By Eric Rashba, M.D.
Atrial fibrillation, or AFib, is generally considered to be reaching epidemic numbers, especially among people over age 60. This condition, which is characterized by an erratic, irregular heartbeat, can cause problems ranging from unpleasant symptoms to serious problems like heart failure or stroke.
At the Stony Brook Heart Rhythm Center, our physicians and entire team of heart rhythm experts are constantly working to help people with AFib live better and longer. These are some of the important new state-of-the-art therapies:
Reducing stroke risk for people with atrial fibrillation
People with AFib have a 5 to 7 percent increased risk of having a stroke compared to people without AFib. To help prevent strokes, blood thinners such as warfarin or direct oral anticoagulants (DOACs) are prescribed. Most people do well with medication, but some experience bleeding problems or have other reasons why blood thinners aren’t the best option.
At the Heart Rhythm Center, our specialists are treating appropriate patients with an implantable heart device, called Watchman™, to offer lifelong protection against stroke. For people who have AFib that’s not caused by a heart valve problem, the device provides an alternative to the lifelong use of blood thinners by blocking blood clots from leaving the heart and possibly causing a stroke.
Miniaturized pacemaker for people with bradycardia
Bradycardia, also called slow heart rate, is when the heart beats at 60 times a minute or less. Not everyone with a slow heart rate needs a pacemaker — the presence of symptoms and the type of rhythm disorder are key. At our Heart Rhythm Center, for people whose slow heart rate can be treated with a pacemaker in just one of the four heart chambers, we use a pacemaker that is 93 percent smaller than traditional pacemakers, called Micra™. It is the world’s smallest pacemaker available and it offers some big benefits to the patient.
Conventional, bulkier pacemakers are visible under the skin and have a lead wire that is threaded from the pacemaker into the heart. Our team implants the Micra pacemaker in the electrophysiology lab where the device is placed aboard a catheter (a thin, flexible tube) and moved up to the heart through the femoral vein in the leg. The device lasts for about a decade, and because it is so small, another one can be added to the same heart chamber years down the road when needed. The patient can also be safely scanned using certain types of full-body MRI.
Ablation is a procedure that uses cauterization to burn or scar the electric pathways that trigger the arrhythmia or abnormal heart rhythm. During a conventional ablation procedure, real-time X-ray, called fluoroscopy, is used and it delivers the equivalent radiation of up to 830 chest X-rays. At Stony Brook, my colleague, Dr. Roger Fan routinely performs complex ablations for AFib without any fluoroscopy at all. This important advance eliminates radiation exposure to the patient, with the same excellent results as conventional ablation. Zero-radiation ablation is such an important advance for the overall health of the patient, since excessive radiation can lead to medical problems over the long term.
Questions about your heart’s rhythm? Call Dr. Rashba at 631-444-3575 or call 631-444-3278. Interested in learning more about your heart health? Take the free heart health online risk assessment at www.stonybrookmedicine.edu/hearthealth.
Dr. Eric Rashba is the director of the Heart Rhythm Center at the Stony Brook University Heart Institute.