University of Virginia Health System

UNIVERSITY OF VIRGINIA CARDIOLOGISTS USE NEW PROCEDURES TO CONTROL IRREGULAR HEARTBEAT

In a normal heart, the sino-atrial node sends signals that determine the heart rate and keep the heart pumping properly. In a person with AF, rapid, irregular signals are generated by multiple areas in the heart. An episode of AF can cause palpitations as well as other symptoms related to diminished delivery of blood, including weakness, fatigue, dizziness, fainting spells and shortness of breath.

Dr. David E. Haines, co-director of Cardiac Electrophysiology at U.Va., explained that atrial fibrillation can precipitate other problems as well. Atrial fibrillation can cause blood clots, and in the worst case scenario, clots can travel from the heart to the brain, causing a stroke. So it's important that we treat atrial fibrillation, not only because patients can be highly symptomatic and feel bad but also because there are serious risks.

In the past, AF has been treated with moderate success with invasive heart surgery and medication. Now, two new treatments that are relatively simple and inexpensive are being offered at U.Va. Health System.

One procedure, focal ablation, is appropriate for patients with only one or a few areas, or foci, of AF. A catheter is inserted through a vein into the affected area of the heart. Using computers for guidance, the physician locates the cause of the irregular heartbeat and destroys, or ablates, those cells by using an electrical current. This prevents the rogue signals from getting to the heart.

We have been using the technology of ablation for a decade, but it has a new use in focal ablation, Haines said. I am very enthusiastic about patients that have only one or two foci of AF and no other cardiac problems at all. The goal for them is to correct the problem and prevent additional AF without major surgery or drugs.

Haines cites an 80 to 90 percent immediate success rate among patients treated with focal ablation at U.Va. Candidates for focal ablation tend to be young and free from other chronic conditions.

Haines is also leading a study for patients with multiple sites of AF using multiple electrode catheter ablation (MECA). A catheter is inserted into the heart through a major artery and multiple electrodes remove tissue in long lines. This creates a wall that stops the abnormal electrical currents and allows the regular rhythm to resume.

Haines says that while the MECA study is showing success, he hopes to further improve the procedure using a new type of catheter currently in development. The study is beginning the second phase and is currently expanding from four sites (U.Va., Riverside Clinic in Cleveland, University of Illinois and Beth Israel in Boston) to 10.

December 20, 1999