Procedures Give Firefighter New Lease on Life

Lieutenant Mike Flaig of the Sycamore Township Fire Department has spent most of his life fighting fires.

"I like helping people," he says. "I've been doing it since I was 19. I started as a volunteer."

As a firefighter and paramedic, Flaig regularly helps people suffering from atrial fibrillation or AFib, a condition where the upper chamber of the heart goes out of rhythm. So he was surprised to discover he was in AFib himself during his annual physical several years ago.

"My physician says, 'How long have you been in AFib?' " Flaig says. "I said, 'I didn't know I was in AFib. I just don't feel well today.' " AFib gave Flaig a serious problem, because the traditional treatment - blood thinners - would prevent him from fighting fires.

"We'll be in a building and be pulling ceilings or whatever, and have stuff fall on us or get hit," Flaig says. "You bruise easy when you're on a blood thinner, and you could have internal bleeding from getting hit too hard."

Flaig's cardiologist wanted him to see an electrophysiologist, a specialist on the heart's electrical system. He recommended Dr. Gaurang Gandhi at TriHealth.

Early on, Flaig's normal heart rhythm could be restored with electrical cardioversion, a brief procedure that delivers timed shocks to the heart. Periodic treatments worked for a time, but with diminishing results. "Dr. Gandhi always said there's something coming in the future, experimental stuff that's new and improved and you'd be a good candidate," he says.

By September 2014, six shocks couldn't bring Flaig out of AFib. It was time to do something more. "Michael is a big guy," Dr. Gandhi says. "Given his body structure, I didn't think we'd be able to do it with one procedure." Instead, he proposed a relatively new combination of surgeries known as the Stepwise approach.Dr. Eric Okum, a thoracic surgeon at TriHealth, would perform a maze procedure on the outside of Flaig's heart to stop the AFib. Three months later, Dr. Gandhi would perform an ablative procedure on the inside of Flaig's heart to solidify the results. Together, these two could achieve what neither could do alone.

"The maze procedure was developed in the late '80s," Dr. Okum says. "It creates certain patterns of scar that disrupt the electrical circuits that cause atrial fibrillation. That pattern of scar looks like a maze, so that's how it got its name.

"In this Stepwise approach, what I basically do is I go first and create the patterns of scar from the outside. It takes a while for the lines of scar to form. Sometimes they don't form the full thickness of the tissue, so when Dr. Gandhi goes in and checks there are some gaps in that box of scar. He closes those gaps three months later from the inside."

The surgery also involves the removal of a part of the heart that leads to eliminating the need to use blood thinners, another welcome benefit for Flaig.

Initial successes have been promising, and suggest the Stepwise method could have lasting benefits for patients like Flaig. "We think going back for that second procedure to close any gaps will give us better long-term results," Dr. Okum says.

TriHealth pioneered the use of the Stepwise approach in Cincinnati in July 2013. "As I understand it, I was the 12th or 13th person to have this done in the Cincinnati area," Flaig says. "It will allow me to finish my pension, not have to go on disability, not have to take blood thinners and not have to take any antidysrhythmics.

"I've had no runs of AFib, which would not have happened if they had just done one surgery or the other. So I'm ecstatic."

Tags Heart