By Dr. Maria Simbra

PITTSBURGH (KDKA) – Dan Farren is an avid hunter.

But he felt barreled over because of a heart condition — atrial fibrillation, or A-fib – which left him severely short of breath.

“Just getting in and out of the truck and taking a short little hike, it was hard to do,” he said. “I had been in it for years on medication. The medication quit working.”

Your heartbeat normally starts in the upper-right chamber of the heart, and the electrical impulses travel in an orderly fashion across the top chambers and along a bundle into the lower chambers, which do the pumping.

With A-fib, bogus electrical signals arise. As a result, the heart doesn’t pump effectively and quivers instead.

Besides shortness of breath, you can have palpitations, lightheadedness, confusion and weakness.

It can come on because of high blood pressure, heart attacks, abnormal heart valves, thyroid disease, excess caffeine or alcohol, lung disease, previous heart surgery, viral infections and sleep apnea.

A-fib can lead to stroke and heart failure.

This abnormal rhythm is easily seen on an EKG.

Medication is the first step. When medicine stops working, the next step is a procedure to ablate or burn the abnormal circuits to re-establish one main circuit.

Because the A-fib had been going on so long, Dan’s heart had actually changed shape. The upper-left chamber became enlarged, and abnormal electrical circuits zipped all through it.

The customary approach is ablation on the inside of the heart, accessed with a catheter up through the groin. But his doctors did not believe this would work well for Dan.

“The most difficult to treat patient is someone who has been in A-fib a long time, is in it all the time, and has remodeled structurally enough, in other words, a really large left atrium,” says Dr. William Belden, a heart rhythm specialist at Allegheny General Hospital.

So they added a second procedure through a small incision in the upper belly, entering the sac around the heart with small scopes and instruments.

The doctors burned along large swaths of the heart muscle from the outside.

“I have a nice roller brush, and Dr. Belden has a very precise trim brush,” says Dr. Robert Moraca, a cardiothoracic surgeon at Allegheny General Hospital.

This combination technique worked so well for Dan, six months later, he went on a strenuous elk hunting trip in Colorado without any difficulty.

“We’re camping at 6,000 feet, we’re hiking two-and-a-half miles up to 8,000 feet where we hunted,” he said.

The doctors at AGH have been doing this combination procedure for about two years now on four to five patients a month. It is only available at major medical centers.

Potential complications include bleeding around the heart, narrowing of major vessels leading to the heart, and stroke.


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