Cox Maze Procedure Keeps Jeff Strickland on the Running Trail

Running is a very important part of Jeff Strickland’s life. But, for 17 years, his training and participation in the sport often were interrupted by a serious medical condition.
Strickland is a veteran of the U.S. Marine Corps (USMC) and a substance abuse counselor at the Federal Bureau of Prisons in Jesup, GA. In 1990, he was diagnosed with atrial fibrillation (AF), the most common form of irregular heart rhythm. Over time, his AF worsened until it became difficult to run and life’s daily routines frequently left him exhausted.
Like many with AF, Strickland went through many years of medical treatment before turning to surgery to cure the heart arrhythmia.
“The way I discovered it was through running,” says Strickland. “Back then, I normally ran six to eight miles, but there were some days I couldn’t run a mile. I said, ‘What in the world is going on?’”
For a long time, medications worked well enough to keep Strickland’s AF mostly in check. Then, several years ago, his symptoms worsened. He sought out a cardiologist at St. Vincent’s Medical Center in Jacksonville, FL, who performed two catheter ablations for atrial flutter.
“After the ablations, I continued to take medications,” says Strickland. “I was able to muddle through it, but I was never completely cured. I’d have episodes and couldn’t stand it anymore, so I’d go back to the doctor and we’d try another medication.”
Meanwhile, Strickland continued his longtime devotion to running and exercise, even competing in a mini-triathlon. “I never was really stopped in my tracks,” he says. “Some days were good and some days were bad. I just ‘kept on keepin’ on.’”
When it became evident different treatment was needed, Strickland’s cardiologist referred him to a cardiologist in Atlanta, who performed several pulmonary vein isolation (PVI) ablations. This treatment eliminated AF for several months, but the symptoms returned after Strickland was injured in a motorcycle accident.
Strickland’s Atlanta doctor had already talked to him about undergoing a Cox-Maze procedure and, at this point, referred him to Washington University Chief of Cardiothoracic Surgery Ralph Damiano Jr., MD.
The Cox-Maze procedure — pioneered by James Cox, MD, at Barnes-Jewish Hospital (BJH) in 1987 — is considered the gold standard of surgical AF treatment. Since the introduction of the procedure, Washington University cardiac surgeons at BJH have treated patients from around the globe with AF; their published success rates are the best worldwide.

In recent years, Damiano and his team have modified the technically challenging “cut and sew” procedure. Instead of making incisions, the surgical team uses radiofrequency energy to create lines of ablation, or scar tissue, on the heart muscle. The ablation lines redirect the abnormal electrical currents responsible for AF.
The new procedure — called the Cox-Maze IV procedure — is easier to perform, reduces OR time and improves patients’ recovery. Its success rates in almost 200 patients are equal to those of the ‘cut and sew’ procedure.

It took about two months to transfer and review Strickland’s medical records and set up the surgery. On May 17, 2007, Strickland underwent a successful Cox-Maze IV procedure. Shorty afterwards, he began walking in the hospital and continued to re-build his strength and endurance when he returned home.
Eight months after the operation, Strickland was free from AF and looked forward to a life without heart rate elevations, cardioversion (a procedure in which electrical shock is delivered to bring the heart into regular rhythm) and counting his heart beat. He also had run three miles on one occasion and planned to start swimming as part of his exercise program.
Although he knows medical therapy is used as initial treatment for the disease, he wishes the surgery had been available many years ago. “Dr. Damiano and his group are the greatest team of professionals I've observed working since leaving the USMC,” says Strickland. “Coming from a former marine, that's a great compliment.”