There are options for heart treatments

special to the Herald-LeaderJanuary 12, 2014 

Dr. Ted Wright

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A healthy heart is an organized instrument, using well-timed electrical impulses to send blood circulating through the arteries — "supply wagon" delivering oxygen to the farthest reaches of the body. These electrical impulses occur in a specific order and within a specific time frame — what doctors call normal sinus rhythm. But when something interrupts these impulses, the heart misfires and struggles to contract smoothly. Any interruption in the smooth, steady flow of oxygen-rich blood can make you seriously, even dangerously, ill.

We call it Atrial Fibrillation, or A-fib.

People with A-fib may feel tired, weak, dizzy, and/or short of breath, especially after exercising or lifting heavy objects. Some patients feel their heart race or skip a beat, while others have no symptoms at all. A doctor can use a variety of tests to confirm whether you have A-fib, such as an EKG or a stress test.

Complications of A-fib include a greatly elevated risk of stroke. Therefore our two treatment objectives are to restore normal rhythm and reduce stroke risk.

Drugs that either help prevent the blood from clotting or help to regulate heart rhythm are a traditional way to treat A-fib. But these drugs have complications and side effects that are expensive and time-consuming to cope with.

Another non-surgical therapy called electrical cardioversion uses targeted electrical shock to stop the heartbeat temporarily. When the heart resumes beating it may return to a normal rhythm, much like pressing the "reset" button.

If these treatments aren't effective, we explore a number of surgical options to replace or complement drug therapy. Kentuckians are fortunate to have access to these procedures, which in some cases aren't available elsewhere in the region.

With a procedure called Mini-MAZE, doctors construct a maze of scar tissue in the heart to reorganize contractions into a normal rhythm.

Other procedures aim to close a small pouch of the heart where clots that cause stroke tend to form.

The Atri-Clip procedure uses small incisions through the chest to deploy a fabric band, pulling the pouch closed much like a rubber band is used to make a ponytail in a girl's hair.

The LARIAT procedure uses two catheters (tubes), each fitted with a tiny magnet. Through small incisions, the doctor guides one magnet inside the pouch, and one outside. Once they click together (much like two magnets between a layer of cloth), a tiny "lasso" is looped around the opening of the pouch and pulled closed like the drawstring on a sack.

Also on the frontier of treatment, but available in Lexington, the AMPLATZER Cardiac Plug operates like a sink stopper to block the pouch opening.

In most cases, these are highly effective and minimally invasive treatments that allow A-fib sufferers to return quickly to an active, healthy lifestyle.

Dr. Wright is a cardiothoracic surgeon with UK HealthCare's Gill Heart Institute

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