Archive for the ‘Ablation’ Category

Traditions

September 29, 2010

One of my earliest memories is getting up very early in the morning and loading into the car for the long drive to see the doctors at Johns Hopkins. My parents were younger back then; with a little luck we could make the trip in one day. Just about sunrise we’d encounter a Stuckey’s Restaurant close to the North Carolina – Virgina state line. That was where we always stopped for breakfast, and the light blue roof became one of our landmarks. I looked forward to the restaurant, and the folks did too. Then one day…

…. one day, we came around the corner to find our favorite restaurant was now a pile of ashes! The only thing left, somehow, was the roof. It was pretty much intact, as if someone or something had gently removed it and set it aside before the restaurant burned, then returned it to its proper place.

Well, that’s not good. So we found breakfast somewhere else, and didn’t think anything about it until we got to Hopkins. There, we found out that my Cardiologist – arguably the best Cardiologist in the world – had left. Dr. Richard Rowe was now Head of Cardiology at a hospital in Canada.

No Stuckey’s, no doctor… these two events must be connected in some way, correct? And by the way, I am not superstitious!

I wear a pair of lucky socks whenever I have a doctor’s appointment. One day they’ll wear out, and I’ll rescue them from the trashcan. If I have to cut a small section out of the toe and stick it in my pocket, I will.

Why? At one appointment my doc looked at the EKG and his eyebrows shot up. That is never a good sign.

“You’ve developed an Atrial Fibrillation since your last appointment,” he said. Not good – A-Fib can lead to fainting or a stroke. And I was already taking Amiodarone to combat A-Fib, so apparently the Fibrillation had broken through.

“Double your Amiodarone and have an EKG test in two weeks. Have them fax us a copy. You may eventually have to have an ablation to try to knock that A-Fib down.”

Ablation – a catheter maneuvered inside of the heart with a probe on the end, designed to burn away the areas causing the out of sync heartbeats. Wonderful.

So two weeks passed, and I had the EKG done and faxed. Naturally, the EKG tech won’t even tell you the time of day, no matter how much you beg. But I got my answer that evening, when they called and told me I needed to come to the hospital for an appointment with the Electrophysiologist.

So the next week I was back, being examined by the specialist – wearing a new pair of socks. Didn’t bring that pair intentionally, just needed an extra pair and tossed them into my carry bag.

The doc hooked me up to a 12 lead EKG (the first one I had ever seen), listened with his stethoscope, and asked me several questions.

“So, how do you feel?”

“Worried about what you are going to find, but other than that, pretty good.”

“Tell me how you feel when you are having an episode.”

“Actually Doc, I can’t tell you. I don’t feel them.”

“Not at all?”

“No sir.”

He put the stethoscope back on my chest. “You are in A-Fib right now. Do you feel any different? Anything at all?”

“No sir,” I said.

He listened some more, and run another EKG. “I’m going to discuss this with your Cardiologist,” he said as he excused himself from the room.

In a few minutes he was back. “Since you don’t even feel it, and it doesn’t seem to be bothering you, I’m going to discontinue the Amiodarone. Get an EKG faxed to my office in two weeks. And if you feel light headed or more tired than usual, call me ASAP. But if it doesn’t bother you, I’m not going to medicate you for it.”

And with that we were out the door. The two-week EKG was acceptable and I felt fine, so all he told me to do was to discontinue the medication and come back for a routine checkup in one year. And ever since then, I walk into a doctor’s office wearing my lucky socks.

But I’m not superstitious…. what makes you think that? 🙂

Is Robot Surgery worth the cost?

April 30, 2010

The coming thing in heart surgery – and almost any type of surgical procedure – is robotic surgery. Forget the popular image of R2D2 wearing a surgical cap and mask, there is ultimately a qualified surgeon at the controls of the robot. When you think of Robotic Surgery, you usually think of the da Vinci Surgical System, which has multiple uses in several medical fields. And just yesterday it was reported that a British citizen had an ablation using a robot to guide the procedure. And recently a computer was used to develop a model of a patient’s beating heart, which would allow a robot to perform a surgical procedure without use of the Heart-Lung machine.

But does Robotic Surgery provide better results or is it just the newest tool? The Robotic arm used in that British ablation cost £350,000. (Over $525,000 US Dollars; using today’s conversion rate) Who pays for the cost of that piece of equipment? Patients.

In a post on KevinMD’s website, Peggy Peck asks if Robotic Surgery for Prostrate Cancer offers any advantages. Disturbingly, the answer is “no”, despite claims to the contrary. In fact, men undergoing the minimally invasive procedure tend to have more problems in the long run.

The Law of Supply and Demand is a major factor in the use of Robotic Surgery options – with the patients providing most of the demand. The average Robotic Surgery costs about $2000 more than hands on surgery, but patients continue to demand it:

It’s come to a point where “patients interview you,” according to a urologist. “‘They say: ‘Do you use the robot? O.K., well, thank you.’ And they leave.”

And with healthcare finances shaky, a hospital almost has to invest in a Robotic Surgical System to keep up with the hospital across town. Patients undergoing any kind of surgery in which Robotic Surgery is an option should do their own research and determine if they would rather have all the bells and whistles or have their surgery done the old-fashioned way.

It isn’t working

April 11, 2010

Durn it!

Dronedarone, the Atrial Fibrillation drug that has been highlighted here before, isn’t living up to the hype. It was already known that it is not as effective as Amiodarone, but it doesn’t have the side effects that drug has. The hope was that if you developed A-Fib at an early age, or have a milder form of A-Fib, you could be switched from Amiodarone to Dronedarone. Amiodarone is an effective suppressor of A-Fib but the side effects can be terrible.

In fact, the last time I wrote about Amiodarone, I was accused of using “scare tactics” to get my point across. I wouldn’t do that – Heart Defects are  scary things; As any parent/CHDer knows. I’m not going to add to the hysteria. Behind every link on this blog is more information about a subject; click and read for yourself. HERE is the link I used the last time, it’s written by a Cardiologist. Obviously, he knows more about this drug than I do, and he isn’t a fan of Amiodarone, either.

Further testing has shown that Dronedarone is only half as effective in humans and doubles the rate of death! Dronedarone is recommended only as a second or third choice for people who can’t tolerate Amiodarone. Britain’s National Institute for Health and Clinical Excellence (NICE) gave the drug its approval after originally turning it down, based on its limited effectiveness and its price.

So while Dronedarone doesn’t look like it can be the answer everyone was looking for, perhaps it does have a place in the “medical toolbox”. For right now, the first drug of choice is still Amiodarone, and Cardiac Ablation is still an option.

And other researchers will continue to search for better answers.

Flip the Switch

March 15, 2010

Nobody likes Amiodarone, not even the doctors who prescribe it. I recently wrote a post about it and all the side effects it can cause. A newer drug, Dronedarone, is usually recommended for younger patients. The longer you are on Amiodarone, the better the chances that the side effects will show. Dronedarone isn’t as effective as Amiodrone in controlling Atrial Fibrillation, but has less side effects.

New research released today at the ACC10 meeting in Atlanta shows that in two seperate trial studies, patients with controlled Atrial Fibrilation can safely switch from Amiodarone to Dronedarone in as little as two days.  If you have a slow heart rate (Bradyarrhythmia) or a long QT interval, the 48 hour guideline probably isn’t the best therapy for you. Your own cardiologist will be your best source of information.

New findings indicate source of A-Fib

December 29, 2009

Atrial Fibrillation, or A-fib, is one of the problems many CHDers will face. In a normal heart, an electrical signal is generated by the Sinoatrial node (also known as the SA node and is located near the top of the Right Atrium) and flows outward, causing the Atria to contract. When the electrical impulse reaches the Atrioventricular node, (AV node) it triggers its own electrical impulse which causes the Ventricles to contract, creating the “lub-dub” heartbeat we are all familiar with.

But when extra electrical impulses are moving through the heart’s electrical system, the Atria won’t contract, but rather fibrillate, or quiver. And if the electrical pulse isn’t strong enough the AV node won’t activate the Ventricles. A-fib is usually asymptomatic and painless, (though you can feel your heart beating out of rhythm) but there is a very real chance that the blood pooling in the not-quite-beating upper chambers can clot and cause a stroke.They can also lead to Congestive Heart Failure. (CHF)

One of the usual techniques used to stop A-fib is ablation. Before an ablation, the heart is examined closely and “mapped” to determine where the extra electrical impulses are coming from. Then a catheter is inserted through a vein in the leg or the neck and is guided to the heart. The sources of the extra electrical impulses are then “zapped” (or frozen) to knock them out, and the heart beat should be restored to normal. It doesn’t always work.

But researchers have recently determined that the cells that produce the heart’s electrical charge – and can cause Atrial Fibrillation – also express the protein DCT. DCT only originates from a couple of sources in the body, and only one inside the heart – the electrical current cells. So if scientists can learn a way to identify DCT cells in the heart, they’ll have a way to determine where electrical pulses can orgininate – and deaden the ones causing A-fib.

But this technology is a long way from being reality, if it works at all. Right now, studies are being conducted on mouse hearts. Mouse hearts are similar to human hearts, close enough to be used in research. But when it comes to transferring the results from a mouse to a man, there is a lot of difference!