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Minimally-Invasive Surgery for Atrial Fibrillation
Cutting-edge procedures stop killer arrhythmia in tracks

More than two million people in the United States suffer from atrial fibrillation, a type of heart rhythm abnormality that disrupts the normal electrical activity of the heart - putting them at considerable risk for the development of blood clots in the heart, which can lead to strokes.

Doctors normally treat atrial fibrillation patients with drugs designed to restore normal heart rhythms, but these by no means represent a cure (and are not without side effects). Another option is the Cox-Maze procedure, a surgical technique that - while effective - is also highly invasive, requiring multiple incisions in the walls of the heart.

Enter minimally invasive cardiac surgery.

"Traditional surgery for atrial fibrillation is, frankly, too traumatic," says minimally invasive and robotic surgery pioneer Michael Argenziano, assistant professor of surgery at Columbia and director of minimally invasive cardiac surgery and arrhythmia surgery at Columbia University Medical Center.

Sensing there had to be a better and more effective solution to the problem, in 1999 Dr. Argenziano - along with fellow physicians in Columbia's Department of Surgery and elsewhere - began developing a minimally invasive procedure for atrial fibrillation using robotic technology in canine animal models.

Minimally invasive and robotically assisted surgery only requires small incisions between the ribs to enter the chest cavity instead of having to open the chest by cutting through the sternum, as in traditional open-heart surgery. In addition, Dr. Argenziano's technique allows the operation to be done "off-pump," without placing the patient on a heart-lung machine.

Since 1999, Dr. Argenziano and colleagues managed to perfect their technique in animal models, using novel energy sources such as microwave, radiofrequency, and laser. Since that time, they have performed nearly 400 atrial fibrillation operations in human patients - achieving an overall success rate of over 75 percent in the process. For patients with lone and parozysmal atrial fibrillation, the success rate has been even higher.

"Initially, cardiac surgeons were reluctant to use minimally invasive techniques for fear that limited exposure might result in decreased safety. But with advances in technology and clinical experience, we can now perform a variety of minimally invasive cardiac operations without sacrificing patient safety," Dr. Argenziano says. "In fact, minimally invasive techniques hold great promise in the successful treatment of many different manifestations of cardiovascular disease, widely known to be the top killer of Americans today.
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