Best Doctors 2014: A-Fib Advances

Freeze Frame 

Akron General's Dr. Robert Schweikert give those with atrial fibrillation a cooler option for treatment.

The hearts of nearly 3 million people in the United States tend to go haywire. The heartbeat becomes irregular — speeding up and slowing down — because the electrical impulses that control them short-circuit.

Known as atrial fibrillation, people with this condition generally deal with discomfort, fatigue, palpitations and shortness of breath. But they are also five times more likely to have a stroke as the normal population and have an increased risk of death from heart-related causes than everyone else.

In the past, to alleviate this condition doctors typically used heat or freezing energy via a catheter to encircle the area around the opening of the pulmonary veins to eliminate or block the electrical impulses that trigger A-fib.

"It's real tedious," says Dr. Robert Schweikert, chief of cardiology at Akron General's Heart and Vascular Center. "It's like spot welding, going point-by-point."

Since November, Schweikert and other cardiologists at Akron General have been using a new technique, called balloon catheter cryoablation, that more quickly and effectively blocks malfunctioning veins.

With the balloon catheter, the freezing energy is delivered around each pulmonary vein opening all at once. This is done once or twice to each of the four pulmonary veins, which results in a more efficient procedure.

It also often leads to the patient being under anesthesia for a shorter time.

"One or two applications can finish the job," Schweikert says. "It's faster and it's more efficient."

Patients are kept overnight for observation, but then are discharged the next day with minor restrictions.

Using heat energy is still an option, Schweikert says, particularly in patients who have more difficult cases. But for patients who haven't had a procedure to correct A-fib before or who suffer from episodic A-fib, which is when the condition comes and goes on its own, he feels balloon cryoablation is a great tool.

"Freezing is more focused and is a little bit safer," he says. "It's not as powerful, in a sense, as the heat, and for some it's not enough. But it does allow us to do it more efficiently."   // Matt Tullis

vein attraction

To help reduce the risk of stroke, those with A-fib generally take blood thinners to prevent clots in the left atrium. But for patients who can't handle that kind of medication, the only remaining option had been open-heart surgery to tie off that section of the heart where blood often pools.

Last April, MetroHealth Medical Center was the first hospital in Northeast Ohio to perform a new noninvasive surgery, called the Lariat procedure, to seal off the left atrial appendage.

After making two incisions — a small needle puncture in a leg vein and a one-fourth- to one-half-inch cut below the rib cage — doctors insert magnet-tipped catheters and guide one toward the outside of the left atrium and the other inside the heart. The magnets attract, allowing a suture loop to be placed over tissue and cinch it closed like a drawstring. Once closed off, blood cannot gather or clot.

"We finally have an alternative to prevent these debilitating and often fatal strokes," says Dr. William Lewis, MetroHealth's chief of cardiology and director of its Heart and Vascular Center.   // Rebecca Meiser

cage match

In addition to new medications and procedures to help reduce the risk of stroke in patients with A-fib, there's a push to improve the medical devices used as well. The Food and Drug Administration is considering approval of the Watchman, a mesh cage placed by catheter over a part of the heart's left atrium called the left atrial appendage.
"Eventually, the body forms a barrier over the appendage," says Dr. Walid Saliba, director of the Cleveland Clinic's Center for Atrial Fibrillation.
The hospital is one of the sites where trials on the device were conducted. The Watchman could help those patients with a high risk of bleeding or who can't take the blood thinners typically prescribed.
Saliba thinks it could also benefit the elderly. "These are the patients who take medications that can interfere with the medications that you give them for blood-thinning purposes," he says.   // Lynne Thompson
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