( Heart surgeons at Washington University...)High-Energy Clamp Simplifies Heart Surgery for Atrial Fibrillation,Health

Heart surgeons at Washington University School of Medicine in St. Louis have helped usher in a new era in the surgical treatment of atrial fibrillation. //Using radiofrequency devices — rather than a scalpel — they've greatly shortened the surgery and made it significantly easier to perform.

"Because of the devices, the procedure — called the Cox-Maze procedure — has gone from an operation that hardly anyone was doing to one that 80 to 90 percent of U.S. heart surgeons are now performing," says Ralph J. Damiano Jr., M.D., the John Shoenberg Professor of Surgery and chief of cardiac surgery at the School of Medicine and a cardiac surgeon at Barnes-Jewish Hospital.

Adults older than 40 have a 25 percent risk of eventually developing atrial fibrillation in which the upper chambers of the heart twitch rapidly instead of contracting fully and regularly. The condition can lead to stroke or heart failure.

For some patients, medications can control the abnormal heart rhythms and the risk of clotting associated with atrial fibrillation, but they do not cure the disorder. The Cox-Maze procedure has a greater than 90 percent cure rate.

Damiano and his colleagues have played a vital role in the development and testing of radiofrequency devices for treating atrial fibrillation. The devices deliver high-energy radiofrequency waves to heart tissue and very quickly create scars or ablations, which replace most of the complex incisions required by the Cox-Maze procedure. The ablations disrupt the atria's abnormal electrical activity and normalize heart rhythm.

The research team found that surgeons needed to apply the devices for only a few seconds at a time to get effective ablation of the atrial wall, and the devices caused no injury to surrounding tissue. The time needed for the procedure went from more than 90 minutes to about 30 minutes.

The modified Cox-Maze procedure eliminated atrial fibrillation in over
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