First New England Hybrid Cardiac Procedure Aids Woodbury Choir Director

BRIDGEPORT — Thanks to the experts in Bridgeport Hospital’s Connecticut Cardiac Arrhythmia Center, a local choir director’s steady beat and rhythm are back in top form, at least as far as his own heart is concerned. That is because doctors at the Cardiac Arrhythmia Center recently performed New England’s first hybrid ablation procedure for the treatment of atrial fibrillation (a-fib), the most common heart rhythm disorder.

Their patient was Geoff Smith, 58, of Woodbury, who says he considers himself fortunate to be the region’s first patient to undergo the innovative procedure. As the organist and choir director at St John’s Episcopal Church in Washington, Mr Smith’s health and performance were suffering after he began developing the symptoms of atrial fibrillation — chest palpitations, fatigue, dizziness, and trouble breathing.

So he sought help from Bridgeport Hospital cardiac electrophysiologist Murali Chiravuri, MD, PhD.

Dr Chiravuri said he and fellow Connecticut Cardiac Arrhythmia Center electrophysiologists and cardiothoracic surgeon M. Clive Robinson, MD, were about to introduce hybrid ablation at Bridgeport Hospital, and that Mr Smith might be a candidate for the procedure.

Ablation blocks the faulty electrical pathways in the heart that cause an abnormal heart rhythm. Traditionally, ablation is performed as a catheter procedure (catheter ablation), during minimally invasive surgery (mini-maze) or during open-heart surgery (maze).

In each case, a scar is created that blocks abnormal electrical signals from spreading from the pulmonary veins through the heart chambers. This in turn keeps the heart beating at a normal rhythm.

Until now, surgical and nonsurgical approaches have been performed separately, with each having their own distinct benefits, challenges, and risks.

 

Why It Happens

In catheter ablation, insufficient scar formation may lead to a recurrence of electrical connections and in more advanced a-fib it may be more difficult to reach critical spots in the left atrium (the heart chamber that receives oxygenated blood from the pulmonary veins).

In the surgical approach, the effectiveness of ablation tends to be better but the available methods until now, including mini-maze, have been unduly invasive.

Hybrid ablation is a combination of the catheter and surgical approaches, designed to maximize the advantages of each and minimize their risks. The two are performed together in a single, significantly less invasive procedure that results in a more comprehensive ablation.

The electrophysiologist (cardiologist who specializes in heart rhythm disorders) and heart surgeon work side by side — the surgeon first from outside the heart inward and then the electrophysiologist from inside the heart out. This combination results in covering the full thickness of the heart and creating a continuous ablation scar.

The radically new surgical component of hybrid ablation is the entry point through the soft tissues of the abdomen and a small hole made in the diaphragm to access the heart. A scope and two tiny instrument ports are used along with the ablation device.

“This surgical approach is entirely new and truly minimally invasive,” said Dr Robinson, a pioneer of minimally invasive heart surgery who also has extensive experience with heart rhythm operations, including the mini-maze procedure.

Combined Approach

Dr Robinson, who performed the innovative June 3 procedure with Dr Chiravuri, says the new combined approach avoids incisions between the ribs, opening of the breastbone and collapsing of the lungs as in open-heart surgery. This results in less discomfort and a more rapid recovery for the patient. In addition, the ablation lines that halt the abnormal heart rhythm are more comprehensive.

“It is likely that the new hybrid ablation procedure will make mini-maze obsolete,” Dr Robinson says.

The hybrid ablation procedure went very smoothly for Mr Smith. He was up and walking again just a day after the procedure and recalls that “there was minimal discomfort” two days after treatment.

In another two days he returned home from the hospital and was soon taking his dog Finnie on walks again.

“When they told me I’d be in the hospital for only four days, I couldn’t believe it,” Mr Smith said, expressing amazement at how well his hospital experience went. He was back conducting his church choir eight days after the hybrid ablation procedure.

As they learned during their time together in the hospital, Mr Smith and Dr Robinson appeared destined to meet. Mr Smith’s day job is director of information technology and in-house publications for the Cathedral of St John the Divine in New York, where Dr Robinson serves as an usher.

When a power outage affected Mr Smith’s home in Woodbury, Dr Robinson helped the musician prepare the cathedral’s program of services for the weekend following his release from the hospital. Dr Robinson jokingly sent Mr Smith a copy signed, “The Hybrid Edition — from your heart surgeon.”

The Heart Institute at Bridgeport Hospital provides a comprehensive range of cardiovascular services, including open-heart surgery, angioplasty, sophisticated heart rhythm care, and cardiac rehabilitation and wellness programs. For information, visit bridgeporthospital.org.