For more than five years, the 55-year-old Jones had suffered
with dizzy spells and decreased stamina. An avid runner, he
started to notice that his race times were slowing and that he
wasn’t performing at his accustomed level. He had regular
physicals, but they didn’t explain why he didn’t feel well and
couldn’t do some of the things that he had once enjoyed.
Then, in May 2008, Jones went to the emergency room
in his Idaho hometown with chest pains. He thought he was
having a heart attack, but the diagnosis turned out to be atrial
“The pieces of the puzzle finally started to
come into place,” he says. “The dizzy spells
during household chores, heart palpitations and
decreased ability to run or hike like I used to were
a result of atrial fibrillation.”
Atrial fibrillation, or afib, is an irregular heart
rhythm caused by the chaotic generation of
electrical signals in the heart’s atria.
Jones didn’t waste any time starting treatment
for his condition. In July 2008, he had a
cardioversion, a procedure that uses electrical
shock to convert an abnormal heart rhythm back
to a normal rhythm.
The results were only briefly successful.
“The procedure only held a couple days before I went back
into afib,” Jones says.
Jones’ doctors offered other treatment possibilities—from
drug therapy to ablation to the Cox Maze, a surgical procedure
that requires opening the chest, stopping the heart, cutting it
into sections and sewing it back together.
“I was told that there was a 20 percent chance the ablation
would work,” says Jones, “and I wasn’t interested in drug
treatment considering how tired and lethargic my current afib
medications were making me feel.”
That’s when Jones started doing some research of his own
and discovered the Ex-Maze, a minimally invasive procedure
designed by FirstHealth heart surgeon Andy C. Kiser, M.D.
Later, when Jones contacted FirstHealth Moore Regional
Hospital to find out if he was a candidate for the procedure,
he learned about Dr. Kiser’s work to develop a combination
of the Ex-Maze and catheter ablation to treat afib.
Called the Convergent Ex-Maze, the procedure merges
the expertise of a cardiothoracic surgeon
with that of an electrophysiologist to provide
complete afib treatment.
“Following conversations with Dr. Kiser and
his staff and receiving more information on the
procedure, I consulted with my cardiologist,”
Jones says. “After looking into the procedure,
he was favorable and had no reservations.”
On Jan. 23, 2009, Jones became the first
patient in the country to have a Convergent
Ex-Maze. Dr. Kiser and electrophysiologist
Mark Landers, M.D., performed the procedure
at Moore Regional Hospital.
Kelly Jones is now a new man. Nearly six months since he
had his Convergent Ex-Maze, his dizzy spells, palpitations
and shortness of breath are gone and he is beginning to
resume the active life he led before atrial fibrillation took
Before having the procedure, he had hiked a 9,400-foot
peak with his family, a trek that took him seven hours. He’s
convinced that he could do much better now.
“I’m ready to get back to doing the things I enjoy like
hiking and jogging,” he says, “and doing them without
giving out of breath.”
to treat atrial
On Jan. 23, 2009, two physicians at FirstHealth Moore
Regional Hospital—a cardiothoracic surgeon and a cardiologist—
teamed up for the first Convergent Ex-Maze ever done
in the United States. The procedure combined a percutaneous
endocardial catheter ablation, performed by the cardiologist,
with a minimally invasive Ex-Maze done by the surgeon,
to correct atrial fibrillation.
Andy C. Kiser, M.D.
Mark Landers, M.D.
Cardiothoracic surgeon Andy C. Kiser, M.D., and Mark
Landers, M.D., a cardiologist specializing in electrophysiology,
combined their skills and experience to perform the
“We can now treat atrial fibrillation without chest incisions,”
Dr. Kiser says. “And, by working with the electrophysiologist
during the procedure, we can do a complete atrial
Dr. Kiser led in the development of the landmark Ex-
Maze procedure, and Dr. Landers has performed numerous
percutaneous endocardial catheter ablations. The two worked
together on several Convergent Ex-Maze procedures in Poland before performing their first collaborative surgery at
Moore Regional in January.
Ker Boyce, M.D., a cardiologist specializing in electrophysiology,
has since joined Dr. Kiser in performing the Convergent
“The power of this new procedure is that we have heart
surgeons and cardiologists taking tried and true technologies and
working together to provide the best option for the treatment of
atrial fibrillation,” says Dr. Landers.
|The procedure called the
may be unfamiliar to the
layperson, but the relief it
promises to people dealing
atrial fibrillation has the
medical world talking.
In a Convergent Ex-Maze, the Ex-Maze portion is done
through a small incision in the abdomen while the catheter ablation
is done with a small catheter in the large vein in the groin.
“This eliminates the need for sometimes painful incisions in the
chest and allows instantaneous confirmation of the success of the
procedure,” says Dr. Kiser. “This approach allows the patient to
have a quicker recovery and also allows us to add new scar tissue
patterns to parts of the heart that we couldn’t reach before.”
Dr. Kiser has done more than 150 Ex-Maze procedures at
Moore Regional Hospital, first on patients who were also having
some other type of open-chest surgery, such as coronary artery
bypass, and more recently as a minimally invasive procedure. He
performed the world’s first minimally invasive Ex-Maze procedure
using paracardioscopy in 2007 in Krakow, Poland.
He began offering the Paracardioscopic Ex-Maze as a treatment
option at Moore Regional in January 2008.
With the Paracardioscopic Ex-Maze, the surgeon uses ports,
small cameras and laparoscopic instruments to look at and operate
on the heart.
Catheter ablation is a common medical treatment of atrial
fibrillation. The cardiologist inserts a long, thin, flexible tube
(called an ablation catheter) into a blood vessel in the arm, groin
(upper thigh) or neck, and then guides it to the heart. A special
machine then sends energy through the catheter to the heart,
finding and destroying small areas of heart tissue where abnormal
heartbeats can cause an arrhythmia to start.
The Convergent Ex-Maze can be used to treat all three types
of atrial fibrillation, but focuses on patients who have been difficult
to treat with traditional methods.
Treatment goals are:
- to restore a regular heart rhythm
- to keep the heart rate as close to
normal as possible
- to prevent blood clots from forming
Treatment for atrial fibrillation begins with services provided by a
cardiologist but can ultimately require a surgical procedure. Treatment
options include medications, electric shock cardioversion, pacemaker
therapy and catheter ablation. All are offered at FirstHealth Moore
Moore Regional also offers the Ex-Maze ablation and the Convergent
Ex-Maze, both of which create scar tissue on the heart to redirect the
electrical impulses of the heart.
Cardioversion uses electrical current to
help normalize the heart’s rhythm.
The area of the atria that is responsible for the afib
is surgically removed or altered (ablated) with various
techniques, including cryoblation (extreme cold) or heatgenerated
In pacemaker therapy, a device
that is implanted in the patient’s
chest sends out electrical pulses
to correct or set the heart’s
rhythm. A computer chip in the
device determines the type of
electrical pulses to send to the
heart and when those pulses
are needed. It also records
information on the heart’s
electrical activity and rhythms
that a cardiologist can use to set
the pacemaker so it works better
at assuring a normal rhythm.
The Ex-Maze ablation developed by
Andy Kiser, M.D., of FirstHealth Moore
Regional Hospital, creates an extensive
pattern of scar tissue on the heart
to properly direct electrical impulses
through the heart muscles. The Ex-Maze
is a comprehensive (full maze), bi-atrial
lesion pattern that is created on the
outside surface of the heart while the
heart is beating and the patient is off
bypass. This pattern has the benefits
associated with the gold standard “cut
& sew” maze pattern, but without the
risks associated with an open-heart
Commonly, the first
line of treatment for
atrial fibrillation involves
rate and rhythm drugs,
medications that are
designed to slow and
regulate the heart rate.
For more information, call (800) 213-3284