Jan. 24, 2008

First live training session of mini-maze heart surgery broadcast to largest meeting of electrophysiologists

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By Sathya Achia Abraham

Cameras follow the action as VCU Medical Center’s cardiac surgery team led by Dr. Vigneswar Karisajan perform a procedure to treat atrial fibrillation. The live teaching broadcast was beamed to physicians attending a conference in Boston. Dr. Kenneth Ellenbogen, (far left), director of VCU’s cardiac electrophysiology lab, narrated during the procedure. Photos by Joe Kuttenkuler, VCU News Services
Cameras follow the action as VCU Medical Center’s cardiac surgery team led by Dr. Vigneswar Karisajan perform a procedure to treat atrial fibrillation. The live teaching broadcast was beamed to physicians attending a conference in Boston. Dr. Kenneth Ellenbogen, (far left), director of VCU’s cardiac electrophysiology lab, narrated during the procedure. Photos by Joe Kuttenkuler, VCU News Services

A group of Virginia Commonwealth University cardiothoracic surgeons conducted a training session of a procedure to help stop irregular heart rhythm that was transmitted live from an operating room at VCU’s Pauley Heart Center to a large audience of electrophysiologists gathered at the 13th Annual International Boston Atrial Fibrillation Symposium in Massachusetts on Jan. 17.

Atrial fibrillation, or a-fib, is an irregular rhythm that affects more than 2 million Americans, interfering with the heart’s ability to efficiently pump blood. As a result, blood can pool in the atria, which can lead to the formation of clots and the possibility of a stroke. It is caused by abnormal electrical impulses that begin at the top of the heart and travel down the upper chambers, or atria, causing them to contract erratically. 

A technician monitoring the Mini-Maze operation from an adjoining room switched between several cameras during the case to give the Boston audience the best views of the procedure.
A technician monitoring the Mini-Maze operation from an adjoining room switched between several cameras during the case to give the Boston audience the best views of the procedure.

The VCU team, led by Vigneshwar Kasirajan, M.D., chair of cardiothoracic surgery, and Kenneth Ellenbogen, M.D., professor of cardiology and director of the cardiac electrophysiology lab, used a minimally invasive technique, called a modified Mini-Maze. This approach allows surgeons to block the abnormal impulse from getting to the heart to trigger the a-fib.  Ellenbogen narrated the procedure as it took place and used several slides to further illustrate the case.

“The opportunity to educate the wider electrophysiology community about the benefits of surgical therapy for atrial fibrillation was tremendous and well received. The satellite transmission was of excellent quality and clearly demonstrated the process,” Kasirajan said.

During the procedure, surgeons insert instruments into the chest through several keyhole-size incisions between the ribs. With the aid of a tiny video camera, a specially designed instrument is placed around the pulmonary veins and atria, and energy is delivered to destroy the tissue near the origin of the irregular impulses. The damaged tissue disrupts the abnormal signaling pathways, stopping the irregular impulses.

Images from the operating room traveled to a satellite truck parked just outside the hospital and then were transmitted to the Boston Atrial Fibrillation Symposium.
Images from the operating room traveled to a satellite truck parked just outside the hospital and then were transmitted to the Boston Atrial Fibrillation Symposium.

Unlike catheter ablation, which treats the inside of the heart, the Mini-Maze technique is performed on the heart’s surface, “which also allows us to map the nerve endings, or autonomic ganglia, in these areas that may be the source of atrial fibrillation, and remove the left atrial appendage where blood clots may form,” according to Kasirajan.

The team at VCU used cardiac ablation technology from AtriCure Inc.