Experts Describe Innovative Treatments for Atrial Fibrillation

Atrial fibrillation (AFib) is a type of irregular heartbeat that affects about 2.3 million people in the U.S. It occurs when there’s a malfunction in the heart’s electrical signals, causing it to beat rapidly and erratically.

According to the National Stroke Association, AFib raises a person's risk for stroke by 500 percent. However, properly treating AFib can greatly reduce this risk.

During a free online health lecture, top experts from the AFib Clinic at Boulder Heart described a range of innovative treatment options for bringing your heart back to a normal rhythm, including minimally invasive procedures such as catheter ablation, the new WATCHMAN and hybrid ablation.

Pillars of Treating AFib
Sameer Oza, MD, one of the most experienced cardiac electrophysiologists in the Denver-Boulder area, started off the lecture by describing pillars to treating AFib:

1. Stroke prevention - Cardiologists often prescribe blood-thinning medications (anticoagulants) to prevent blood clots and reduce the risk of a stroke. Sometimes your doctor may recommend a catheter-based procedure to seal off your heart’s left atrial appendage.
2. Heart rate control - Your doctor may also prescribe drugs that help slow your heart rate. Those who cannot tolerate medications can also undergo atrioventricular (AV) node ablation – a cardiac catheterization procedure that’s performed in conjunction with the placement of a permanent pacemaker.
3. Heart rhythm control - Medications or cardioversion, a procedure where an electrical shock is delivered to the heart, can restore normal heart rhythm.
4. Risk factor modification - To reduce your risk of complications associated with AFib, the American Heart Association says you should:

• Get regular physical activity
• Eat a heart-healthy diet, low in salt, saturated fats, trans fats and cholesterol
• Manage high blood pressure
• Avoid excessive amounts of alcohol and caffeine
• Don’t smoke
• Control cholesterol
• Maintain a healthy weight

Catheter Ablation to Restore Normal Heart Rhythm
If you wish to avoid medications or cardioversion — or if medications don’t work well enough — Dr. Oza said that catheter ablation offers the best alternative for restoring a normal heart rhythm. This minimally invasive procedure selectively destroys the tissue creating problematic electric signals and interfering with the heart’s regular rhythm.

Using an all-digital biplane cardiac imaging system and a three-dimensional cardiac mapping system, the cardiac electrophysiologist inserts narrow, flexible catheters into a vein, usually in the groin area, and then guides the catheters into the heart. Depending upon the type of catheter being used, the physician either applies electrical energy to destroy the malfunctioning tissue (radiofrequency ablation) or freezes it (cryo-ablation).

Foothills Hospital hosts one of Colorado’s most sophisticated electrophysiology (EP) labs for catheter ablation procedures.

Watchman: An Alternative to Blood Thinners for Stroke Prevention
Following Dr. Oza’s presentation on catheter ablation, interventional cardiologist Srini Iyengar, MD, BCH's structural heart program director, spoke about the Watchman procedure.

According to Dr. Iyengar, blood-thinning medications, such as warfarin (Coumadin®), are the most common treatment for protecting AFib patients from stroke. These clot-preventing medications can greatly reduce stroke risk if taken properly and no side effects are seen.

Yet, more than half of all AFib patients are not prescribed these medications. For certain individuals, there are barriers to taking a blood thinner, including dangerous interactions with other medications, dietary restrictions, high prescription costs, and concerns about bruising or excessive bleeding from an injury.

Dr. Iyengar stated because of these concerns, the Watchman procedure could be an alternative to taking blood-thinning medications for some AFib patients.

Watchman is a one-time procedure performed under general anesthesia in a catheterization laboratory setting. The procedure usually lasts about an hour and the patient is typically in the hospital for 24 hours following the procedure. Learn more about Watchman here.

Minimally Invasive Surgical and Hybrid Procedures

• Cox-Maze 4 is a minimally invasive heart procedure. Through small incisions and punctures in the chest, a surgeon uses radiofrequency or freezing to create scar tissue in the upper chambers of the heart. The scar tissue then interrupts the electrical signals causing AFib. According to Dr. Mahan, this procedure has high success, with some studies showing a 95 percent cure rate 10 years after the surgery.
• Thoracoscopic hybrid ablation is a collaborative procedure performed by both a heart surgeon and an electrophysiologist. The heart surgeon creates scar tissue on the outside of the heart, while the electrophysiologist does the same on the inside using a catheter-led device to freeze the malfunctioning heart tissue. This scar tissue then blocks the damaged electrical pathways that cause AFib. The procedure involves small incisions on each side of the chest and a few small punctures in the groin.

Dr. Mahan explained that these procedures are most commonly performed when a patient is having heart surgery for some other reason such as a coronary artery bypass, atrial valve replacement or mitral valve repair.

View PowerPoint slides from the free health lecture titled “Innovative treatments for atrial fibrillation.”

Call 303-442-2395 to schedule a consultation with Boulder Heart’s specialized AFib cardiology team.