New afib duel procedure

A North Carolina surgeon and cardiologist have done the first ex-maze and catherter ablation on a patient at FirstHealth Moore Regional Hospital. It looks like the second one was done in Austin, TX - isn't that were Dr. Natale is?
There is a press release at www.firsthealth.org and [stdavids.com]

Carl,
Thanks for the post. This is really interesting. Maybe it will be the answer for the 10-20 percent who have failed ablations.

It could have been Horton at TCA. He teamed up with a surgeon that used key hole surgery combined with followup catheter ablation to fix a patient that had an extremely enlarged left atrium and it worked. As you said this would cover the patients that are almost impossible to treat with catheter ablation and is much less morbid than Cox Maze. We are getting closer to day where Cox Maze will only be used on patients that requiredhave other open heart repairs such as CABG.

I could not pull up that link. I think this might be it.

[www.firsthealth.org]

I think the ex-maze is the Cox-Maze - it is done minimally invasive. There is a website that gives a lot of detail. www.exmaze.com
These two procedures seem like they would address all the issues - you have a full maze and the ablation. I guess we'll have to see how the patients do - but it looks like the people that had only ex-maze had some pretty good results.

Doing a dual procedure too could answer one of Natale's main concerns with the maze-like procedures, no way to confirm complete isolation of the pulmonary veins from inside the left atrium. And no way to effectively address complex fractionated Electrograms.

This method would also allow the 'team' of EP and Surgeon to address any possible atrial flutters with the catheter ablation from inside that may be created as part of the mini-maze procedure itself, which happens more than rarely, as even Cox said when he witnessed that mini-maze in North Carolina and complained that everyone in the room, including the North Carolina surgeon who pioneered that version of the mini-maze, were all clapping and congratulating each other when their patient supposedly converted to NSR when the mini-maze was finished, but in fact the patient had only converted to Atrial flutter and everyone in the room missed it.

That led Cox to assume more than a few such patients that were part of their 'cure' statistics really were only converted to atrial flutter than was controlled some on the fdrugs commonly given after mini-maze for some time.

It highlighted the importance of having a skilled EP on hand for what is , after all really an EP problem. It just so happens that a surgical approach has some merits too and a combination of a sufficiently minimally invasive mini-maze along with a high quality interior catheter ablation/monitoring with a skilled EP could be very worth while for difficult cases who have failed first, second or third standard ablation, depending on the circumstances.

Going to a top EP can often sort it out in one or two visits in most cases in any event.

Shannon

For a description of the Horton hybrid procedure being pioneered at Natale's Texas Cardiac Arrhythmia Institute:

[www.tcainstitute.com]

(You can keep up with Natale's activity by checking his blog.)

For other hybrid procedures:

[www.nmh.org]

[www.ingentaconnect.com]

For negative comments on the ExMaze by Dr Cox:

[health.groups.yahoo.com]

-- Dick

The duel procedure is a great option for patients - the ex-maze, pioneered by Dr. Kiser seems like the key procedure along with the ablation. Kiser's ex-maze is not a mini-maze - it is the full maze. I heard the Dr. Cox came to see Kiser's procedure, however, I'm not surprised Cox had some negative reaction to the ex-maze. Dr. Kiser doesn't use the equipment that Cox endorses. For a description on where the FIRST convergent/hybrid procedure was done in the US - go to www.firsthealth.org