The new AFib Center at Doylestown Hospital puts special emphasis on a growing cardiac problem. We are one of the Top 10 facilities in the country in volume for cryoablation, says Dr. Harding, and we are also a national training site for the procedure.
For millions of Americans, chronic, debilitating heart conditions are a part of life and often a barrier to quality living. At The Richard A. Reif Heart Institute of Doylestown Hospital, our physicians, nurses, and technologists are at the leading edge of diagnosing and treating all of these conditions, including atrial fibrillation (AFib), a degenerative heart-rhythm disorder that affects 20 million people nationwide. In response to the growing need for this care in our own community, the hospital has formed the AFib Center at The Richard A. Reif Heart Institute of Doylestown Hospital, a comprehensive center where inpatient and outpatient treatments are tailored to each individual, in order to control and eliminate AFib.
Atrial fibrillation is the most common form of irregular heart rhythm (arrhythmia). When the electrical impulses that power the heart fail to travel in an orderly fashion through the atria (the upper chambers of the heart), multiple impulses spread simultaneously; this causes a fast, chaotic rhythm. As a result, the atria cannot contract or squeeze blood effectively into the ventricle (the bottom chambers), which in turn causes a rapid, irregular heartbeat. The symptoms of AFib include heart palpitations, chest pain or abdominal pain, shortness of breath, lightheadedness, and fatigue. Although there is no one specific cause of AFib, the condition has been closely linked to high blood pressure, coronary artery disease, heart valve disease, and chronic lung disease. AFib has also been indicated as a major risk factor for stroke; those with AFib are five times more likely to have a stroke, and the National Stroke Association estimates that approximately 15 percent of all people who have strokes have AFib too.
AFib primarily affects people over 60, explains Robert Sangrigoli, MD, an electrophysiologist at Doylestown Hospital. With a growing population of people 65 and older in this country, we are definitely seeing more and more cases of AFib.
Why an AFib Center?
In thinking about the best ways to manage AFib, says Dr. Sangrigoli, we asked ourselves, "How can we more efficiently handle AFib patients, starting with the Emergency Room, where many patients are diagnosed for the first time?" Creating a center focused on AFib emerged as the best choice.
It allows cardiologists, cardiothoracic surgeons, and electrophysiologists to fully integrate AFib care and tailor therapies for patients from the first time we see them, says John Harding, MD, Director of the Electrophysiology Lab at The Richard A. Reif Heart Institute of Doylestown Hospital. Having a more structured program also makes navigating our healthcare system easier for patients, and allows physicians to provide better follow-up care on important issues like stroke risk reduction.
Patients treated through the AFib Center have access to a broad range of therapies for cardiac rhythm disorders. We always start with the least invasive options, says Harding, noting that this usually involves lifestyle management and medication to control the arrhythmia. Cardioversion, an outpatient procedure in which low-energy shocks are delivered to the heart in order to restore a normal rhythm, is another option. Also available are cardiac resynchronization therapies. This includes pacemakers (implanted under the skin just below the collarbone to treat a heartbeat that is too slow; a wire going from the pacemaker to the heart delivers a stimulus if the heart misses a beat), which allow physicians to start or increase medication used to control AFib, and implantable cardioverter defibrillators (ICDs), for patients at high risk of sudden cardiac death from particularly dangerous arrhythmias such as ventricular tachycardia or ventricular fibrillation.
If these therapies aren't enough, patients can be treated with a more aggressive, yet minimally invasive, approach.
* Catheter-based ablation: For the past decade, this meant using radiofrequency ablation to create lesions around the pulmonary vein, thereby blocking irregular electrical signals, explains Sangrigoli. Now, physicians at The Heart Institute of Doylestown Hospital are offering a new catheter-based ablation procedure, just recently approved by the FDA. This technique, known as cryoablation, uses a freezing agent rather than heat to create lesions that block irregular signals. Cryoablation has several advantages over heat ablation. Heat ablation requires that multiple lesions be created in order to prevent electrical signals from reaching the atria, but between these lesions, there may be spaces where abnormal signals can still sneak through, resulting in the need for repeat procedures. By contrast, cryoablation creates a full circle of lesions that irregular signals are less likely to penetrate. Additionally, heat ablation can occasionally cause a complication known as pulmonary vein stenosis, a narrowing of the vein due to the development of scar tissue; this does not appear to happen with cryoablation. We are one of the Top 10 facilities in the country in volume for cryoablation, says Dr. Harding, and we are also a national training site for the procedure.
* Convergent surgery: As AFib progresses, patients with more stubborn arrhythmias may find that medication and ablation techniques are not enough to control their irregular rhythms. In these cases, physicians at The Heart Institute turn to an innovative surgical technique, a combined approach known as convergent surgery. The new convergent procedure allows us to address AFib with a team approach, explains Dr. Sangrigoli. Using a small incision, an experienced electrophysiologist is able to deliver energy to the heart from the outside, while a cardiothoracic surgeon delivers energy to the inner areas of the heart. Adds Dr. Harding, Convergent surgery is really the best of both worlds when dealing with the toughest cases, since it can completely eliminate AFib, unlike pacemakers, which just manage the disease. Currently, only 36 facilities nationwide perform convergent surgery, he says, so we're especially proud to offer it at Doylestown. To facilitate these procedures, the hospital constructed a special hybrid room that serves as both a catheterization lab and an operating room the two components necessary for performing convergent surgery.
As medical research progresses and additional therapies are developed for the treatment of AFib, Dr. Harding and Dr. Sangrigoli both express confidence that the AFib Center at The Heart Institute of Doylestown Hospital will stay in step with these advances. New anti-arrhythmia medications with fewer side effects are one area of innovation we're hoping to see come to fruition in the next 10 years, says Dr. Sangrigoli. The current drugs we have, while effective, do come with the potential for significant side effects, since they act on all cells in the body. The drugs currently being studied target only the abnormal cells causing the arrhythmia. There are also new energy sources being investigated for future ablation procedures. In addition to cryoablation, says Dr. Sangrigoli, we hope to soon be able to do ablation procedures with ultrasound, microwave, and laser frequencies. We will stay on top of all of these advances to meet the needs of the patients in our community.
For more information about the AFib Center at The Richard A. Reif Heart Institute of Doylestown Hospital, call 215-345-2850.