STEADY BEAT

Ablation sets the stand fibrillation. New safety

Ablation sets the standard of care for atrial fibrillation. New safety procedures improve its administration and results. t common arrhythmia o in the atria ch the heart, is on the ri even con atria to Dr. Va a clinical cardiac elec at Heart of The Villag fibrillation is essentia of each indiv

Atrial Fibrillation, the most common arrhythmia originating in the atria (upper chamber) of the heart, is on the rise. Physical stress, excessive alcohol intake, high blood pressure, diabetes, and even caffeine all contribute to an increased risk of atrial fibrillation.

According to Dr. Vatsal Inamdar, a clinical cardiac electrophysiologist at Heart of The Villages, atrial fibrillation is essentially an irregular beating of each individual muscle fiber of the top chambers of the heart. The concern is that the irregular beating could lead to blood clots. It could also lead to high heart rates, which in turn could lead to other symptoms such as fatigue, shortness of breath, heart failure, and cardiomyopathy (weakening of the heart muscle). With advancements in procedural techniques and technology, have improved safety measures with atrial fibrillation ablation procedure, to assure the best treatment outcomes. normal rhythm. Medication works approximately 45-50 percent of the time. If that does not work, then the next step is consideration for an ablation. A cardiac ablation for atrial fibrillation is not a surgery, rather a catheter-based treatment option.

“We take a personalized approach to patient care,” said Dr. Inamdar.

Dr. Inamdar has been in practice for four years. Ten years when including his training: internal medicine and cardiology at Winthrop-University Hospital, an echocardiography fellowship at the University of Alabama and fi nally an electrophysiology fellowship at the Mayo Clinic in Arizona. Upon completion of his training, he worked with a private practice in Jacksonville before moving to The Villages area to be closer to his family. He has been with the Heart of The Villages for one year, joining Georg Couturier, MD FACC and Mark Rothschild, MD FACC, in the area.

According to Dr. Inamdar, there are various causes of atrial fibrillation. Hypertension, valvular atrial fibrillation (which occurs when you have a problem with one of your heart valves leading to atrial enlargement), sleep apnea, excessive alcohol, caffeine, and there is a genetic component.

“After the age of 65, almost 10 percent of the population will endure atrial fibrillation at some point in their life,” said Dr. Inamdar.

“We take a catheter from the femoral vein near the groin and go all the way up to the right side of the heart and then go across the inter-atrial septum to enter the left upper chamber – the left atrium,” left side,” said Dr. Inamdar. “We visually see where the septum is and the other related structures to help minimize risk.”

They also use 3D Mapping. “This allows us to recreate, in real time, a 3D map of the left atrium to accurately mark and track where we put our ablation lesions. This in turn helps create a more complete lesion set to improve outcomes,” said Dr. Inamdar.

The latest innovation is the tactile sensory catheter. It is known as the Smart Touch by Biosense Webster, Inc., a Johnson & Johnson company.

“This catheter allows us to directly get the force in grams being applied by the catheter tip in the heart,” said Dr. Inamdar. This decreases the chance of perforations or trauma to the heart and allows for more effective lesion delivery. “You are monitoring it in real time, accurately, not just going by feel,” he said.

The treatment options depend upon how long the patient has had atrial fibrillation. There are three main categories. Paroxysmal Atrial Fibrillation, where the arrhythmia last a week or less. Persistent Atrial Fibrillation symptoms last for more than a week and remains in the condition throughout the duration. Permanent Atrial Fibrillation occurs when a patient has been in atrial fibrillation for years. Over one year, 20 percent of patients with paroxysmal atrial fibrillation can progress to persistent atrial fibrillation.

Dr. Inamdar’s, treatment progresses from an initial conservative to a more invasive approach depending on response. An attempt is made to use medications first to restore said Dr. Inamdar. “There are four pulmonary veins, which are the veins that drain oxygenated blood from the lungs to the heart. The area where these veins connect to the atrium is where we target our ablation for atrial fibrillation. There are various vagal ganglion plexi, that are adjacent to these veins, which play a role in triggering atrial fibrillation in the patient.”

The catheter is used to provide radio-frequency lesions to small areas of the heart tissue that are generating and triggering abnormal electrical activity, causing the irregular heart rhythm.

“We have several measures now, such as intercardiac echocardiogaphy, which gives us a direct visualization of the inter-atrial septum before we go across to the

Dr. Inamdar says flouroscopy usage is minimized during the procedure so there is less radiation exposure for the patient. “In the past, patients would receive up to an hour of radiation per every procedure,” said Dr. Inamdar. “Now, I rarely go over 15-20 minutes.”

Ablation sets the new standard of care for most symptomatic atrial fibrillation patients. These improved safety procedures keep complication percentages during ablation treatment very low, ranging from 1 to 3 percent.

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