Atrial Fibrillation Procedure Eliminates Need for Drugs
James Conroy first noticed something wrong about six years ago while watching a basketball game.
"My heart started beating fast, like I had just run a hundred miles," said the 70-year-old retired Boston Edison worker from Franklin.
Mr. Conroy went to lie down and the episode passed.
"The next morning I was fine," he said.
But it happened again a few months later, and multiple times after that. He was also feeling weak all over. So he finally went to see a cardiologist.
Mr. Conroy, like about five percent of those over age 60 and 10 percent of those over age 80, was suffering from atrial fibrillation (AF): irregular heartbeat episodes stemming from faulty electrical signals in the heart. As a result, blood can pool and clot in the atria, or upper chambers, leading to heart failure, or a debilitating or fatal stroke. Symptoms include shortness of breath, fatigue, chest discomfort, light-headedness and anxiety. Mr. Conroy's doctor told him he had paroxysmal AF — an irregular heartbeat that comes and goes.
The condition is on the rise all across the United States. Fortunately, atrial fibrillation can usually be treated successfully - either with medications or interventions, including a non-surgical procedure called ablation.
Many patients can control their symptoms with medications such as beta-blockers or calcium channel blockers, which slow the heart rate and, as a result, the severity of symptoms. Anti-arrhythmic drugs are another treatment option, and help reduce the frequency of episodes. Most patients must take blood thinners to reduce the risk of developing blood clots.
However, many of these drugs carry unpleasant side effects, including fatigue, loss of libido, and bleeding.
Conroy was diagnosed at a hospital near his home and started on sotalol, an anti-arrhythmic drug, but it led to an episode of ventricular tachycardia, a fast heart rhythm that originates in the ventricles (lower heart chambers) and can lead to ventricular fibrillation or sudden death. It was discontinued. The condition is a known potential side effect of the drug.
He later went on another anti-arrhythmic drug, amiodarone, but it caused different side effects, including an unsteady gait, hand tremors and photosensitivity.
"I couldn't go out in the sun and I like to golf," Conroy said. "It made me feel weak. I didn't feel 100 percent."
Catheter Ablation Procedure
Eventually, Conroy found his way to the CardioVascular Institute at Beth Israel Deaconess Medical Center in Boston, on the recommendation of a relative, and saw Dr. Mark E. Josephson, Chief of Cardiovascular Medicine and an internationally recognized expert in electrophysiology. In 2006, Dr. Josephson performed a catheter ablation procedure (also called radiofrequency ablation or pulmonary vein isolation) on Mr. Conroy.
Mr. Conroy's case was especially complex, according to Dr. Josephson. Besides the drug-induced ventricular tachycardia, he had a leaky heart valve and hypertrophic cardiomyopathy.
"These patients have thick heart walls and elevated pressure in the ventricles and atria," Dr. Josephson says. "In addition, his atrial anatomy was different than most people. Whereas most of us have four pulmonary veins, Mr. Conroy had a fifth pulmonary vein arising from the back of his heart. Since the basis of the procedure is to isolate the pulmonary vein, which causes perhaps 90 percent of AF, Mr. Conroy's anatomy made the procedure more difficult."
The non-surgical procedure involved using a catheter (tube) to reach the areas of the heart tissue where abnormal electrical impulses are causing the irregular beats. The catheter is snaked through the groin to the heart. The membrane between the right and left atria is punctured. Catheters are placed through the hole and placed circumferentially at each pulmonary vein opening as a guide to where the ablation will be performed. The cardiologist then delivers a high-frequency, low-voltage current to the site, burning the tissue so that it channels the electrical impulses into the proper path.
"The goal is to disconnect the muscle fibers that surround the pulmonary vein from the body of the left atrium because it is impulses from the muscle fibers that reach the left atrium to initiate AF," says Dr. Josephson.
The procedure is effective in significantly reducing the frequency of atrial fibrillation as well as the symptoms associated with it about 70 percent of the time. About 30 percent of patients will have a recurrent arrhythmia, either AF or atrial tachycardia. In some cases, these recurrences will quiet down in time. In other cases, patients may need a repeat procedure.
"The ideal candidate for ablation is someone with paroxysmal AF, like Mr. Conroy," says Dr. Josephson. "For many patients, appears to be more effective than drugs. Nonetheless, following the ablation, Coumadin® or newer blood thinning drugs must be maintained for at least six months and in many cases for life, especially in elderly individuals where the risk for stroke is extremely high."
In Mr. Conroy's case, one procedure did the trick. His procedure took about two hours under general anesthesia and he stayed in the hospital one night. Most ablation patients can return to a desk job in one week and moderate exercise in two weeks. After the procedure, Mr. Conroy took Coumadin for a year and was then able to discontinue it.
"It was like a piece of cake," he said. "I felt great the very next day. I would recommend the procedure 100 percent based on what happened to me."
But he does have one small complaint. While he is doing everything he wants with no restrictions, even playing golf, he says, "It didn't improve my game."
Above content provided by the CardioVascular Institute at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted January 2014