BACKGROUND: Atrial fibrillation (AFib) is a quivering or irregular heartbeat that can eventually lead to stroke, blood clots, heart failure, and other heart-related complications. Approximately 2.7 million Americans are suffering from AFib. A normal heart contracts and relaxes to a regular beat, but in AFib the upper chambers of the heart (the atria) beat irregularly (or quiver) instead of beating normally to move blood into the ventricles. Around 15 to 20 percent of people who have strokes have this heart arrhythmia. When blood is allowed to slow down or pool, it increases the risk of clotting and also increases the risk of stroke. According to the 2009 “Out of Sync” survey only 33 percent of AFib patients think it is a serious condition, even though it is called the most common “serious” heart rhythm abnormality in people over the age of 65. (Source: www.heart.org)
SYMPTOMS: Sometimes people with AFib do not have any symptoms and their condition is only detectable through a physical examination. However, others may experience: rapid and irregular heartbeat, dizziness, fluttering in the chest, weakness, shortness of breath and anxiety, faintness or confusion, sweating, chest pain or pressure, and fatigue when exercising. (Source: www.heart.org) Risk factors can include age, a family history, cardiovascular or lung disease, and chronic health conditions. Some lifestyle factors can increase the risk of AFib including stress, smoking, stimulant drugs like caffeine, and alcohol abuse. (Source: www.tristarcentennial.com)
NEW TECHNOLOGY: Most AFib patients can benefit from medication and ablation procedures to restore normal heart rhythm. However, some patients still experience AFib after an ablation or they can have a more persistent version of the disease. The nContact procedure is a new alternative treatment option. NContact is a new hybrid procedure for treating atrial fibrillation using surgical and minimally invasive therapies. Dr. Gregory Bashian with Centennial Medical Center was quoted as saying, “before nContact was available, AFib patients who needed additional treatment beyond an ablation, had to go through multiple procedures, taking a toll on their bodies and requiring a lot of their time for additional appointments and then recovery. Now, we are able to offer AFib patients an alternative that will return their heart to a regular rhythm in one overall procedure and even reduce their recovery time.” The surgical procedure is performed first, followed by the ablation of the remaining areas of the left atrium. The benefits of this alternative treatment are the increase in safety, the increase in precision, and comprehensive assessment and diagnosis. Some patients experience greater quality outcomes and a shorter, less painful recovery. (Source: www.tristarcentennial.com)
Gregory Bashian, MD, Electro-Physiologist at Centennial Medical Center, talks about a new treatment option for atrial fibrillation.
What is atrial fibrillation?
Dr. Bashian: Atrial fibrillation (a-fib) is a common abnormal heart rhythm. Instead of beating in a nice, coordinated fashion, the two upper chambers of the heart are basically quivering, and that has two main implications. First of all, the blood doesn’t move well within those chambers and that can lead to blood clots, which can cause a stroke. Secondly, it tends to make the lower chambers of the heart go very fast, which can cause people to have multiple symptoms including a sensation of palpitations.
Are there a lot of treatment options out there?
Dr. Bashian: Correct. There are many different treatment options for atrial fibrillation. Medications, unfortunately, are not that effective and they certainly carry with them their own set of long-term risks. Catheter-based therapies are very effective in a certain population of a-fib patients, but there is a very large population of patients that are underserved by that catheter treatment; both due to low success rates as well as difficulty actually performing the procedure. In those patients, we found that the hybrid procedure has provided them with a more durable result in one procedure.
What is your role in the hybrid approach?
Dr. Bashian: So, it is a two-step procedure. During the surgical portion of the procedure performed by my partner, the heart is burned on the outside. I then go in after he has completed his portion, and from the inside of the heart using the traditional, more minimally invasive approaches, I connect the lesion set that he has created and complete it to give us a long-standing isolation of the pulmonary veins, which is really the crux of an a-fib ablation.
So he takes care of the big obvious problems and you go in and get the more detailed?
Dr. Bashian: Exactly. Kind of sharp shoot the gaps of certain places where his catheter cannot get to from the outside of the heart, but mine can from the inside.
This is a pretty new approach, correct?
Dr. Bashian: Correct. In particular, one of the advantages of this particular hybrid approach is that although his is more invasive than the traditional, it is a lot less invasive than other surgical approaches. The two of them work together very well by having him go first and effectively debunk a lot of the atrium, and then I get to see the final isolation.
Can you explain how you burn the atrial tissue?
Dr. Bashian: The atrial tissue is being burned using radiofrequency energy to heat the tissue. The advantage to his ablation is that it is very effective at making full thickness burns that are very contiguous over a large area. The disadvantage is that unfortunately with his approach, he cannot get to all the different parts of the heart; just by the virtue of the cardiac anatomy. So, the two together work nicely because I can get everywhere, but catheter-based procedures tend to use smaller lesions and thus it is much more difficult to create a lesion set that has no gaps in it.
In both cases, are you using that energy or is it different?
Dr. Bashian: It is different catheters, but the same type of energy.
Which candidates are right for this treatment?
Dr. Bashian: So, all a-fib ablation really should be targeted at patients who have symptoms, but within that group of patients there are those that are well treated with catheter-based approaches, meaning they have very high success rates with a very safe procedure. Then there are those that are undertreated or I should say underserved by that procedure. That typically is the patient who has either longer standing persistent atrial fibrillation, meaning their heart has been out of rhythm for an extended period of time despite medications and perhaps even previous catheter-based therapies. We cannot get sinus rhythm in them or people who have more diseased atria, where the atrium itself has actually grown in size and enlarged. Those patients tend to be the ones that we choose to use the hybrid approach on.
So you said it is not really for people who only experience it once in a while. This is for people who have a-fib all the time, correct?