More than 2.6 million Americans suffer from atrial fibrillation (a-fib)—an erratic heartbeat. If left untreated, the condition can lead to stroke or heart failure. For three decades, 58 year old David Ryan was one of the millions of Americans suffering from the disease. His illness affected him both emotionally and physically; his episodes became so frequent he wouldn't travel because he feared he wouldn't make it to the emergency room on time. In December of 2009, the father of two finally took back control of his life after seeking help from Northwestern Memorial Hospital's Bluhm Cardiovascular Institute's (BCVI) Center for Heart Rhythm Disorder. The Center takes a comprehensive approach to treating a-fib exploring both medical and surgical approaches for each patient.
"Each patient is unique and there is not a one-size fit all approach to treat the disease," said Richard Lee, MD, surgical director for the Center for Heart Rhythm Disorders. "Because a-fib is such a complex disease the course of treatment must take on a multidisciplinary approach and patients like Mr. Ryan benefit from receiving care from a number of specialists in order to identify the best treatment for that individual."
A-fib is a lifelong disorder where the heart's two small upper chambers (the atria) quiver instead of beat effectively. This decreases the amount of blood ejected from the heart with each heartbeat and when blood isn't pumped completely out, it may pool and clot. If a piece of a blood clot in the atria leaves the heart and becomes lodged in an artery in the brain, a stroke results. About 15 percent of strokes occur in people with a-fib.
Symptoms can begin to present in people as early as 40 years old. They include palpations, rapid pulse, dizziness, fainting, confusion, fatigue, shortness of breath and tightness in the chest. For many people symptoms may begin and/or stop suddenly and for a nearly 40 percent of patients symptoms are not present at all. While many patients can be treated with medicine, many cases cannot be successful with drugs alone.
"Once we fully understand the patient's disorder, our team offers therapies and procedures that will best help the patient lead a life that is free from a-fib," said Rod Passman, MD, associate professor of medicine and medical director for the Center for Atrial Fibrillation. "For Mr. Ryan, medicine was not enough so we moved on to the second phase of treatment called catheter (radiofrequency) ablation."
Catheter ablation is a non-surgical procedure performed in the electrophysiology laboratory by specially trained cardiologists called electrophysiologists. The minimally invasive procedure involves inserting catheters (tubes) into the heart and locating the abnormal electrical signals causing the atrial fibrillation. Once found, the pathway is destroyed with energy sources.
"The doctors and I agreed to try the ablation procedure because it was the least invasive but unfortunately that didn't work so we moved on to the next treatment option," said Ryan.
The final phase for patients like Ryan experiencing an irregular heartbeat is minimally invasive surgery. BCVI physicians are treating a-fib with the Hybrid Maze procedure in which small incisions are made on the sides of the chest to access and place scar lines around the pulmonary veins which stop the irregularity.
"Hybrid Maze allows for a faster recovery, shorter length of stay in the hospital, lower infection rates, and less bleeding and trauma than traditional cardiac surgery where you must open the chest in order to access the heart," added Lee, who is also an assistant professor at Northwestern University's Feinberg School of Medicine. "There is also a 90 percent success rate with patients when we combine surgery and electrophysiology. This is remarkable when you put into perspective that these patients won't have to live on medication for the rest of their life or experience the anxiety associated with the chance of having a stroke."
Ryan's Hybrid Maze procedure was successful and the Irving Park resident is now a-fib free. "I am so grateful for the doctors and the time they spent with me. I feel great and have not had an episode in more than a year. The best part, I now get to travel with my wife," said Ryan.
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