Modified Maze Procedure Helps Patient

Frank Fleischer has battled heart problems for more than a decade. At unpredictable times, his heart went into atrial fibrillation, beating too fast. The condition made Fleischer feel tired, irritable and anxious.

After trying medication without success, Fleischer came to the University of Chicago about four years ago to correct his irregular heart beat with a catheter ablation. Doctors hoped the procedure--done by an electrophysiologist who threads a catheter through the leg and into the heart to deliver radiofrequency waves at the source of arrhythmia--would fix Fleischer’s problem. But the procedure worked only for a short while and soon Fleischer’s abnormal heartbeats returned.

Last year, the Mokena, Ill., resident returned to the University of Chicago Medicine to see if he could receive another ablation. But scar tissue had formed in the folds of Fleischer’s heart, making one impossible.

"You get to the point where you’d do anything to get rid of it," Fleischer said. "It drives you nuts."

Fleischer’s electrophysiologist turned to Shahab Akhter, MD, a cardiac surgeon at the University of Chicago, who had an alternative way to help Fleischer.

Akhter is one of a few surgeons nationwide who regularly performs a minimally invasive surgery, known as a modified Maze procedure, for atrial fibrillation patients who have failed or are not candidates for other options, including catheter ablation. During the formal Maze procedure, numerous incisions are made on the left and right atrium to redirect abnormal electrical impulses in the heart and restore normal heart rhythm. This requires an incision in the breastbone and use of the heart-lung bypass machine. But the modified procedure, which uses a newly developed surgical ablation device, is much less invasive and requires only one small 4-centimeter incision on either side of the chest and no bypass support.

It’s a good option for patients like Fleischer who already received a catheter ablation or for those who do not want to be on medication long-term. It’s also an option for patients whose anatomy doesn’t allow for catheter ablation, for example if the esophagus is too close to the heart’s left atrium, and could be injured by catheter ablation.

Akhter hopes as more physicians learn about the minimally invasive surgery, they will discuss it with their atrial fibrillation patients.

"There isn’t a whole lot of knowledge that this is a great option for many patients," Akhter said, adding that the number of centers and surgeons who are able to offer this procedure is small.

Fleischer will be monitored at the medical center in three-month intervals to make sure his arrhythmia is gone for good. Surgical patients who show no signs of atrial fibrillation after one year are unlikely to experience a reoccurrence, Akhter said.