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New Technology Improves Heart Treatment

  The word “heart” carries much meaning. The heart of the matter denotes the core of a subject. The heart is where love and emotion hold sway. The heart of the home is the place of comfort and contentment. In health, too, the heart holds a central spot in thinking about well-being.

There is good reason. Heart disease is the leading cause of death worldwide and is a major cause of disability.

But, there’s good news in the battle to detect and treat heart disease and the many different ways in which heart disease presents itself.

According to the American Heart Association, atrial fibrillation is found in about 2.2 million Americans. In this disorder, the heart’s two small upper chambers, the atria, quiver instead of beat effectively. Because the blood isn’t pumped completely out of the chambers, it pools and may clot. If a piece of the blood clot leaves the heart and becomes lodged in a brain artery, a stroke results.

Dr. Nirav Sheth, M.D., a physician at Hampden County Cardiovascular Associates, said that the diagnosis of atrial fibrillation has remained constant, but treatment has changed. Medications to slow down the heart rate, drugs that restore the heart’s rhythm have been used with great success, as has implantation of pacemakers.

In the past five to 10 years, a treatment called ablation has come to the forefront and has shown to be effective in patients when medications don’t work, Sheth said. In ablation, thin, flexible tubes are introduced into the body through a blood vessel and are directed to the heart muscle. Then, a burst of radio frequency energy is delivered to destroy tissue that is triggering the abnormal electrical signals to the heart.

This procedure is appropriate for only a selective group of heart disease patients, those without structural heart disease. But it can be a lifesaver, he said.

Ablation is one way to manage the irregular heartbeat that is the hallmark of many forms of heart disease, and it’s an important step forward and another tool for cardiologists to use.

“When we can manage the heart arrhythmia better, then we will have a better outcome,” he said.

Another syndrome, syncope, can also be an indication of a heart problem, said Cardiothoracic Surgeon Dr. Masharn Doanes. In syncope, a person loses consciousness temporarily and faints. It can have various causes, such as neurological, cardiac or cochlear, which is related to the inner ear. It is a syndrome whose causes have been difficult to diagnose.

A device called an implantable loop recorder was first announced in 1997, but major use of it started in 2002-2003. It has proved valuable in determining what is occurring in the heart and what kind of treatment will be effective.

“The loop is a means of getting a long-term cardiac profile,” Doanes said. An EKG will give a physician only an idea of what is happening in the examining room.

“The loop recorder, whether it is implanted for one week, 10 weeks or 18 months can determine what the heart is experiencing,” Doanes said. The patient can go home and return to normal activities. When a dizzy spell or fainting occur, the loop recorder provides a record of the heart activity. The cardiologist must interpret what the underlying reason is for the heart rhythm to determine the best course of action.

One possible course is a pacemaker, which monitors the heart’s rhythm through electrical impulses and prompts the heart to beat at a normal rate.

If a pacemaker is called for, today’s patients have an advantage. “The device has changed over 15 years. They are reduced to about one-quarter of the size they used to be, and they do more,” he said.

There are three major types of pacemakers. “I consider them a Buick, a Cadillac and a Rolls Royce,” Dr. Doanes said. The choice of which one should be used is dependent on what the patient needs, he said.