Heart rhythm disorders, the diseases that affect the normal beating of the heart, both fast and slow, are increasingly prevalent as we age. Often these changes are part and parcel to a life well-lived, an expression of the day-to-day wear and tear on the electrical system of the human heart. In other circumstances, it is the unfortunate consequence of other heart issues like coronary artery disease and valvular heart disease.
The result can be life threatening or life altering. Thankfully, medical technology and sub-specialty training have continued to progress, allowing for safe, effective, and often curative interventions to help correct heart rhythm issues. This is the field of cardiac electrophysiology, and this is what I love to do!
Over the course of my 20-year career, I have witnessed tremendous progress in how we care for the electrical system of the heart. I have been fortunate to participate in these developments through my training years at Scripps, UC Irvine, and NYU, and the decade I spent in NYC prior to settling in Monterey allowed me to refine my practice through a high volume of interventions. I am grateful to be able to bring innovative therapies to our community.
Progress in heart rhythm treatment has focused on three key areas: pacemakers, ablations, and stroke prevention.
Cardiac pacemakers, devices that help keep the heart from beating too slowly, have been around since the 1950’s. Until recently, the only changes seen in pacemaker therapy were more complex programming options for the pacemaker generator, and smaller sized devices so the implant was less bulky under the skin in the chest wall. Regardless, the pacemaker procedure still required an open chest incision, and the placement of wires into the heart. We now have what are known as “leadless” pacemakers, which are devices the size of a vitamin pill, which are implanted into the heart with a simple puncture in the femoral vein…no incisions, no wires! Furthermore, the kinetic energy of the beating heart, the motion of the heartbeat, powers the pacemaker battery, and as a result they last much longer than conventional pacemakers. More advanced forms of pacemakers are also in use to prevent sudden cardiac death (defibrillators) and to improve the management of heart failure(biventricular pacemakers).
Our ability to detect, map, and eradicate unhealthy heart rhythms using cardiac ablation has also been a huge advance. The most common and most recognized heart arrhythmia is atrial fibrillation, which can cause stroke and heart failure amongst other problems. This irregular heart rhythm disturbs the normal cadence of the synchrony that is necessary for normal heart health. In some cases, this problem can be managed with medications and simpler procedures like cardioversion. The more definitive therapy, however, is achieved with ablation, or short-circuiting of the abnormal rhythm, using a minimally invasive, catheter-based procedure that is guided by precision heart mapping. Truly space age science, reduced to a simple application that has become increasingly effective and curative.
It is important to note that atrial fibrillation affects 15 million Americans every year. Symptoms include fatigue, shortness of breath, palpitations or irregular heartbeat, chest pressure and dizziness. Others may have no symptoms at all. If you are in atrial fibrillation, a simple EKG can diagnose the problem. Many people with this problem fluctuate in and out of atrial fibrillation, making it harder to detect. For these individuals, we have wearable short-term heart monitors, as well as tiny implants that can remain in place for years, allowing us to monitor heart rhythms over time using cloud-based technology.
The latest advancement in stroke prevention in patients with atrial fibrillation, involves a procedure known as Watchman. When a person is in atrial fibrillation, blood clots can form in the heart, in a structure known as the left atrial appendage. It is a small outpouching in the upper chamber of the heart that collects clots the way a pants pocket collects lint. If a blood clot in that location breaks free, which is an unpredictable event, the clot flows through the heart and into the circulation of the brain, where the clot lodges and causes stroke. Prior to Watchman, we treated this risk by either using blood thinners to prevent the formation of blood clots, or with ablation to get the patient out of atrial fibrillation. Well, not everyone can safely tolerate lifelong blood thinners, and not everyone is amenable to ablation. Watchman attacks the problem at its source by implanting a small device in the left atrial appendage and completely closing the pocket where blood clots can form. This not only has demonstrated tremendous prevention of strokes after implant, but it eliminates the need for blood thinners altogether.
Advancements in electrophysiology continue to evolve at a rapid pace, and it is an exciting time to be engaged in this field. We look forward to bringing the latest, cutting-edge treatments to this community to keep you in rhythm!
