As new and existing oral anticoagulants vie for top honors in treating America’s #1 heart rhythm disorder, a magnetic ablation procedure to help cure the problem (or at least zap it into remission) is attracting the attention of cardiologists and their patients diagnosed with a rhythm disorder called atrial fibrillation (AF).
According to the Mayo Clinic, more than five million Americans live with atrial fibrillation, a condition that occurs when errant electric signals cause the upper part of the heart (the atria) to beat much faster than the rest of it. While some patients experience no symptoms, others describe AF as skipped heartbeats—or even like a “fish flopping” in the chest. Still others feel over-tired, dizzy, or chest discomfort. (See AF Symptoms, below.)
The first line of treatment, drugs help restore a normal beat and reduce the risk of clots that can potentially form as blood swirls chaotically throughout the heart. When pills don’t work, cardiac ablation to short circuit irregular heartbeats offers a long-term solution.
“In general, most AF patients are eligible for cardiac ablation,” says leading heart rhythm expert and Post contributor Douglas Zipes, M.D. “Heart rhythm experts generally prefer patients to have tried and failed at least one antiarrhythmic drug, but that is not mandatory. If ablation appeals to a patient, patients should discuss their risk and potential benefit with the doctor.”
During conventional ablation therapy, surgeons use x-ray images to thread a flexible yet firm tube through the blood vessels into the upper heart chambers. Once there, they send energy via the catheter to zap errant signals at the source and in the process potentially stop atrial fibrillation. However, there are limitations to the revolutionary procedure.
“Traditional ablations utilize a catheter with a certain degree of stiffness,” explains cardiologist Rodney Horton who is affiliated with Texas Cardiac Arrhythmia and UT Southwestern Medical School. “Obviously the stiffness provides a bit more control as the catheter is advanced around the heart. However, a stiffer catheter is more likely than a softer one to cause mechanical injury to the blood vessels and heart. As a result, there are limits to where a firm catheter can be guided easily and safely.”
The Stereotaxis Remote Navigation System is designed to overcome these problems. Stereotactic procedures use 3-D, GPS-like technology to locate small targets inside the body—in this case, specific areas of the heart known to generate abnormal heartbeats.
The advanced system presently in use at 140-plus medical centers and FDA approved to treat patients with cardiac arrhythmias comprises of: 1) a catheter equipped with a magnetically sensitive tip; and 2) two magnets that pivot on either side of the patient table. Using sophisticated computer-guided technology, physicians direct the catheter to the targeted area.
“With Stereotaxis, we no longer depend on stiffness to get the catheter tip to a certain location,” says Dr. Horton, “Instead, physicians utilize the magnetic field across the patient’s chest to pull a flimsy catheter into the desired, precise location with a lower risk of complications—and less x-ray exposure.”
A Grateful Patient
In 2008, Fr. Bill Diltzer became one of the first heart patients in Wisconsin to benefit from advances in cardiac ablation technology for heart rhythm disorders. Despite a family history of heart disease (“Everyone on my mother’s side dies of a heart attack or stroke between age 55 and 65,” says the pastor, now in his 60s,) Fr. Bill was initially unconvinced when a routine EKG discovered atrial fibrillation (AF). “I said, ‘that tracing can’t be mine! It’s all over the place,’ but the specialist assured me that it was,” he recalls. “Looking back, my health was deteriorating for quite some time. But I had no specific symptoms of AF, and any earlier episodes were overlooked.”
After an initial course of medicines, Fr. Bill’s heart rhythm expert recommended cardiac ablation using the Stereotaxis Magnetic Navigation System. He agreed. And it’s a decision for which he is very grateful.
“I was told that either the procedure will work, or my life will be very short,” he says. “My doctor expected tremendous results, but my experience still astounds her. My recovery was longer than anticipated. But within one year I was walking close to 2 miles a day. Now I walk 3 miles a day and don’t think anything of it.”
No one can say whether Fr. Bill’s arrhythmia is gone for good. Outcomes of ablation therapy improve symptoms in 83 to 87 percent of AF patients but remain “tantalizingly unpredictable” in those with persistent or longstanding symptoms, according to a 2011 British single-center study that followed 100 patients for three years after an initial ablation.
“My ablation has held perfectly for 3 ½ years now,” the pastor reports enthusiastically. “They say we may need to do something else later. But if they can control my AF for the next 40 years, I’m fine with that!”
Symptoms of atrial fibrillation (AF) can vary from person to person. Many feel no symptoms and are completely unaware they have AF, while others can tell as soon as it happens. Symptoms include:
- Feeling over-tired or a lack of energy (most common)
- Pulse that is faster than normal or changing between fast and slow
- Shortness of breath
- Heart palpitations (racing, pounding or fluttering)
- Trouble accomplishing everyday exercises or activities
- Pain, pressure, tightness, discomfort in your chest
- Dizziness, lightheadedness, fainting
- Increased urination