Swedish teams combine efforts in new atrial fibrillation procedure
August 17, 2010
By David Hayes
Steve Beer has always enjoyed living in the Issaquah area for its convenient access to outdoor activities, such as hiking to motorcycle riding.
Then, a few years ago, as he approached his 50s, Beer noticed his energy reserves were sapped more quickly.
“I could work out in the yard for hours and be dead as a doornail afterwards,” he recalled. “I just thought I was getting older, out of shape.”
Then, in 2008, an unrelated sinus surgery had to be postponed due to anomalous electrocardiogram readings that concerned his doctors. Further tests by a cardiologist proved Beer had atrial fibrillation, the most common type of arrhythmia or abnormal electrical activity in the heart.
Beer wasn’t alone in his diagnosis. According to the American Heart Association, about 2.2 million Americans live with AF. It is also the most common “serious” heart rhythm abnormality in people over age 65.
Atrial fibrillation occurs when the heart’s two small upper chambers (the atria) quiver — instead of beating rhythmically and effectively — and won’t fully contract (squeeze blood out of the heart completely). Some electrical signals go to the ventricles, which still pump out blood. But blood isn’t pumped completely out of them, so it may pool and clot. If a piece of a blood clot in the atria leaves the heart and becomes lodged in an artery in the brain, a stroke results.
Thus began a two-year journey to cure Beer of his arrhythmia. But the typical treatments weren’t working. He underwent three cardioversions — a brief procedure where an electrical shock is delivered to the heart to convert an abnormal heart rhythm back to a normal rhythm. He was put on blood thinners. Beer also underwent cardiac ablation surgery, essentially inserting a catheter into the heart and scar tissue is left over short-circuited electrical pathways that were causing the arrhythmia.
Each solution was only temporary, leading Beer’s heart back into arrhythmia.
That’s why, at age 50, he volunteered to be Swedish Medical Center’s first patient west of the Mississippi River to undergo a hybrid procedure for atrial fibrillation.
“Actually, I didn’t learn of the ‘first west of the Mississippi’ part until after the surgery,” Beer said.
Dr. David Gartman, Beer’s cardiothoracic surgeon, said the procedure is so new that only a few people east of the Mississippi had undergone it.
The hybrid procedure combines the benefits of surgical and catheter-based ablation to treat patients with persistent and long-standing forms of AF. During back-to-back procedures done in the same operating room, the physicians used minimally invasive surgical ablation products (on the outside of the heart, or epicardial) in conjunction with a catheter ablation platform (on the inside of the heart, or endocardial) to return the patient’s heart to a normal or “sinus” rhythm.
Electrophysiologist Darryl Wells said the breakthrough was realizing there was no reason both specialists could do their procedure while the patient was under just the one time.
“This is really powerful stuff,” he said.
Gartman added that a patient used to have to be opened up like regular heart surgery, cracking the chest cavity.
“Now, we make three, noninvasive holes on the side of the chest a half-inch in length — one for the TV and the other two to operate through,” Gartman said.
He said the benefits to the patient include combining the procedures into one trip to the operating room for quicker treatment, a shorter two- to three-day hospital stay and an expedited return to normal activities.
“And from a physician’s perspective,” Gartman added, “there are numerous benefits to the approach, including the direct visualization afforded a surgeon with the sophisticated mapping and electrical signal technology within the realm of a cardiac electrophysiologist.”
Beer went in for the combined procedure June 9, spending six hours in the operating room. He was given three and a half days of recovery time.
“It was way easier than I expected,” Beer said.
He was walking his neighborhood hills the next day. He was taken off the blood thinning drugs and his heart remains in rhythm to this day.
Now, he’s up to walking four to five miles a day, rebuilding his stamina, getting reacquainted with the area.
“My wife and I like hiking,” he said. “Thanks to the procedure, I can love living in this area with its access to the outdoors again.”
What to know
The symptoms of atrial fibrillation include:
- irregular heart pounding
- shortness of breath
- exercise intolerance
David Hayes: firstname.lastname@example.org, 392-6434, ext. 237. Comment at www.issaquahpress.com.