minimally invasive approach to AF treatment, often called the “Mini Maze.” It is similar to the open chest surgery, except that the surgeon reaches the heart through three small incisions on each side of the chest. As in the open chest procedure, the surgeon uses an energy source to make precise scars, or ablations, on the heart to block the irregular electrical impulses that cause AF. Because the chest does not have to be opened, recovery is much easier and the average hospital stay much shorter.
The following physicians perform these procedures:
Buffalo Cardiology & Pulmonary Associates
Richard Corbelli, MD
Gregorz Rozmus, MD
Buffalo Medical Group
Chee Hoon Kim, MD
Donald Switzer, MD
General Physician, PC
Ashish Bhatia, MD
Cevher Ozcan, MD