Where do the abnormal electrical impulses come from?
Based upon work by Haissaguerre, we now believe that the abnormal impulses may originate within the openings of the pulmonary veins which empty newly oxygenated blood from the lungs back into the heart. (Reference: Haissaguerre M, Jais P, Shah DC et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating within the pulmonary veins. N Engl J Med 1998;339:569-66.) Are there treatment strategies that try to block these abnormal impulses? Yes. Dr James Cox devised a surgery called the Maze Procedure 20 years ago in which he used scissors to carefully place incisions in the atria which he then sewed closed. One important part of the procedure includes cutting the tissue connecting the pulmonary veins to the heart and reconnecting them. The resulting linear scar tissue acted as electrical insulation, forcing the impulses to travel in a more normal direction. The operation was exceedingly successful. For the first time, Afib could be cured. However, the operation is tim
