Friday, June 20, 2014

Skipping a Beat

What is the number one cardiac arrhythmia? What heart condition affects over 3 million people in Europe alone? What is the fastest growing technique in cardiology?

The answer may surprise you. It isn't about cloning, stem cells or any of the in utero procedures you might think it would be. The condition isn't something that people talk about, yet 5% of the population over 75 suffer from it. That's 5% of all adults. The percentage of adults with congenital heart defects (CHDs) who suffer from this condition is 15% -- three times that of the population at large.

What is it, you may wonder? It's atrial arrhythmias or atrial fibrillation. It's commonly called Afib or AF in the heart world. This arrhythmia is characterized by a rate or rhythm problem with the heart's beat. According to the National Heart, Lung and Blood Institute, "During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. AF occurs if rapid, disorganized electrical signals cause the heart's two upper chambers -- called the atria -- to fibrillate. The term "fibrillate" means to contract very fast and irregularly."

Why is this important and why should people in the heart world care about this situation? The reason is that people with undiagnosed Afib are at a much greater risk for stroke and heart failure than those who know they have Afib and are under a doctor's care for treatment of Afib.

This is especially important for the aging congenital heart defect population. According to Circulation, those born with CHDs have a much greater likelihood of developing Afib as they age. In fact, certain heart defects such as: Ebstein anaomaly, transposition complex (transposition of the great vessels also known as transposition of the great arteries), univentricular heart (which include but are not limited to: hypoplastic left heart syndrome, single ventricle, double-inlet left ventricle, double-inlet right ventricle, mitral or tricuspid atresia or single ventricle heterotaxy syndrome), and atrial septal defects have an even higher percentage of Afib associated with them as survivors of these congenital heart defects age.

Last week we talked about the concern of losing adults with congenital heart defects to follow-up care and this is one of the reasons why maintaining regular cardiology visits is so important. When people are born with congenital heart defects, they may have arrhythmias for all or most of their lives. If they are like my son, they don't feel these arrhythmias as being unique, special or worrisome. It's the way their heart has always beat. Because of that, unless they are suddenly experiencing fainting, an usually fast or slow heartbeat (for them) or sudden weakness, they may not even know they are suffering from Afib at all. For many people, they have no symptoms. I have watched my son's electrocardiogram being done on him and have watched the arrhythmias being documented on paper while my son tells his cardiologist that everything is fine. This is what is the most concerning part about Afib. For many there are no symptoms. For some, that can be life-threatening.

What's really exciting is that according to News Medical, atrial fibrillation ablation is one of the fastest growing cardiology techniques. According to this article, there are two different ways to treat Afib. One way is with anti-arrhythmia drugs (AAD) and the other way to treat the problem is through catheter ablation of atrial fibrillation. However, I know of another technique that is being used -- and it's one that I hope will save my son from future problems with Afib. The other procedure I know about is called the Maze Procedure. According to WebMD, the Maze Procedure is a surgical treatment for Afib and is also known as surgical ablation. My son had this procedure while having a Fontan revision. Since his chest was open already and he had known Afib issues, the surgeon decided to do a modified Maze Procedure on his heart to stave off future arrhythmias.

I think it's exciting to note that doctors are learning ways to prevent arrhythmias through catheterization techniques because these techniques usually result in shorter hospital stays, less chance for infection and thus less complications. It's gratifying to see that many of our children with congenital heart defects are being followed into adulthood and that doctors are trying to find ways to keep our children healthy into and throughout their adulthood. Preventing life-threatening arrhythmias is one of the ways doctors can ensure our adults with CHDs continue to live quality lives.

According to the News Medical article mentioned, "It is estimated that more than 10,000 atrial fibrillation ablation procedures are performed annually in Europe and the number is increasing exponentially since over the last years availability of more sophisticated techniques and equipment has produced a marked increase in the number of centers performing atrial fibrillation ablation. Three dimensional mapping systems, robotic techniques, new energy sources and new and more reliable catheters are easing the procedure and improving efficacy and safety." Catheter ablation plus surgical ablation are two invasive ways of saving adults' lives from fatal or near-fatal arrhythmias. Parents in the heart world know that our lives can change in a heartbeat. It's nice to know that doctors can make sure that our children's heartbeats can continue to stay regular despite their funky hearts.

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