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Be Still, My Quivering Heart

New technique cures atrial fibrillation without medication

WEDNESDAY, March 20, 2002 (HealthDayNews) -- There's a new treatment for the 2 million Americans who suffer from the abnormal heart rhythm condition known as atrial fibrillation.

It's a surgical procedure that stops the heart from beating erratically without medications or a pacemaker, says Dr. Francis Marchlinski, director of cardiac electrophysiology at the University of Pennsylvania Health System. His team has documented the effectiveness of the procedure.

"This treatment can actually cure the arrhythmia (abnormal heart rhythm)," says Marchlinski, who presented his findings today at the American College of Cardiology scientific session in Atlanta. "It eliminates the need for chronic drug therapy."

Atrial fibrillation is a very fast, abnormal rhythm of the heart that starts in the top chambers known as the atria. Those chambers start quivering because of wayward electrical impulses. These impulses can cause the heart to beat as many as 600 times per minute, compared to the normal 60 to 80 beats per minute.

Because the heart is beating ineffectively, blood can pool in the chambers. This sometimes causes clots to form, and if a clot breaks free, it can travel to the brain and cause a stroke. About 15 percent of strokes occur in people with atrial fibrillation, according to the American Heart Association.

Symptoms of atrial fibrillation include rapid heartbeat, fatigue, dizziness, chest pain and shortness of breath, Marchlinski says.

About one in five people will experience atrial fibrillation at some point in their lives, he says. One in 20 require treatment for the disorder, he adds. George Bush Sr. and former New Jersey Sen. Bill Bradley have experienced the condition.

The most common treatment is medication that slows the heart rate, along with blood-thinning drugs to prevent clots from forming. The condition is also sometimes treated with pacemakers. However, these treatments don't cure the condition and can have side effects, Marchlinski says.

"Patients don't want to live with daily medication and the risk of stroke," he says.

That's why Marchlinski and his colleagues have been refining a technique developed by French physicians called pulmonary vein ablation.

"Triggers" on the pulmonary veins that attach to the heart cause some cases of atrial fibrillation. These "triggers" are thin muscle fibers on the edges of the veins that extend like fingers, Marchlinski explains.

As you get older, the veins stretch and some of the fibers can separate from the heart. When this happens, the fibers fire electrical impulses randomly to try to reach out to the heart. These errant electrical impulses are what cause the heart to beat erratically.

During pulmonary vein ablation, heart surgeons thread a catheter into the left atrium, and pinpoint the veins with separated muscle fibers. The fibers are then sealed off, using electrodes to cauterize the fibers. Patients are awake during the procedure, which lasts from two to five hours, Marchlinski says.

Like any surgery involving the heart, this procedure is not without risk. Complications can include excessive bleeding or blood clots.

Marchlinski says the procedure is being used in about 10 to 15 hospitals, but he expects it will become standard care for many people with atrial fibrillation.

"It is a method of curing the arrhythmia. It can replace ineffective drug therapy," he says.

The procedure may not be right for all patients, cautions Dr. Neil Bernstein, a cardiologist with New York University Medical Center. Since atrial fibrillation can be caused by many different factors, including cardiovascular disease and high blood pressure, no single treatment will work for everyone with the disorder.

However, Bernstein adds, pulmonary vein ablation is an effective treatment for those whose atrial fibrillation is caused by these "triggers." Ideal candidates are most likely younger patients who don't have any other heart abnormalities, he says.

"For people that are good candidates, this [treatment] represents a potential cure. All the other therapies are Band-Aids," Bernstein says. "This essentially cures the problem without the need for medication."

What To Do: To learn more about atrial fibrillation, read this information from the American Heart Association or St. Jude Medical Inc..

SOURCES: Francis Marchlinski, M.D., director, cardiac electrophysiology, University of Pennsylvania Health System, Philadelphia; Neil Bernstein, M.D., cardiologist, New York University Medical Center, New York City
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