"I couldn't get a breath," the 58-year-old Malad City, Idaho, man said. "The pain was excruciating."
Plagued with atrial fibrillation - abnormal heart rhythms involving the two upper chambers of his heart - Boley had little success managing the problem with a pacemaker or high doses of anti-arrhythmic medications such as amiodarone. His feet, which weren't getting enough blood pumped to them, would often swell up and turn a purplish hue.
Boley's next option was surgery. That's when his Idaho doctor told him about a procedure called the "mini maze," performed by Utah heart surgeon David Affleck.
"He [Affleck] told me I was a prime candidate for it," Boley said. "He thought it would be 90 to 95 percent successful."
Boley was hopeful. For people like him, atrial fibrillation, or "afib" as some doctors call it, can cause dizziness, fatigue, confusion - or, as he experienced in May, breathing difficulties and the sensation of tightness in the chest.
A minimally invasive version of the "maze," an open-heart surgery in which a number of incisions are made in the patient's atrium to disrupt errant signals, the mini maze is done through small cuts made just beneath the patient's arms.
It's through these incisions that Affleck inserts his instruments, allowing him to access the heart without having to open patients' chests and crack their ribs.
One at a time, Affleck deflates the lungs. He then goes in with a bipolar, radio frequency clamp to make circular burns around the right and left pulmonary veins. The scarred tissue, in turn, blocks erratic electrical impulses that cause atrial fibrillation.
During the surgery Affleck also uses an "Isolator Pen," approved by the FDA in July 2006, to ablate, or remove, nerve bundles along the heart that also contribute to irregular electrical impulses. He is then able to test the bundles with that same pen to make sure they've been disabled.
"If [the pen] activates the heart, then I take the pen and then I step on a pedal and I burn that nerve bundle. And then I test it again," he said.
Finally, Affleck removes the left atrial appendage, where blood can sometimes pool and clot, increasing a person's risk of stroke.
Once the mini maze is completed, the "normal pacemaker can take over," Affleck said. "It's not seeing interference from these other signals firing off."
The whole procedure, which has been performed on about 1,000 people worldwide, Affleck said, takes around four hours. Most patients are able to leave the hospital within a few days after the surgery.
For some of the 2.2 million Americans who suffer from atrial fibrillation, the mini maze can be a good option, eliminating their lifelong dependency on drugs that regulate their heart beat and reduce their risk of stroke, Affleck said.
"What happens is, over 15 years there is about a 30 percent incidence of major complications with medical therapy - that means bleeds, strokes and death," he said. "So, in my mind, the medical option is a nonoption."
The only heart surgeon in Utah and among only a few dozen in the country who are trained to perform mini mazes, Affleck has operated on about 70 patients in the past two years at St. Mark's Hospital in Salt Lake City and Timpanogos Regional Hospital in Orem.
Among those patients who have "intermittent" atrial fibrillation, the cure rate is 90 percent, he said. Among those who have "consistent" atrial fibrillation, however, that number is lower - 50 to 70 percent.
"But I don't know if that will last," he said, adding that consistent afib is more difficult to treat. "I'm anticipating some of those patients will come back."
Boley said he won't be among them.
"I can't explain to you, tell you how much better I feel," he said. "I have a little more energy. I feel a lot better with my life today. I quit smoking, I changed my diet. It just really changed my attitude for life around."
lrosetta@sltrib.com
