Atrial Fibrillation: Cox Maze, Epicor

Atrial fibrillation remains an important clinical problem because of the sequelae of stroke, intolerable dysrhythmias, left ventricular dysfunction and the side effects of long term treatment with antiarrhythmics and anticoagulants. A useful overview of atrial fibrillation( http://www.sts.org/sections/patientinformation/arrhythmiasurgery/ ) has been presented by the Society of Thoracic Surgeons

The treatment of atrial fibrillation continues to evolve. Because medication controls symptoms without decreasing the overall risks of the dysrhythmia, Dr. James L. Cox developed a surgical procedure (known as the Cox Maze III) to restore A-V synchrony, eliminate embolic risks, preserve LV function, and to significantly reduce the need for antiarrhythmic medications. We have had a very successful track record in our performance of that procedure at Northern Michigan Hospital over the past six years. However, because the Cox Maze III procedure involves a considerable technical undertaking, it is offered by relatively few cardiac surgery centers.

Dr. Cox has now developed a second and much simpler procedure to effectively cure atrial fibrillation. The EPICOR device (St Jude Medical) delivers precise, continuous transmural lesions to the eipcardial surface of the heart using a minimally invasive method which does not require the use of the heart-lung machine. Lesions are made to replicate proven ablation lesions. The EPICOR system safely delivers energy to all layers of the myocardium to interrupt aberrant electrical pathways responsible for the atrial fibrillation rhythm. It delivers a safe, effective and reproducible ablation in less than ten minutes. It can be safely added to other cardiac surgery procedures such as coronary bypass or valve replacement with no increase in morbidity.

We are now screening patients with primary atrial fibrillation for the EPICOR procedure. The initial release of this device has been limited and we are the only community hospital in the USA to have been chosen to participate at this time. We would be happy to discuss specific cases with you and believe the EPICOR procedure will provide a tremendous addition to our ability to effectively treat this dysrhythmia.