HACKENSACK MERIDIAN HEALTH OFFERS STATE OF THE ART, COLLABORATIVE CARE FOR ATRIAL FIBRILLATION

BY LISA BUFFINGTON • PHOTOS BY AMESSE PHOTOGRAPHY

The heart is considered the engine room of the body, the organ responsible for sending blood through the 60,000 mile long circulatory system, delivering a constant supply of fresh oxygen and nutrients. It’s a big job the heart beats over 100,000 times per day and 40 million times per year.

Atrial Fibrillation, often shortened to AFib, is a condition that affects the heart’s electrical system, resulting in an irregular rhythm in the upper chambers of the heart called the atria. This irregular heart rhythm prevents blood from properly flowing through the heart. Although AFib is a common cardiac condition, effective treatment is critical to prevent serious complications. If left untreated, AFib increases the risk of stroke and heart failure and may have a negative impact on a patient’s quality of life.

The condition affects more than 2.5 million people in the U.S. including 9% of people over the age of 65 and is associated with more than 450,000 hospitalizations each year.
Some people with AFib experience symptoms that include:

• Heart palpitations that feel like fluttering, racing, or pounding in the chest
• Lightheadedness
• Extreme fatigue
• Shortness of breath
• Chest pain
• Reduced ability to exercise
• Congestive Heart Failure

AFib, however, doesn’t always cause noticeable symptoms, and some patients may not even be aware that they have it.

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“AFib is one of the most common conditions we see in general cardiology,” said Aaron Feingold, M.D., chairman of the Division of Cardiology at Hackensack Meridian JFK Medical Center. “Primary care physicians often discover the condition during a routine exam and send the patient to a cardiologist.”

Dr. Feingold explained when a patient comes to him with suspected AFib, he asks about their history of symptoms and other cardiac risk factors such as high blood pressure. He also asks patients about lifestyle factors that could affect heart rhythms, such as consuming too much caffeine or alcohol. Next, he orders tests to rule out other conditions, such as blood work to check thyroid function, an echocardiogram to look for other problems in the heart, and a stress test to check for blockages that may affect blood flow.

After the AFib diagnosis is confirmed, Dr. Feingold’s next step is to manage the patient’s stroke risk by using anticoagulant medications, also known as blood thinners.

“When a patient has AFib, blood clots can form in an area of the heart called the left atrial appendage (LAA),” noted the doctor. “If one of these clots leaves the LAA and travels to the brain, it can cause a serious stroke. Blood thinning medications help to prevent clots from forming.”

Antiarrhythmic medications may also be used to restore a normal heart rhythm or reduce symptoms, but they don’t work for everyone. Another treatment option is cardioversion, which is performed in the hospital by a cardiologist. Cardioversion delivers electrical shocks to the heart that restore normal rhythm. Some patients may need additional care from an electrophysiologist (EP), a cardiac subspecialist that treats irregular heart rhythms.

Riple Hansalia, M.D., a cardiolo gist and EP at Hackensack Meridian Jersey Shore University Medical Center, said one of the most common procedures to treat AFib is catheter ablation.
“Catheter ablation procedures are effective in reducing the amount of AFib a patient experiences,” explained Dr. Hansalia. “If we can eliminate AFib entirely or even significantly lower a patient’s AFib burden, patients typically feel better, improve their exercise capacity, lower their risk of heart failure, and restore their quality of life.”

Before a catheter ablation, the EP performs a transesophageal echocardiogram (TEE) to check for blood clots and other heart conditions that could cause complications. Then the EP uses advanced mapping software to create a three dimensional model of the heart with a catheter inserted into a vein through a small incision in the leg that is guided to the heart.

“The 3 D mapping software shows where the abnormal electrical signals are occurring and gives us a specific road map to follow during the ablation procedure,” said Dr. Hansalia
The EP uses heat or extreme cold to create small lesions inside the heart that disrupt the abnormal electrical signals that cause AFib. The procedure takes about one and a half to two hours and many patients will go home the same day.

Dr. Hansalia said EPs also perform a catheter based procedure called Watchman®, which reduces stroke risk for people with AFib who cannot tolerate blood thinning medications or have a high risk of bleeding. Under TEE guidance, EPs place the Watchman device in the LAA opening, closing it off and preventing blood clots from forming. Once inserted, the Watchman allows blood thinners to be stopped while still protecting patients from having a stroke.

For patients with advanced AFib who can’t take blood thinners, or have AFib that hasn’t responded to other treatments, surgical treatment may be an option.

“Patients with AFib who need open heart surgery for another reason, such as a cardiac artery bypass graft (CABG) or valve surgery, can receive concomitant AFib treatment at the same time,” said Mark Anderson, M.D., chief of the Division of Cardiac Surgery and a cardiothoracic surgeon at the Heart and Vascular Hospital at Hackensack University Medical Center and Hackensack Meridian Health.

Just as catheter based ablation creates lesions inside the heart to block abnormal electrical signals, the doctor explained, cardiac surgeons can create similar lesions outside the heart during open heart surgery.

However, for patients with AFib who don’t need open heart surgery for another condition, Hackensack Meridian Health physician’s offer a less invasive, two stage hybrid procedure called CONVERGENT. During the first stage of CONVERGENT, a cardiac surgeon makes a small incision near the bottom of the sternum and performs an ablation outside the heart. The surgeon also closes o the LAA from the outside, which drastically reduces stroke risk and eliminates the need for anticoagulants.

In the second stage of the CONVERGENT procedure, an electro physiologist performs a 3 D mapping and catheter ablation to treat AFib from inside the heart.

“CONVERGENT is a less invasive, multidisciplinary treatment for AFib with high success rates, and we are now seeing it used as a first line therapy in certain cases,” said Dr. Anderson.
For patients concerned about AFib, Dr. Hansalia explained that keeping their blood pressure and cholesterol under control can lower their risk of developing the condition. “If you notice AFib symptoms, having a comprehensive evaluation by a cardiologist can help you avoid dangerous complications and get the care you need. We now have amazing AFib treatments compared to 15 20 years ago, and the treatment options keep expanding.”

The doctors also stressed the importance of maintaining heart care amid the COVID 19 pandemic.
“Patients should maintain their appointments if they are already under the care of a physician and should seek care if they experience symptoms,” said Dr. Feingold. “Doctors and hospitals have enhanced processes in place to keep patients and caregivers safe for all levels of diagnosis, treatment, and surgery.”

Hackensack Meridian Health
844.HMH.WELL / hmhhasheart.com