Hospital Offers Innovative, Hybrid Procedure for Difficult Cases of Atrial Fibrillation

February 14, 2011

Media Contact: Liat Kobza, 650.723.1462,
Writer: John Sanford, 650.723.8309,

Paul Wang, MD
Gan Dunnington, MD
Paul Wang (top) and Gan
Dunnington have performed a new
multidisciplinary treatment
for atrial fibrillation.

Cardiologists and heart surgeons at Stanford Hospital are honing a new technique to treat the most difficult cases of atrial fibrillation.

Joining forces in the operating room, they are seeking to deliver a one-two punch to the source of the abnormal heart rhythm by using minimally invasive surgery and an intravenous catheter to get at the problem-causing tissue on both sides of the left atrial wall.

Stanford is one of a handful of institutions worldwide doing this combination of surgical and catheter ablation at the same time. “After reviewing the medical literature, we didn’t think surgical ablation alone was achieving the success rates that we would like to have with the most advanced patients,” said Paul Wang, MD, a Stanford Hospital cardiologist who is at the forefront of the technique. “So our rationale was that if you could combine the surgical and catheter components, maybe you could get better results. It’s a logical hypothesis, and now we’re testing it.”

About 2.2 million Americans suffer from atrial fibrillation, in which rogue electrical impulses in the heart’s upper chambers, the atria, disrupt the normal cardiac rhythm. Some patients suffer from an intermittent, or paroxysmal, form of the disease. For others, it’s persistent. In either case, the disorder increases the risk of blood clots — especially in the left atrial appendage, a muscular pouch connected to the left atrium — which, if they dislodge, can travel to the brain and cause a stroke. Medication, cardioversion (an electrical shock to the heart) and either catheter or surgical ablation are common treatments for atrial fibrillation. But for patients who do not respond to these measures because they have particular heart characteristics, such as a large atrial cavity or thick atrial tissue, the new procedure could offer some relief.

In the past, only a select number of hospitals have offered combined surgical and catheter ablation, breaking it up into two separate operations over the course of about a week. Stanford Hospital, however, is one of the first to do both procedures at once. This means patients do not need to endure two separate preparation and recovery periods. And because the two sets of specialists are in the same room at the same time, they can immediately consult with one another about the specific case — making it easier, for example, for the cardiologist to target the locations needed to complete the ablation.

The surgeons operate first, making fingernail-sized incisions to insert a tiny camera, which guides their work, and a small instrument that delivers cell-destroying energy to tissue on the outside of the left atrium. Then cardiac electrophysiologists guide a catheter from the femoral vein into the left atrium, where they ablate many of the same portions of tissue but from the inside. “The goal is to treat the full thickness of the tissue,” Wang said.

Robert Robbins, MD, chair of the Department of Cardiothoracic Surgery at Stanford, said the technique is just one example of the trend toward more multidisciplinary treatment strategies in cardiac medicine at the hospital. “That we’re able to offer this treatment option to patients demonstrates the kind of innovative and pioneering spirit of Stanford medicine,” he said. “It also shows the efficacy of collaboration.”

Gan Dunnington, MD, a Stanford cardiothoracic surgeon who has performed the procedure, agreed. “The hybrid approach has definitely shown some exciting early success in patients whom I feel had very little chance of success through the traditional routes of ablation,” he said. “What’s more, we are able to eliminate the left atrial appendage, surgically, which is where the majority of stroke-causing clots form in patients with atrial fibrillation.  Our complementary procedures really do give the patients the best option for cure of their A-fib, and hopefully stroke prevention.  I think there’s no question this combined approach is the future of A-fib ablation.”

Wang, Robbins and Stanford cardiologist Amin Al-Ahmad, MD, are also developing technology to allow cardiologists and surgeons to ablate the same section of tissue simultaneously. “That’s the next frontier for this procedure,” Wang said.
Research into the new treatment is being supported by a grant from the National Institutes of Health and Stanford’s Department of Medicine.

For more information about this procedure at Stanford Hospital, please contact Linda Norton, RN, MSN, CCRC, at (650) 725-5597 or

About Stanford Hospital & Clinics
Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiovascular care, cancer treatment, neurosciences, surgery, and organ transplants. It is currently ranked in the top 20 on the U.S. News & World Report’s "America's Best Hospitals" list and No. 1 in the San Jose Metropolitan area.  Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients.  The Stanford University Medical Center is comprised of three world renowned institutions: Stanford Hospital & Clinics, the Stanford University School of Medicine, the oldest medical school in the Western United States, and Lucile Packard Children's Hospital, an adjacent pediatric and obstetric teaching hospital providing general acute and tertiary care. For more information, visit

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