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Surgical Treatment of Cardiac Arrhythmias and Rhythm Management
For the past four decades, our laboratory has conducted studies to develop surgical treatments for cardiac arrhythmias and translated them into clinical practice.
Our earliest efforts were directed at arrhythmias associated with ischemic heart disease, Wolff-Parkinson-White syndrome, and atrioventricular node reentry, and resulted in clinical interventions routinely used today.
For each arrhythmia, we initially defined the fundamental substrates and mechanisms in animal experiments.
The surgical approach was worked out first in the laboratory and then perfected in clinical studies to account for the differences between animal and human arrhythmia mechanisms.
The validity of this innovative approach has been borne out by the long-term success and adoption of these interventional approaches both by surgeons and electrophysiologists.
Our work has led to the development of the most successful single treatment for atrial fibrillation (AF), the Cox-Maze procedure. In the Cox-Maze procedure, lines of scar are created on the atria to disrupt potential reentrant pathways.
Our laboratory also spearheaded the effort to simplify the Cox-Maze procedure by replacing the surgical incisions with lesions created using thermal ablation technology, which made the procedure easier to perform with less morbidity while preserving its high efficiency.
The Cox-Maze procedure has become the gold standard for the treatment of AF, and it is the only surgical procedure to have received FDA approval.”
In a propensity-matched study of patients with AF undergoing heart surgery, a concomitant Cox-Maze procedure resulted in a 10-year survival rate of 62%, compared to 42% for patients who did not receive a Cox-Maze procedure.
Ablation Technology
In the original Cox-Maze procedure, lesions were created by cutting and sewing tissue. To simplify the procedure, cryoablation and radiofrequency ablation were introduced. Both methods are thermal: Cryoablation cools the tissue to kill it while radiofrequency ablation heats the tissue until it dies.
Our laboratory has tested every major cryoablation and radiofrequency ablation device that has been used clinically, as well as alternative technologies such as focused ultrasound and microwave ablation that were never widely adopted clinically.
Currently, a new ablation approach called pulsed field ablation (PFA) is in clinical testing. PFA uses strong electric fields to electroporate the membranes of cells. The figure on the right illustrates PFA ablation of an atrial appendage. The ablation clamp closely resembles those used in radiofrequency ablation.
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