A Spokane heart surgeon is performing a new, less invasive procedure, called the Wolf mini-maze, to treat the irregular heartbeat condition known as atrial fibrillation.


The physician, cardiovascular and thoracic surgeon Dr. Mandya Vishwanath, says the mini-maze is an endoscopic alternative to the current surgical procedure used in treating the condition, simply called the maze procedure, which involves opening the chest cavity. After a mini-maze operation, patients typically experience less pain and spend fewer days in the hospital than following a maze procedure.


The maze is the gold standard in treating atrial fibrillation, Vishwanath asserts. The mini-maze is the Holy Grail.


During atrial fibrillation, an upper chamber of the hearttypically the upper left chamberbeats rapidly, or quivers. When the heart quivers, it doesnt pump as efficiently, and blood stagnates, which allows blood clots to form and increases the likelihood of a stroke or heart failure.


Vishwanath says the quivering occurs when the electrical system that regulates the heartbeat produces erratic impulses.


Both maze procedures involve making scars in the hearteither by cutting and stitching tissue or by burning or freezing itso that the electrical impulses have only one route to travel, and cant travel erratically about the chamber. The surgeries are called maze procedures, because the scars resemble a maze path.


A conventional maze procedure involves opening a patients chest and hooking him or her to a heart-and-lung machine for two to four hours while the procedure is conducted, Vishwanath says. Following surgery, a patient typically will be in the hospital for five to 10 days.


With the mini-maze procedure, he says, two small incisions are made in a patients chest through which a two-pronged, clamp-like device and an endoscope are inserted. Using the endoscope to see inside the body, a physician manipulates the clamp-like device, which transmits radiofrequency waves, to make maze-like burns into the heart. Frequently, during the mini-maze procedure, the clamp-like device also is used to remove nerve tissue around the veins leading into the upper chambers of the heart and to remove a natural atrial appendage that can cause stagnant blood to pool and form clots, he says.


Vishwanath has conducted two of the mini-maze procedures so far and says each took about two hours to complete. He suspects the time in surgery will decrease as he performs more of the procedures.


A patient typically will be in the hospital for two days after undergoing a mini-maze, but recovery is much faster than after a maze procedure because the patient hasnt had his or her chest opened and doesnt have to be on a heart-and-lung machine during surgery, Vishwanath says.


Vishwanath says he typically performs the open-chest maze procedure when hes also performing another form of heart surgery, such as replacing a heart valve. Rarely does he open a patients chest just to perform a maze operation.


Typically, he says, maze procedures are performed only after nonsurgical efforts to deter atrial fibrillation have been attempted.


Before the maze procedures are used, patients suffering from atrial fibrillation usually will be treated first with medications and blood thinners. Vishwanath says those have varying degrees of success and sometimes have side effects.


Patients who dont respond to the medications or blood thinners often will undergo a procedure in which a catheter is inserted through a femoral artery in a leg and guided to the heart, where a device is used to burn or freeze some nerves around the veins leading into the heart. The effect can be similar to that of the maze procedures.


Atrial fibrillation isnt exclusive to any one age group, but the frequency of irregular heartbeat in those who have the condition tends to increase with age, Vishwanath says. The effects of the condition vary; some people can tell their heart is beating rapidly, while others describe general feelings of fatigue, discomfort, or apprehension, he says.


The Wolf mini-maze is named after Dr. Randall K. Wolf, a Cincinnati surgeon who developed the procedure. His practice, University of Cincinnati Surgeons Inc., estimates that the procedure has been performed 150 times nationwide thus far.


Vishwanath is a partner in Northwest Heart & Lung Surgical Associates PS, of Spokane.