All Things Afib

Dr. Marc Gerdisch is my guest for this episode.

Dr. Gerdisch is currently the Chief of Cardiovascular and Thoracic Surgery at Franciscan Health in Indianapolis, IN, and owner of Cardiac Surgery Associates in Downers Grove, Illinois, just outside Chicago. 

During the last 21 years, Dr. Gerdisch has performed more than 5,000 innovative surgical procedures, of which 3,500 involved heart valve operations. He is an innovator in heart surgery and presents internationally on novel heart valve repair techniques and participates in ongoing landmark research in next-generation heart valves and heart tissue regeneration.

Join us for a discussion focusing on the exciting and illuminating results offered by the ATLAS Study, aka the AtriClip® Left Atrial Appendage Exclusion Concomitant to Structural Heart Procedures (ATLAS).

Discussion points: 

Introduction and background – Dr. Marc Gerdisch

What drove the clinical ATLAS study into being?

How heart surgeons like Dr. James Cox started closing the left atrial appendage as an avant-garde move many years ago

Patients CHADVASc scores and risks for Afib

The LAAOS III study and its outcomes

Atriopathy and why all atrial diseases are related

The next phase of the ATLAS study will have thousands of patients, multi-national

ATLAS study only studied clips, LAAOS included sewing and stapling, which don’t function as well

How a poorly closed appendage can be worse than not closing it at all

There is such a large amount of data out there on AFib, as diagnostics improve and its danger is recognized

Physicians should be screening for AFib if patients have the related risk factors

Any patient who has ever snored should have a sleep study done

In closing– to all heart surgeons with access to the left atrial appendage during surgery, you should discuss a pre-op plan for closing it in your patients!

Resources:

Dr. Marc Gerdisch LinkedIn

ATLAS Study

LAAOS III Study

Cardiac Surgery Associates Website

Dr. Kiankhooy LinkedIn

All Things AFib Website

All Things AFib Twitter 

All Things AFib YouTube Channel

Today I’m speaking with Dr. Nitesh Sood, an electrophysiologist who is board-certified in internal medicine and holds certifications in echocardiography, nuclear medicine, and cardiovascular disease.  Dr. Sood is currently the Director of the Atrial Fibrillation Wellness Program at Southcoast Physicians Group in Dartmouth, Massachusetts.

Dr. Sood was selected as “Star Fellow” “Fellow Elite in Training” 2012 by the American College of Cardiology (ACC) and also “Young Investigator of the year” 2012. Dr. Sood has a special interest in treating patients with atrial fibrillation, syncope, and implantation of pacemakers and implantable cardioverter-defibrillators.

Sood was the first electrophysiologist to utilize pulse-field ablation and has now completed 33 procedures using PFA for atrial fibrillation, more than any other physician in the world at this point.  Join us for a discussion on the use of pulse-field ablation, and its many advantages over cryo or radiofrequency ablation.

Discussion points:

Introduction and background – Dr. Nitesh Sood

Why PFA and how has cryo ablation progressed over time

PFA is very young, has only existed for about 20 years

Apoptosis vs. necrosis in ablation procedures

What structures may be at risk when performing ablation

Animal studies have shown that PFA causes minimal damage in many at-risk areas

PFA has potential for temporary nano-pores that can be useful for delivering medicine such as those used for cancer treatment

MRI data shows incredible cell recovery 3 mos. After PFA, vs. radiofrequency ablation

The length of time needed for PFA is much shorter than cryo or radio, thus minimizing risks of time under anesthesia

The learning curve for PFA is around 4-5 cases

Other uses and some minimal risks of PFA

Afib is on the increase, partly due to more monitoring and tests being available

Afib can easily be monitored by patients themselves, with things like Fitbit and Apple watches, to help doctors treat them more effectively

Take a look at our website ClubAfib.com to find out more and track your own Afib– give us your feedback!

Resources:

Dr. Nitesh Sood at Southcoast Physicians Group

Dr. Nitesh Sood LinkedIn

ClubAfib.com Website

Dr. Kiankhooy LinkedIn

All Things AFib Website

All Things AFib Twitter

All Things AFib YouTube Channel

I’m speaking with Dr. Patrick M. McCarthy, a Board Certified Thoracic and Cardiac Surgeon, currently the Executive Director of the Bluhm Cardiovascular Institute, and Chief of Cardiac Surgery at the Feinberg School of Medicine at Northwestern.  His list of honors and awards is extensive, and his focus and specialties include:

Valve Repair/Replacement

Mitral Valve Repair

Atrial Fibrillation Surgery

Maze Procedure

Aortic Aneurysm

Coronary Bypass Surgery

Hypertrophic Cardiomyopathy / Myectomy

Minimally Invasive Surgery

Join us as we discuss Dr. McCarthy’s findings and how they have affected, or should affect, treatments and surgeries for AFib.

Discussion points:

Introduction and background – Dr. Patrick M. McCarthy

Why this paper? Why was it necessary?

When you think about the industry before this paper, what percentage had AFib pre-surgery?

How AFib nurses at Northwestern identify AFib patients pre-surgery

Percentages of mitral valve surgical patients with AFib before surgery

Surgeons MUST discuss and find any history of AFib with patients before surgery

How should we screen for AFib?

Why were certain female/diabetic patients in the study not treated?

Why aren’t more surgeons treating AFib?

How Dr. McCarthy’s trainees are educated re: treating AFib

Discussion of the newer variations on the Maze IV procedure

It only takes a total of about 8 minutes for the cryoablation procedure, so there’s no excuse not to treat

Surgeons need about 5 surgeries to master the procedure

McCarthy’s message to surgeons: Don’t shy away, its easier to learn these days, and should be performed

Resources:

Link to the published paper: Prevalence of atrial fibrillation before cardiac surgery and factors associated with concomitant ablation

Dr. Patrick McCarthy at Northwestern U.

Dr. Kiankhooy LinkedIn

All Things AFib Website

All Things AFib Twitter

All Things AFib YouTube Channel

Welcome to the first episode of “All Things AFib.” I am your host, Dr. Armin Kiankhooy. As a board-certified cardiothoracic surgeon, my focus is on advanced treatments for heart and lung failure and minimally-invasive surgical treatments for atrial fibrillation such as the Hybrid Maze procedure. You can find me on staff at Adventist Health Heart and Vascular Institute in St. Helena California. 

For our inaugural episode, I’m thrilled to welcome Dr. James Cox, a legend in the field of cardiothoracic surgery, and inventor of the Cox maze surgery. The world is lucky that Dr. Cox decided to become a surgeon because he also had an offer to play professional baseball with the LA Dodgers. 

Dr. Cox was the Evarts A. Graham Professor of Surgery, vice-chairman of the department of surgery, and chief of the division of cardiothoracic surgery at Washington University School of Medicine and Barnes Hospital in St. Louis, MO. It was here in 1987 that he developed the eponymous “maze” procedure, which is still the gold standard in the world today. 

Dr. Cox was the 81st (and youngest) president of the American Association for Thoracic Surgery (AATS), a member of the editorial board of more than 20 scientific journals, and editor-in-chief of two AATS journals. Among the numerous awards and honors he has received throughout his illustrious career, Dr. Cox is the only surgeon to receive the Distinguished Scientist Award from the AATS, the Society of Thoracic Surgeons, and the Heart Rhythm Society. He is the only U.S. cardiac surgeon in the Russian Academy of Medical Sciences. 

Cox is dedicated to clinical excellence, the development of new techniques, and the training of the next generation of surgeons. 

Discussion points:

What is Atrial Fibrillation (AFib)?

The AFib word origins actually meant the appearance of a “sack of worms”

The two types of Macro Re-Entry– Automaticity and micro/macro re-entry

Treatment methods– Cardiothoracic Surgeons vs. Electrophysiologists

The technicalities of terms Maze III vs. Maze IV, the confusion, and even a lawsuit

What are the confusing statistics around pacemaker implantation and the Cox maze procedure?

Post-operative and medicinal damage to the sinus node

Around 5% of patients may need pacemakers due to “sick” sinus nodes, not AFib surgery

A discussion of Left Atrial Appendage management

Is there a percentage of AFib patients that should have more than the Left Atrial closure procedure?

Do we need to get more surgeons to do Left Atrial closure?

Discussion of hybrid maze procedures

Will we still be doing maze procedures in 30 years?

Imagining tools we may be using in the future

Resources:

Dr. James Cox Original Papers: 

The surgical treatment of atrial fibrillation. I. Summary of the current concepts of the mechanisms of atrial flutter and atrial fibrillation. 

The surgical treatment of atrial fibrillation. II. Intraoperative electrophysiologic mapping and description of the electrophysiologic basis of atrial flutter and atrial fibrillation. 

The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. 

Modification of the maze procedure for atrial flutter and atrial fibrillation. I. Rationale and surgical results. 

Modification of the maze procedure for atrial flutter and atrial fibrillation. II. Surgical technique of the maze III procedure.

Dr. James Cox LinkedIn

Dr. James Cox Receives Jacobson Innovation Award 

Dr. Kiankhooy LinkedIn

All Things AFib Website

All Things AFib Twitter

All Things AFib YouTube Channel