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Avera Heart Physicians Develop Effective Approach to Treat Atrial Fibrillation

Aug 08, 2019 07:00AM ● By MED Magazine

By Jarett C. Bies

An innovative, multidisciplinary approach at Avera Heart Hospital is successfully helping atrial fibrillation (AFib) patients recover and gain better quality of life.

The convergent approach combines a pulmonary vein isolation (PVI) with surgery to address the irregular heartbeat that goes with AFib conditions. People who face this cardiac disorder deal with palpitations, chronic fatigue, dizziness and lower energy levels. They also have an increased risk for stroke.

“We have patients who are now a year out from the original procedure who are having success and normal heart rhythms,” said Beth Terveen, RN, BSN, CCRN, Avera Heart Hospital Director of Surgery. “We are happy with the results of this approach, and we’re continuing to use it with AFib patients for whom other approaches have not worked.

Patients with irregular heartbeats that AFib causes may have tried medication, attempts to use electrical shock to reset the heartbeat, or PVI.

A convergent procedure brings together expertise and technology, and involves both an electrophysiologist and a cardiothoracic surgeon. In a first minimally invasive surgical procedure, radiofrequency ablation is used to create an area of ablated tissue on the back wall of the left atrium from the outside of the heart.

Then in a second cardiac catheterization procedure, the electrophysiologist threads a catheter through to the inside of the heart. Using radiofrequency ablation, the electrophysiologist fills treats the inside of the heart as well, and tests to confirm that abnormal electrical impulses are eliminated.

“The convergent procedure has proven a good approach for patients with persistent AFib, and in eight of our nine cases so far we have seen successful response to this combination,” said Steven Feldhaus, MD, FACS, a cardiovascular/thoracic surgery specialist with North Central Heart. Feldhaus, who also subspecializes in peripheral vascular surgery, took part in a fellowship where he became more familiar with the technique. “Our ninth patient only recently completed the two parts of the process, and we will monitor that case and see how it develops.”

Avera Heart Hospital of South Dakota is the only facility in the state to try convergence procedures. The first was completed in June 2018.

“With the hybrid procedure, we can achieve more durable, full-thickness ablation of the posterior wall and veins connecting to the back of the heart,” said Jonathon C. Adams, MD, FACC, FHRS, an electrophysiology and cardiovascular disease specialist with North Central Heart. “These areas are known to be common sites for abnormal cells that trigger AFib.”

The two parts of the convergent procedure are done about six weeks apart to give patients the time to recover and for inflammation to subside. In the cases they have so far seen, sinus – or normal – rhythmic heartbeat returned for patients. And the normal heartbeat continued.

“This is a promising approach for patients who fit the description of persistent AFib, especially those who have tried other remedies,” Terveen said. “The bottom line is that it can help people and do so safely – and that it is a great alternative for patients who have struggled with AFib who had no recourse.”