Cardiac arrhythmias—disorders affecting the normal rhythm of the heart—are very common in the United States and around the world. Foremost among them is atrial fibrillation, or AFib, which affects a tremendous number of patients and increases in incidence as people get older. In fact, approximately 15 percent of people over age 65 have AFib and that percentage climbs higher and higher as they get older.
ProMedica electrophysiologist Kamala Tamirisa, MD, explains that AFib is an irregular heart rhythm in the top chambers of the heart, usually (but not always) the left chamber. “In people with this form of arrhythmia, the top chamber of the heart quivers and doesn’t contract properly so it becomes an inefficient pump. As a result, blood is not sent down to the bottom chambers effectively. Instead, the blood pools, which can allow clots to form and potentially lead to the complication of stroke,” she says.
In some cases, AFib is incidentally diagnosed during other medical testing, but most people with the condition notice symptoms such as heart palpitations, chest pain with shortness of breath, fatigue, weakness, dizziness or lightheadedness, or confusion.
Though AFib is very common, people who are obese and have sleep apnea are at highest risk for developing the condition. Others at elevated risk include people over age 60 as well as those who have high blood pressure (especially if not well controlled), heart disease, a history of prior heart surgery, or certain other chronic conditions such as diabetes. AFib is also sometimes seen in certain athletes who are otherwise very fit, particularly those who participate in endurance sports that demand long periods of elevated cardiac performance, for example marathons, triathlons, cross-country skiing, and long-distance cycling.
To ensure people in our community who have AFib or other cardiac arrhythmias get the most advanced, specialized care available, ProMedica recently launched our region’s first dedicated Heart Rhythm Center at ProMedica Toledo Hospital. “This center, which is focused exclusively on treating heart arrhythmias, has been two and a half years in planning and execution,” states ProMedica electrophysiologist Johan Aasbo, DO. “The facility includes 6,500 square feet of space, with three operative electrophysiology labs, four procedure rooms, teaching space, and other support areas.”
However, Dr. Aasbo emphasizes that the ProMedica Heart Rhythm Center is not just a physical space. “It’s also a philosophy focused on working collaboratively as a multidisciplinary team to provide the highest quality care to this patient population,” he says.
According to Dr. Tamirisa, there are numerous options for treating AFib, the simplest being cardioversion—essentially jolting the heart to restore a normal rhythm. However, cardioversion is a temporary fix and only 40 to 50 percent effective.
The second treatment option is antiarrhythmic medication to get the heart out of AFib and into a normal rhythm. But this treatment option has two drawbacks: “One is that, at most, it’s 40 percent effective. The other is that these drugs can cause significant side effects, such as lung or liver toxicity, so you have to monitor them very closely,” says Dr. Tamirisa.
If more conservative methods fail and the patient’s quality of life is being affected, the best treatment option for AFib is an advanced, minimally invasive procedure called ablation. This technique involves threading a flexible wire catheter through a vein in the groin and up to the heart. Then, the small area of abnormal heart tissue that is causing the irregular heartbeat is ablated using either radiofrequency energy or liquid nitrous oxide. Dr. Tamirisa remarks that ablation is relatively low-risk and, depending on the type of AFib, has a cure rate between 60 and 80 percent. In younger patients, that rate climbs to 85 percent.
Ablation can also be used in conjunction with a pacemaker. In this case, the antrioventricular (AV) node—the nerve that conducts electrical impulses from the top chambers of the heart to the bottom chambers—is ablated. As a result, the top chambers remain in AFib, while the bottom chambers pump normally with help from the pacemaker.
Dr. Aasbo adds, “Whatever treatment we’re considering, a strategy to reduce stroke risk always has to be part of the conversation. For most patients, that means the use of blood thinners. Also, while we have a lot of treatment options at our disposal, it’s important to keep in mind that treatment is always more effective when it’s started at an earlier stage. The longer you wait to treat AFib, the lower the chances of correcting the problem.”
In addition to having access to the most advanced treatment options, patients of ProMedica’s new Heart Rhythm Center stand to benefit from the extensive combined experience of the multidisciplinary care team. As Dr. Aasbo explains, “With ablation or any other intervention, there’s always some risk, so safety and efficacy are our key priorities. Research clearly shows that concentrated expertise and procedural experience—not just of the doctor, but of the entire center—yields better outcomes.”❦