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Atrial Fibrillation - May '08
Treating atrial fibrillation the non-invasive way
Yousuf Kanjwal, MD, FAACC
More than 2.2 million Americans suffer from a heart-rhythm condition known as atrial fibrillation (afib or AF). In order to provide the most effective treatment, specialists at The University of Toledo Medical Center urge people to see a doctor if they experience heart palpitations. “Treatment is more successful when the condition is addressed sooner,” says Yousuf Kanjwal, MD, FAACC, director of electrophysiology. “That’s why it’s important to consult a physician right away.”
Dr. Kanjwal began practicing cardiology in 1987 and since then he has seen the evolution of afib treatments firsthand. “We used to consider afib incurable, and patients were confined to using blood thinners and other toxic medications for life,” he says. “Within the past 10 years, we’ve started looking at afib as a curable condition.” Dr. Kanjwal outlines some possible non-invasive treatments below:
Medication
To treat afib as conservatively as possible, specialists at UT Medical Center start with medications. Since a rapid heartbeat is a symptom of afib, prescribed medications are used to normalize the rate. However, they only help 40- to 50-percent of patients long term. Additional medications, such as blood thinners, may be used in combination with other therapies to reduce the risk of stroke.
Electrical Cardioversion
Used in conjunction with medication, electrical cardioversion uses electricity to jolt the heart to a new beat. “We use paddles on the chest to deliver electrical therapy that regulates the heart’s rhythm,” Dr. Kanjwal says. “A patient’s heart will beat normally afterwards about 50 percent of the time.” However, electrical cardioversion alone doesn’t cure patients. Medications are needed in combination with therapy to keep the heart in normal rhythm.
Pacemaker implantation
Another way to control heart rate is through pacemaker implantation. This minimally invasive procedure implants a pacemaker under the skin – on the front side of the chest just below the collarbone. The small device weighs only 1.5 ounces and is powered by a lithium battery, which lasts about 10 years. An electrode is attached to the heart’s wall, and the pacemaker sends electrical impulses through a wire to regulate heart rate. “The procedure is simple and only takes five minutes,” Dr. Kanjwal says.
Radiofrequency ablation
Before surgery, the last option for non-invasive afib treatment is radiofrequency ablation (RFA), which destroys faulty tissue. Patients considered for RFA are highly symptomatic and have not had success with other treatments. Like pacemaker implantation, catheters are guided through the groin. “In RFA, physicians use moving X-rays to place the catheter inside the heart – to the location where cells give off electrical signals that cause an abnormal heart rhythm,” Dr. Kanjwal says. “Then painless radiofrequency energy is transmitted to that area, destroying faulty tissue.” The success rate for patients with intermittent episodes of afib is 70 to 80 percent. However, for patients with continuous episodes lasting more than six months, the success rate decreases to 50 percent.
Unlike the quick pacemaker implantation procedure, RFA takes five hours. “It’s time consuming because it involves mapping and finding those areas in the left upper chamber of the heart that are responsible for afib,” Dr. Kanjwal says. UT Medical Center is the only location in northwest Ohio that has specialists who perform RFA. “To perform RFA, doctors need to be specialized and most fellowship programs require an extra year to become certified,” Dr. Kanjwal says. “RFA is also more time consuming and not as profitable so many practices would rather perform other afib treatments.”
In addition to giving patients a better quality of life, treating afib can prevent a stroke and congestive heart failure. “We dedicate ourselves to curing afib,” Dr. Kanjwal says. “That includes giving patients the most individualized and leading-edge treatments available.”
To schedule an appointment with one of UT Medical Center’s atrial fibrillation specialists within 24 hours, call 877-451-2299.
