Surgical Procedures

Robotic Atrial Fibrillation Surgery

Totally endoscopic, beating heart atrial fibrillation ablation.

Atrial fibrillation (AF) is a form of arrhythmia, or irregular heartbeat, in which the atria (the two small upper chambers of the heart) quiver instead of beating effectively. It is one of the most common forms of cardiac arrhythmia, affecting 0.4% of the general population and 5 to 10% of persons over 65 years of age. In addition, AF occurs in as many as 50% of patients undergoing cardiac operations.

Abnormalities in the heart's electrical impulses in patients with AF cause blood to be pumped improperly, resulting in pooling or clotting. If a blood clot moves to an artery in the brain, AF can lead to stroke. AF is also associated with increased risk of congestive heart failure and cardiomyopathy (heart muscle disease). These risks warrant medical attention for patients with AF even if symptoms are mild. While nonsurgical treatment options, such as electrical cardioversion, often help restore a normal rhythm initially, recurrence rates as high as 75% have been reported.

Columbia surgeons have performed over 300 operations for atrial fibrillation, with a success rate approaching 80% at one-year follow-up. A variety of energy sources, including radiofrequency, microwave, and laser have been utilized to perform these ablative procedures. The majority of these operations have been performed in conjunction with other cardiac operations (such as valve repair or coronary bypass), but the procedure has been used for atrial fibrillation as the sole indication.

In addition to performing several beating heart epicardial atrial fibrillation operations, we have developed a totally endoscopic, beating heart version of the procedure. In this minimally invasive, robotic operation, atrial fibrillation ablation is performed through small puncture wounds in the chest and without stopping the heart or using the heart-lung machine. We performed the first such closed chest, off-pump atrial fibrillation operation in February 2003, and now offer this approach as a clinical option for treatment of lone atrial fibrillation.

Postoperative photos taken 10 days after totally endoscopic, beating heart atrial fibrillation surgery.