Patient resumes horsemanship after atrial fibrillation surgery

A busy Realtor in Ann Arbor, Mich., Marian Gregor was very concerned about her irregular heartbeat and had expressed her concerns to her doctor, but had not received any treatment. One Sunday morning, her apprehension proved to be justified. As she was taking two of her large horses out of their stable, she became extremely light-headed. She was rushed to the emergency room, where physicians determined she had had a stroke.

Gregor, then 50 years old, recovered from the stroke and tried to get back her life, which had included horsemanship and gardening as well as her career. She started taking medication for her arrhythmia – diagnosed as atrial fibrillation (AF), the most common type of irregular heart rhythm – and had four catheter ablations to destroy the heart tissue causing the AF. But none of the treatments was effective.

“I was resigned to having a compromised lifestyle,” she says. “I couldn’t go up a flight of stairs without being exhausted, and it was really, really hard to ride my horses or deal with the animals. I was like an inactive 80-year-old person.”

Then, one Friday evening, Gregor spoke to a real estate client in St. Louis, a 50-year-old dentist, who also had AF. He and his wife had adopted two young children, and because of his AF, he was having difficulty keeping up with them. He told her he was about to undergo the Cox-Maze procedure, considered the gold standard for atrial fibrillation surgery, in which a surgical team uses radiofrequency energy to heat and create scarring on the heart muscle, which redirects the abnormal electrical currents responsible for AF.

A month later, Gregor called her client, and he was doing very well. At that point, Gregor began an intensive Internet search to find out more about the procedure and who performed it. Her search led her to Ralph Damiano Jr., MD, chief of Cardiothoracic Surgery at Washington University School of Medicine and Barnes-Jewish Hospital (BJH), who had also performed the surgery on her client. The original Cox-Maze procedure, which used surgical incisions to create scar tissue, was pioneered at Washington University and BJH by James Cox, MD. Damiano had modified the surgery with the use of radiofrequency energy and introduced a minimally invasive approach – through a small, right-sided chest incision rather cutting down the center of the breast bone.

Gregor’s insurance company initially declined her request to have the minimally invasive procedure and would only approve the traditional surgery performed by a Michigan surgeon. But the more invasive surgery was unacceptable to Gregor, and she and her husband, Matthew Kerwin, went to work to make their case to the insurance review board.

“Matthew and I were a tag team,” Gregor says. “We pointed out that research supported the radiofrequency procedure and that Dr. Damiano had been doing it for about five years. They were very interested in this.”

In December 2006, the insurance company reversed its decision, and a month later, Gregor, at the age of 53, had the procedure at BJH.

“It was rough for Marian immediately after the operation because of her basic fear of hospitals and needles,” Kerwin says. “But the procedure went well, and the staff was great. They put a cot in her room so that I could stay overnight with her.”

Gregor’s goal was to ride her Dutch Warmblood horse, Jackpot, in a four-day riding clinic in northern Michigan three months after the surgery. She achieved her goal and then some – Jackpot was a “trouper” and Gregor has maintained good health and energy since having the surgery. She is still working as a Realtor and rides Jackpot at dressage events, where horses show off their athletic ability and willingness to perform. She also resumed gardening and has an abundant flower garden to show for it.

“When I saw my heart surgeon in Michigan, he was absolutely thrilled with my progress,” Gregor says. “Things are good. I am here. I am really healthy, and it’s fabulous.”