Atrial Fibrillation

New treatments for arythmia go beyond blood thinners

For most of her life, Maria Sanabria has been affected by heart problems, starting when her father had a heart attack in his 40s. When Sanabria, now 47, was diagnosed with atrial fibrillation or AFib, last April, memories of her father’s experience inflamed her fears.

Like her father, she also suffers from serious hypertension. A-Fib, which causes an irregular heartbeat, can result in shortness of breath, lightheadedness, heart palpitations, chest pains and extreme weakness. While some patients feel no symptoms, severe AFib results in blood clots that can lead to stroke. After episodes landed her in the emergency room, Sanabria’s cardiologist tried a blood thinner, which prevents clots from forming. It didn’t work.

“I still went into atrial fibrillation,” Sanabria says, ending up in the emergency room and unable to work.

According to the Centers for Disease Control and Prevention, more than 2.5 million people had AFib in 2010, and as many as 12 million will have the condition by 2050. A person can develop AFib at any age, but the risk increases as we age. The average age for patients is 66.8 years for men and 74.6 years for women. Because of Florida’s high elderly population, the state’s Afib rate is one of the highest in the country. The primary risk factor is hypertension, doctors say.

Over the past 20 years, according to the CDC, mortality rates in which Afib was an underlying cause of death have steadily increased. Estimated cost of treatment of atrial fibrillation in 2005 was $6.65 billion per year, including hospitalization, physician care and medications.

Blood thinners, like the one used to treat Sanabria, work well, but many patients can’t tolerate the side effects. They affect diet, and some patients are prone to bleeding. Other drugs are designed to prevent or stabilize the irregular heartbeat, but also cause serious side effects and often don’t work.

“The anti-arythmic drug area has been a disappointment. They haven’t been as effective as we’d hoped,” said Dr. Robert Myerburg, professor of medicine and physiology at University of Miami’s Miller School of Medicine.

If medications don’t work, and the patient’s quality of life has deteriorated, doctors may recommend ablation, a non-surgical procedure in which doctors insert a catheter and destroy a small area of heart tissue that is causing the irregular heartbeats. Ablation once required doctors to open up the chest, and resulted in long recovery times. Today the procedure generally requires only a couple of days in the hospital.

“For AFib, it doesn’t work for everybody and fairly frequently you have to go back and do it a second time,” Myerburg said.

Sanabria’s doctor suggested she talk to a surgeon known for performing a relatively new ablation procedure, the Hybrid Maze, in which doctors make small incisions in the patient's stomach to access the heart and create surgical lesions that block A-Fib triggers and pathways. Then, another doctor, an electrophysiologist, uses cardiac mapping technology to plug any small gaps in the surgical lesions. Sanabria, a tech nurse at Mount Sinai Medical Center in Miami Beach, saw Dr. Angelo LaPietra, a cardiothoracic surgeon at Mount Sinai, who began performing the procedure in 2009. The procedure is more effective, doctors say, because it combines two procedures, targeting both the inside and outside of the heart. LaPietra says that success rates are more than 80 percent.

Sanabria had the surgery last month, and says she has not had another incidence of AFib. She returned to work a month later.

“Just not to go into atrial fibrillation again and have those complications,” she said, “it’s a great feeling.”

Another new option for patients who cannot take blood thinners is the Lariat procedure, which prevents blood clots and has a success rate of from 90-95 percent, says Dr. Ramon Quesada, medical director of interventional cardiology and cardiac research at Baptist Cardiac & Vascular Institute.

Quesada was the first physician in the Southeastern United States to perform the Lariat procedure. A rope-like device is used to cinch off a piece of the heart where blood tends to collect, stagnate and clot, often leading to stroke.

George Busse, 81, has a history of heart disease, wears a pacemaker and has had two stents inserted. Busse also has AFib. When he could not tolerate the blood thinner, he opted to have the Lariat procedure last month.

An avid swimmer for much of his life, Busse says, he stopped a couple of months ago.

“After I see the doctor next week…,” he says, “I’m going back to the pool.”

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