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Stephen Waterford, MD in the operating room.

Upstate offering minimally invasive TT Maze procedure and clip to eliminate atrial fibrillation and reduce risk of stroke

Upstate University Hospital is now offering a new minimally invasive treatment for people with persistent atrial fibrillation, or A-fib.

Total thoracoscopic Maze, commonly referred to as TT Maze, uses four small incisions to create a new pathway (or maze) within the atria for the heart’s electrical impulses. The procedure is a highly effective new option for patients with long-standing A-fib or for those who have tried one or more catheter ablations. In addition to eliminating atrial fibrillation, the procedure also reduces the patient’s risk for stroke.

About six million Americans suffer from A-fib, which is an irregular, often rapid heart rate that can cause poor blood flow. Some may feel the irregular beats while others may experience symptoms such as shortness of breath or fatigue. A-fib can also weaken the heart, which can lead to congestive heart failure, said cardiothoracic surgeon Stephen Waterford, MD.

Most people who experience A-fib start out with occasional irregularities. Some people then progress to chronic A-fib, which is when the person is in atrial fibrillation at all times, Waterford said. A common treatment for A-fib is catheter ablation, which freezes or cauterizes lines across the circular electrical currents causing the irregular heartbeats. Some patients experiencing chronic A-fib may have already tried catheter ablation, which has about a 50 percent success rate and sometimes has to be repeated, he said.

“The TT Maze is most appropriate for people who are in A-fib all the time,” Waterford said. “For those with chronic A-fib, a catheter ablation is less successful. Catheter ablation is better if they are in and out of A-fib.”

Waterford said the benefits of TT Maze are significant as the procedure is minimally invasive – the largest incision is just 12 millimeters wide – and requires far less hospitalization and recovery time than open-heart surgery.

“I would say the biggest difference is No. 1 it’s much safer. It reduces the risk of the procedure several fold,” he said. “The second thing is that it reduces the recovery time to one third of what it would be with open heart surgery. People usually will stay in the hospital two to three days. Open heart surgery can be one to two weeks.”

Waterford joined Upstate in August 2020. He completed his fellowship at Washington University in St. Louis where in 1987 surgeon James Cox invented the treatment, which is also known as the Cox Maze Procedure. Waterford introduced a minimally invasive version while working as director of arrhythmia surgery at Mount Sinai Hospital in New York City. He is eager to talk with patients at Upstate who are suffering from chronic A-fib and seeking relief.

“Our goal is to be a regional center of excellence for A-fib,” he said, noting that Upstate offers several treatment options including the Convergent procedure for patients who might not be a candidate for TT Maze. “We have a multidisciplinary team offering a team-based approach to tackle many kinds of A-fib to determine what’s best for the patient.”

When completing a TT Maze procedure, Waterford also inserts a clip on the patient’s appendage, which is the back of the upper left chamber, or atrium, of the heart. This is the area of the heart where blood clots form in A-fib, leading to stroke.

“Every time someone has a TT Maze their appendage is clipped,” Waterford said. “And that means is their stroke risk from A-fib is gone. And that to me is half the benefit of a TT Maze. You rarely have this opportunity in medicine where you have just one single thing you can attack and you’ve made a dramatic difference.”

For more information about Upstate options treating A-fib, call 315-500-AFIB (315-500-2342.)

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