Posts Tagged ‘case study’

Case Study: A Catheter Ablation Approach to Atrial Fibrillation

In recent posts, we’ve presented various case studies and examples of patients suffering from atrial fibrillation (A-fib). We’ve seen how debilitating this condition can be, and how severely it can affect a patient’s quality of life.

In this post, we’ll take a glimpse into the life of a Georgia 55-year-old school administrator who developed A-fib over a two-year period, causing him to suffer from fatigue, shortness of breath, and a decreased ability to exercise.

His local physicians made every effort to restore the rhythm of his heart through the use of anti-arrhythmic drugs—unfortunately; the medication generated side effects that necessitated the placement of a pacemaker implant.

When the patients’ A-fib continued to reoccur, the physicians realized that the drug therapy was failing and decided to pursue a course of rate control and anticoagulation therapy. This attempt failed to alleviate the symptoms as well, which prompted his local cardiologist to refer him to Emory University Hospital Midtown to be evaluated for catheter ablation.

Catheter ablation is a minimally invasive procedure that doesn’t involve open-heart surgery, making it a viable option for patients suffering from A-fib. In our patient’s case, it was the ideal solution for his condition—which is why in February of 2010 he underwent the procedure for treatment of his arrhythmia.

Catheter ablation involves threading catheters through the blood vessels towards the heart, which destroys (or ablates) the abnormal heart tissue that causes the condition. We performed the ablation on our patient using conscious sedation, and achieved femoral vein access with catheterization into the patient’s left atrium. Electro-anatomic mapping guided the irrigated-catheter ablation system.

The procedure was completed in less than three hours, and our patient was discharged the following morning. He was able to return to normal activity two days later. After the ablation, we continued to keep him on anti-arrhythmic medication for a month.

At his 3-month and 6-month follow-up visits, he showed no signs of A-fib, and we were able to discontinue the use of the anti-arrhythmic drugs. Today, our patient says that he feels “great”, and he continues to be completely free of atrial arrhythmia and its symptoms.

When anti-arrhythmic drugs fail to alleviate the symptoms of A-fib, catheter ablation is an advantageous alternative. While the procedure works best for patients with recurring A-fib, it can also make sense for A-fib cases without the presence of significant heart disease. Further, recent pilot studies have revealed that catheter ablation is superior to medication as the primary form of therapy for A-fib.

Do you have questions about this procedure, or about A-fib in general? If so, please let me know in the comments section.

About Angel Leon, MD:

Dr. Leon is a Professor of Medicine and the Chief of Cardiology at Emory University Midtown. His specialties include electrophysiology, cardiology, and internal medicine, and his areas of clinical interest include arrhythmia ablation, electrophysiology lab, and pacemaker. Dr. Leon holds organizational leadership memberships with the American College of Cardiology and the American Heart Association, and he’s been practicing with Emory since 1991.

An Innovative Emory Cardiothoracic Surgical Treatment

Imagine experiencing atrial fibrillation (A-Fib), or a quivering of the heart, half of each day, every day. Now imagine a solution—and it doesn’t involve open-heart surgery. The only after effects: a few half-inch marks beneath your armpit accompanied by a new approach to life.

In one anonymous case study, a 46-year-old female executive had suffered from seven years of disabling A-fib, and described how the symptoms of her condition resulted in “zero quality of life.” She was unable to participate in numerous medication trials due to a variety of negative reactions to anti-arrhythmic medications, and she underwent two unsuccessful percutaneous catheter ablation procedures out-of-state.

After thoroughly researching multiple surgery options across the region, she agreed to be Emory’s first patient for a trial of a “Totally Thorascopic Mini-Maze”, involving a fully endoscopic approach to bilateral pulmonary vein isolation, a procedure utilizing bipolar radiofrequency energy and “stapled occlusion” of the left atrial appendage procedures.

On February 14, the patient received three tiny incisions in her chest on each side of her armpit. We made no other incisions, and a thorascopic camera provided our only visualization. At the beginning of the procedure, we carefully measured the exit and entry areas across the pulmonary veins on each side. Electrophysiology measurements confirmed a conduction block across the pulmonary vein on each side.

We stapled the patient’s left atrial appendage shut with an endoscopic, or “no-knife” stapling device, a tool that safely closes the base of the left atrial appendage with three rows of staples and no incisions, thus reducing risk of hemorrhage. Consequently, the patient experienced very little blood loss, and the cosmetic results were ideal, as her three incision sites were hidden beneath her armpit.

The procedure allowed the patient to be discharged a mere three days after surgery, and she only experienced one single brief episode of irregular rhythm upon her return home. At both her 1-month and 3-month follow-up appointments, she showed no signs of A-fib. As part of our comprehensive follow-up, on the anniversary of her 3-month visit, we provided her with a small, portable cardiac rhythm monitor that she used for two weeks to record her heart beat 24 hours a day. The monitor also documented a complete absence of A-fib.

We’re thrilled with the success of this procedure—this pioneering patient, once disabled by severe A-fib symptoms, is enjoying life once again. For carefully selected patients, this procedure could very well be an ideal solution.

If you have questions about this procedure, or about A-fib in general, I’m happy to address them in the comments section below.

About John D. Puskas, MD:

Dr. Puskas specializes in adult cardiac surgery. He began performing coronary bypass operations on beating hearts without using a heart-lung machine in 1996. In 1997, he performed the world’s first triple off-pump bypass surgery using minimally invasive coronary artery bypass graft (mini-CABG) instrumentation. Dr. Puskas is PI of a grant from the National Institute of Health’s National Heart Lung and Blood Institute that makes Emory one of eight U.S. centers charged with rigorous scientific evaluation of newer methods of fighting cardiovascular disease.