Doctors at Heart Hospital in Plano have combined two technologies in a new approach to treating atrial fibrillation. It’s the most common form of irregular heart beat and affects three to five million Americans. Dr. J. Brian DeVille talked about this in a KERA Health Checkup.
Dr. DeVille: In atrial fibrillation, the upper chambers of the heart, the right and left atria, stop beating. They don’t contract normally, they just sort of quiver. This results in, usually, a rapid, irregular rate, and in fact puts the patients at stroke risk.
Baker: What’s the reason for that?
Dr. DeVille: Some cases are what we call idiopathic, where there’s no discernable cause for the atrial fibrillation. However, atrial fibrillation’s associated with high blood pressure, obesity, sleep apnea, coronary artery disease and heart failure.
Baker: So it sounds like something maybe you can prevent, or at least maybe keep from getting worse?
Dr. DeVille: There are certainly things that you can do to reduce your risk. Maintaining a healthy body weight, controlling blood pressure, doing preventative maintenance for heart disease. These are things that can reduce the risk. In spite of that, some patients still get atrial fibrillation.
Baker: And how dangerous a situation are we talking about?
Dr. DeVille: The rhythm itself is not fatal. For example, it’s very rare that you would have a cardiac arrest from it. You would have to have some other condition as well. But it does increase the risk of stroke by a factor of five.
Baker: How is it normally treated?
Dr. DeVille: The most common way of treating it is the use of medication; either using medicines to control the rate, or to reduce the number of episodes of atrial fibrillation. In addition, patients are often on anticoagulants to try to prevent clot formation within the heart that can then break off and cause a stroke.
Baker: But now you and doctors at Heart Hospital in Plano combined a couple of approaches to come up with a new therapy.
Dr. DeVille: One of the treatment options that you have is called catheter ablation. And with this we can either freeze or burn the tissue that is causing the atrial fibrillation. We basically isolate the area from the rest of the heart that is triggering the atrial fibrillation, if you will. And we recently combined two new technologies for this.
One is maneuvering a catheter with magnetic navigation, so that rather than standing and moving the catheter by hand we’re served with the use of a computer, which shapes magnetic fields that pulls the catheter within the heart. And then, along with that, we paired up a new software mapping program that increases the speed and accuracy of the procedure.
Baker: The magnetic mapping – how exactly does this work?
Dr. DeVille: Magnetic navigation, the patient lies on a table similar to a cardiac cath lab, or a standard electrophysiology laboratory table. Two large rare earth magnets are brought in immediately beside the patient’s sides. And they generate a strong magnetic field. So rather than pushing a rather rigid catheter, we are pulling a very soft, flexible catheter inside the heart by shaping a magnetic field used on a computer. This allows for a very high degree of precision and a low risk of perforation because of the soft nature of the catheter.
Baker: Are we talking robotic surgery here, or something maybe akin to that or similar to it?
Dr. DeVille: It is very akin to robotic surgery, and in fact, for the developments of this system, we’ll involve robotic manipulation of a second catheter that we use in the heart for the procedure.
Baker: The advantage of this is what?
Dr. DeVille: One is, because the catheter is very soft and flexible, the risk of perforation is reduced. In addition, it allows for a very precise and stable position of the catheter within the heart. Third thing is, we’ve found that we have reduced the amount of X-rays that are required during the procedure by as much as 50 percent for the patients and 90 percent for the staff and physicians in the room.
Baker: Meaning, what?
Dr. DeVille: Lower radiation exposure. So, hopefully improve safety.
Baker: Usually one of the things that’s talked about as an advantage of robotic surgery is a quicker recovery time for patients. Is that the case here?
Dr. DeVille: It seems to be very similar. And we still do a lot of cases that are manually navigated as well as magnetically navigated. Hospital length of stays, recovery times are all very similar.
Baker: How would you know it if you had it?
Dr. DeVille: Sometimes it can present with no symptoms whatsoever, and patients may just be found to have it during a routine physical examination. Unfortunately, sometimes the first symptoms are stroke. Usually it’s either palpitations or shortness of breath, or dizziness, or chest pain.
Baker: So how then should people look out for this, guard for this?
Dr. DeVille: Awareness is the main thing. If you are feeling irregular heartbeats, talk to your physician. Your doctor will be able to find a specialist in rhythm management, an electrophysiologist.
Dr. J. Brian DeVille is Medical Director of Electrophysiology at the Heart Hospital Baylor Plano.
For more information:
http://www.nhlbi.nih.gov/health/health-topics/topics/af/
http://www.webmd.com/heart-disease/atrial-fibrillation/heart-disease-atrial-fibrillation-basics
September 13 seminar on Atrial Fibrillation:
http://www.thehearthospitalbaylor.com/handler.cfm?event=practice,main&CFID=5752805&CFTOKEN=37718763