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Cardiothoracic surgeon Stephen Waterford, MD (photo by Susan Kahn)
Cardiothoracic surgeon Stephen Waterford, MD (photo by Susan Kahn)

A fix for A-fib

Surgeon offers a new technique for stubborn cases of atrial fibrillation 


What is A-fib?

Atrial fibrillation, called A-fib for short, is an irregular, often rapid, heart rate that can cause poor blood flow.

The majority of the up to 6 million Americans with A-fib discovered the condition through a routine medical exam that included an electrocardiogram. A growing number of people are discovering unusual heart rhythms through commercial monitoring devices they connect to mobile phones. Only a few patients are able to feel palpitations. Other common symptoms — shortness of breath and fatigue — can be vague.

How serious is it?

Untreated, A-fib doubles a person’s risk of heart-related death and is associated with a fivefold increased risk for stroke, according to the American Heart Association. Strokes caused by A-fib can have severe repercussions, says Stephen Waterford, MD, an Upstate surgeon who specializes in cardiothoracic surgery.

Atrial fibrillation can be treated by a procedure called TT Maze to help reduce the risk of stroke.  The Watchman procedure also reduces stroke risk.Atrial fibrillation can be treated by a procedure called TT Maze to help reduce the risk of stroke. The Watchman procedure also reduces stroke risk.

What are the treatments?

A-fib can be a complex medical problem. Treatment may include controlling the heart rate, resetting its rhythm, or reducing stroke risk — or all three. Strategies differ from patient to patient. Medications may be used, along with a variety of specific procedures, including ablation.

How does ablation work?

“A-fib forms a circle of current, and it just goes around and around in a circle. What ablation does is put lines across these circles of current so that the current can no longer travel in a circle,” Waterford says.

The lines are made either through freezing or cauterization, either through a catheter (a hollow tube) by a cardiologist with training in electrophysiology, or through a surgical procedure. It’s something that may be considered for people in whom medications have not been effective.

Waterford offers a minimally invasive ablation procedure called the TT Maze. Working through incisions in the patient’s chest that are no larger than a centimeter (about the width of a pencil), he touches the beating heart with a radiofrequency tool that makes the lines. The pattern of the lines is standardized, like the scaffolding of a building.

The TT Maze is an option for a person who remains in A-fib after a year, or after catheter ablation.

Where does the stroke risk come from?

Human hearts have an appendage in the back of the upper left chamber, or atrium, of the heart. Clots can develop in this appendage. A stroke can occur if a clot moves into the atrium and travels through the bloodstream to the brain.

A surgeon can place an umbrella-shaped device called a Watchman in this appendage. “It closes it off, almost like shutting the door to a room so that things like clots can’t go in and out of that room,” Waterford describes. “I can also put a fabric clip on the outside of the appendage that clips it closed. That reduces or eliminates, in many cases, the risk of stroke.”

Will ablation work?

Catheter ablations, which may have to be repeated, have up to a 50 percent success rate, Waterford says.

He says 95 percent of patients who undergo the TT Maze have a normal heart rhythm at the end of the procedure, although they may need to continue to take medications for a few months afterward.

He says one patient he cared for at Upstate woke up from the procedure and felt a difference right away. Most patients will realize the treatment worked when they feel an increase in their energy level and a decrease in their shortness of breath. If they undergo an ultrasound afterward, they’ll probably see that the heart’s pumping action has strengthened.  Waterford says patients also experience great relief in their stroke risk, “because with all of my TT Maze patients, I always clip off that stroke center of the heart called the appendage.”

Waterford fields inquiries about A-fib at 315-500-AFIB (or 315-500-2342.)

Upstate Health Magazine

This article appears in the winter 2021 issue of Upstate Health magazine

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