Research Medical Center February 03, 2014

After 53 years of marriage, Jerry and Ann Poston have shared a lot, including the same heart ailment, atrial fibrillation.

by Linda Cruse, Special sections contributing writer | Reprinted courtesy of Kansas City Star

Jerry and Ann Poston of Kansas City are used to sharing things, but several years ago they discovered they shared something neither one wanted: the same heart ailment, atrial fibrillation.

Also known as A-fib, atrial fibrillation is the most common type of arrhythmia. A-fib occurs when disorganized electrical signals cause the heart’s two upper chambers to fi brillate, contracting fast and irregularly. A-fib can cause blood to pool in the heart and form clots that travel to the brain and cause a stroke, said Dr. H William Stites III, cardiac electrophysiologist at Research Medical Center. He is a fellow of the American College of Cardiology.

Patients with A-fib are at five times the risk of suffering an ischemic stroke.

“It’s most common in people age 60 and older, and 10 percent of people above age 80 have A-fib,” Stites said. The Postons are 77.

According the Centers for Disease Control and Prevention, more than 2 million people have A-fib and as many as 12 million people will have the condition by 2050.

Stites said patients may or may not have symptoms. Jerry discovered that he had A-fib 13 years ago when giving blood shortly after the Sept. 11, 2001 tragedy. “I had no symptoms I was aware of, but when I went in to give blood they told me my heartbeat was irregular,” he said.

Jerry went to see his physician, who recommended that he undergo an electrocardioversion, which involves using an electric current to restore his heart’s normal rhythm. His heartbeat returned to normal, but only for two weeks.

Jerry was then prescribed Coumadin, a blood-thinning drug, to reduce the risk of stroke. He found regulating the medicine difficult, and the required blood testing left him with sore fingertips. “I hated it,” he said.

Ann developed A-fib in June 2010 after undergoing surgery. She was also put on Coumadin.

Both Jerry and Ann said they had serious concerns about taking bloodthinning medications. The most common side effect of Coumadin is abnormal and sometimes profuse bleeding.

“A friend of my sister’s who was on a blood thinner died after a minor car accident,” Ann said. “She had a brain bleed that couldn’t be stopped. I was always worried about taking the medication.”

Medication Alternative

Jerry’s physician, Dr. Tracy Stevens, a cardiologist at Saint Luke’s Mid America Heart Institute, told Jerry and Ann about a new procedure that would eliminate the need for medication.

Called the WATCHMAN Left Atrial Appendage Closure device, it is an alternative treatment for patients unable or unwilling to take blood thinning drugs because of potential complications.

In patients with A-fib, blood can pool in the left atrial appendage, which can then clot and travel to the brain, causing a stroke. The WATCHMAN device closes off the left atrial appendage and reduces the risk of stroke, eliminating the need for longterm use of blood thinning medications.

The device is pending approval by the FDA; however St. Luke’s Mid America Heart Institute has been enrolling patients in a registry for the device as part of a national study.

Jerry and Ann underwent the WATCHMAN procedure two weeks apart. Dr. Kenneth C. Huber, coexecutive medical director of Saint Luke’s Mid America Heart Institute, performed both procedures. A lead investigator in the PROTECT AF trial, he participated on the FDA Advisory Panel for the WATCHMAN device.

Jerry and Ann said they are thrilled with the results. “I’m a nurse practitioner and marriage and family therapist,” Ann said. “I’m still able to work several days a week without the fears I had when being on Coumadin.”

Huber said the WATCHMAN is “changing lives. The impact is profound because a large percentage of patients – probably 30 to 40 percent – don’t take their prescribed blood thinners because of fears.”

Huber has performed the procedure on 80 patients. The minimally invasive procedure to implant the device requires a small incision in the groin and involves access to veins, not arteries, and takes about one hour. Patients stay overnight in the hospital and go home the next day. They are back to normal activities in 24 hours.

“This exciting new technology could impact hundreds of thousands of patients,” he said. “It’s safe and effective, and the long-term benefits can outweight the upfront risks.”

A national study presented in 2013 indicated that the WATCHMAN was superior to the anti-coagulant drug Coumadin in preventing cardiovascular death, stroke and embolism, he said.

Other A-fib Procedures

Stites said that while anti-coagulant drugs such as Coumadin are still the standard for treating A-fib, promising advances are being made in other areas.

These include ablation techniques such as radiofrequency ablation, catheter ablation and cryoablation.

Each ablation technique involves inserting thin, flexible wires into a blood vessel in the thigh, groin, neck, or elbow and threading them through the blood vessel and into the heart under X-ray guidance. The wires allow physicians to record the electrical activity of the heart and determine what kind of heart rhythm problem exists.

Next, tiny areas causing the rhythm problem are located. The wires are then used to send energy in the form of either extreme heat or cold to those areas in the heart. The heat or cold destroys, or ablates, the heart tissue. Destroying the tissue can cure the heart rhythm problem.

Stites said cryoablation is particularly promising because cryoablation scar tissue is less likely to develop gaps, eliminating the need to repeat the procedure. “Other ablation techniques need to be redone about 30 percent of the time,” he said.

Ablation has a high success rate, a low risk of complications and patients can resume normal activities in a few days, he said. The procedure is done under mild sedation with local anesthesia.

“For patients who can’t tolerate drugs there are technological advances being made that are very promising,” Stites said. “The old approach only suppresses symptoms. Even if the heart returns to its normal rhythm there is still a high risk of stroke. New technologies are designed to cure A-fib.”

Stites said there is a substantial need for A-fib solutions that don’t involve taking medication. “So many people can’t take anti-coagulant drugs,” he said. “We need to determine out what is the best and safest way to handle A-fib and it’s looking very promising.”

Photo by Judy Revenaugh/The Star