Treatment Guide: Arrhythmias

How to keep your heart beating just right

Every time passion sets your heart aflutter or excitement sets it pounding, you’re getting a taste of what it feels like to have an arrhythmia. But with a real arrhythmia, there’s a malfunction in the electric system that regulates the heartbeat, which can lead to a heart attack or stroke. The most typical arrhythmia is rapid heartbeat or atrial fibrillation (AFib), which affects some 2 million Americans.

[sidebar]If you’re experiencing an abnormal heart beat, here are some of the newest treatments available in the Philadelphia area:
    
Drugs: Beta blockers are currently the most popular drugs available for controlling the bom-bom-bom-bom of AFib, but they can have unwanted effects on other organs. Ask your doctor about some of the other options coming available every month or so. One example: replacements for blood thinners, like Coumadin, that have long been used for stroke prevention. The improvements will eliminate the need for frequent blood tests. The most promising new drugs already in clinical trial, according to Dr. Peter Kowey, chief of cardiology and president of Main Line Heart Center at Lankenau, are the ones that will actually restore normal heart rhythm. One of them, dronedarone, was shown to be effective and safe with few side effects. Kowey often runs trials on drugs that are being tested to synchronize the heart beat; if you are interested in participating in one, contact him at 610-645-2684.

Catheter ablation: When drugs alone don’t work, the next step is a catheter ablation, which uses a wire threaded into the atrium of the heart to cauterize (burn) the trigger points of the irregular rhythms. In the last several years doctors in the electrophysiology department at the University of Pennsylvania Health System have done more than a thousand of these highly sophisticated four- to six-hour procedures, and there is usually a waiting list. Lately patients from all over the country are being referred to Dr. Francis Marshlinski, chief of the lab, for another highly complicated ablation aimed at the ventricle chamber of the heart to correct a rarer and potentially more dangerous arrhythmia. Available locally only at Penn, it painstakingly rewires the inside and outside of the heart itself and zaps the abnormal circuits to stop them from misfiring. “The results,” he says, “are really dramatic.”

Electromagnetic mapping: Penn also has a $3 million robotic machine for mapping the source of the arrhythmias electromagnically. “The robot has more stability, says Marshlinski, “and can move three-dimensionally much more easily than a human. The more precisely we can identify the location of the problem, the more precisely we can adjust it. I am really excited by all these advances.”

Heartbeat monitors: Another lively nexus of activity in arrhythmias is the continual updating of technologies that diagnose and monitor heartbeat problems as well as prevent them from sparking fatalities. For instance, in the past when doctors wanted an extended record of your heartbeat, you had to lug around a cumbersome halter monitor for days at a time. No more. Dr. Arnold Greenspon, director of the Cardiac Electrophysiology Lab at Jefferson, now gives his patients a lightweight wireless device that sends him heart signals 24/7 for as long as two weeks. The newest gadget for telling docs what they need to know about hard-to-diagnose patients is a microchip implanted under the skin that sends continuous heartbeat data for up to a year.

Defibrillators: In the prevention department, the market is exploding with smaller and longer-lasting implantable cardiac defibrillators (ICDs). These tiny computerized rescue squads can shock the heart when needed, adjust the pacing, and also gather and transmit diagnostic information. They are, however, very expensive, and the question, says Dr. Greenspon, “is which patients need the bells and whistles of a Ferrari and which ones would fine with just a Ford.” Nobody, however, doubts that ICDs definitely save lives, and the latest thinking is to routinely implant them in high-risk patients as primary prevention. Some 300,000 people die of sudden cardiac arrest every year — more than AIDS, breast cancer and lung cancer combined. “If you identify the right patient and put in an ICD,” says Greenspon, “many of them could be saved.”