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 fibrillation.

“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 it away.

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.”

Cardiothoracic
surgeon,
cardiologist
work together
to treat atrial
fibrillation

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.

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 successful procedure.

“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 fibrillation treatment.”

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 Ex-Maze procedure.

“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.

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 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 Regional Hospital.

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
Cardioversion uses electrical current to help normalize the heart’s rhythm.

Ablation Therapy
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 radiofrequency ablation.

Pacemaker Therapy
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.

Ex-Maze Ablation
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 procedure.

Medications
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