Miniature electronics that power smartphones and gaming consoles are sparking new innovations in cardiology. Wireless devices monitor the heart 24/7 to save lives in specialized hospital units. Now, the sophisticated gizmos are standing watch over heart patients after they go home.

Today’s tiny implants monitor blood flow or heart rhythm, among other key measures. Then, when something goes wrong, the device signals a medical professional and alerts the patient to seek help immediately. Research proves that implanted heart failure monitors reduce hospitalizations and improve outcomes. Pacemaker and defibrillator monitors with wireless communication features routinely perform checkups without a trip to the doctor’s office.

On the horizon: an early warning system to detect heart attacks before symptoms occur, ensuring the best, most timely treatment possible. Clinical trials of the AngelMed Guardian device (the ALERTS study) are recruiting patients at nearly 80 study locations nationwide.

Innovations in Heart Health The Saturday Evening Post

Caffeine: You’re probably well aware that coffee can cause erratic or rapid heartbeats. It can also lead to atrial fibrillation in susceptible people. Some feel palpitations when they consume caffeinated soda, tea, or chocolate.

Overeating: For some individuals over-indulging at the buffet table may cause symptoms. Why? A full stomach can irritate nearby nerves, stimulating the heart and triggering extra heartbeats.

Red Wine: Small amounts of alcohol, particularly red wine, can benefit the heart. In excess, however, alcohol may cause heart arrhythmias and “holiday heart,” or palpitations on Monday after a weekend binge.

Supplements: It’s impossible to say which dietary supplements can potentially affect the heartbeat (or interfere with heart medicines) because most are unregulated and untested. “Natural” does not mean “safe,” and consumers can unknowingly take products that contain hidden and potentially harmful ingredients. Diet pills can be especially dangerous. For example, the FDA warned last October that 20 brands of dietary supplements for weight loss were tainted with sibutramine—the active ingredient in prescription weight-loss drug Meridia that was linked to elevated blood pressure, heart rhythm problems, heart attacks, and stroke and removed from the U.S. market in 2010.

Common Causes of Irregular Heart Rhythms The Saturday Evening Post

AF occurs when the heart’s two upper chambers (the atria) quiver instead of beating effectively. In paroxysmal AF, the abnormal heart rhythm starts and stops on its own.

When drugs to control erratic heartbeats don’t work, doctors may use electric shock or thread catheters through blood vessels to zap cardiac cells with heat, a therapy called radiofrequency ablation.

The innovative therapy reported at the American College of Cardiology (ACC) 2010 Scientific Sessions utilizes freezing technology, or cryoablation, instead.

“Cryoablation could offer a straightforward and significantly simplified treatment for patients with very symptomatic and obnoxious atrial fibrillation,” says Dr. Douglas Packer, professor of Medicine at the Mayo Clinic in Rochester, Minnesota, and principal investigator of the Stop AF (Sustained Treatment of Paroxysmal Atrial Fibrillation) study.

In the pivotal trial, the Arctic Front Cardiac CryoAblation Catheter System from Medtronic kept nearly 70 percent of AF sufferers symptom-free for one year, compared to 7.3 percent of those given the usual drug therapy.

“There are 150,000 to 200,000 new cases of AF in the U.S. every year, Dr. Packer explained to Post editors. “Some will be asymptomatic and treated with blood thinners to prevent strokes. Others might be treated with anti-arrhythmic drugs. But the target population for ablation is people who don’t respond to drug therapy—and there are a lot of them.”

To date, more than 9,000 patients have been treated worldwide with the Arctic Front Cryocatheter. The treatment is not yet approved in the U.S., however.

“Seeking FDA approval for the system is the next step,” says Dr. Packer. “Data from Europe support the approach, but the FDA requires a large U.S. trial to demonstrate the device’s effectiveness and safety,” he explains. “This is the hallmark clinical trial in the U.S.”

Other ACC News on Atrial Fibrillation

Ablation therapy: Dr. Packer also reports that the CABANA pilot study of 60 patients with persistent or long-standing AF and underlying cardiovascular disease found that catheter ablation more effectively prevented recurrent AF than drug therapy. But the NIH-funded study is just getting started.

“The 4 to 5 year Cabana trial will consider longer-term issues of ablation: Does it reduce mortality, does it prevent strokes, and how much does it cost,” notes Packer.

Drug therapy: Analysis of pooled data from the EURIDIS and ADONIS trials suggest that it’s safe for doctors to prescribe dronedarone (brand name: Multaq) for their patients with atrial fibrillation within two days after discontinuing treatment with the drug amiodarone (brand name: Cordarone).

“Many doctors want to switch their AF patients from amiodarone to dronedarone,” says Dr. Peter Kowey, lead investigator and chief of the division of cardiovascular diseases at the Main Line Health System in Wynnewood, Pennsylvania. “These data will give some guidance until a randomized trial is completed.”

Atrial Fibrillation The Saturday Evening Post

A: What you describe is not common, though it unquestionably happens. Unfortunately, atrial fibrillation generally recurs unless the factors that first produced it are no longer present — for example, a narrowed heart valve is replaced by a prosthetic one, or hypertension that made the heart work harder is now under control. Another factor to consider is that having AF actually changes or “remodels” the atrial heart muscle into tissue more conducive to having AF. However, the reverse is true also.

Having a normal rhythm can help reverse the remodeling and deter future AF recurrences. You are most fortunate, and I hope the normal rhythm continues. Do let me know what happens.

Atrial Fibrillation Stops on Its Own The Saturday Evening Post

Coumadin (trade name warfarin) “thins” the blood by interfering with its normal clotting processes. This action is important in patients who have a condition that may predispose to the development of blood clots, such as some forms of phlebitis, a heart-rhythm problem called atrial fibrillation, foreign bodies in the bloodstream such as artificial heart valves, and a host of other conditions. In these patients, Coumadin can prevent blood clots from forming, and thus prevent dangerous complications such as strokes. The degree to which Coumadin is affecting clotting is monitored by a blood test called INR (international normalized ratio), generally checked monthly. Changes in the dose of Coumadin, diet, and the action of other drugs that can affect the metabolism of Coumadin can reduce or augment its actions.

When you say your blood was “dangerously thin,” it sounds like something enhanced the effects of Coumadin and your blood became excessively anticoagulated. Think back to whether you added a new medication, changed doses, altered your diet, or did something else that might have affected the Coumadin. Go over this with your doctor because it is important to prevent excessive anticoagulation from happening again. It sounds like you did not have a permanent complication, but that can happen if your blood gets too thin, and such a bleeding complication needs to be avoided.

Aspirin (Bufferin is just a trade name for aspirin) also affects the normal clotting process but by a different mechanism. Aspirin interferes with the ability of platelets to clump together to form clots. Sometimes aspirin and Coumadin are taken together, but that can increase the chance of bleeding.

Thinning Blood and Coumadin The Saturday Evening Post