Listening to the beat of your heart: Advanced treatments for atrial fibrillation
The medical team quickly determined Cynthia was experiencing atrial fibrillation, often referred to as AFib. This common heart arrythmia occurs when there is a disruption in the electrical signals within your heart that tell it when to pump blood.
Cynthia was placed on an intravenous drip with arrythmia medication and admitted to Paoli Hospital overnight for close monitoring. It was the following day when general cardiologist Andrew R. Bowman, MD, came to see her.
"The medication Cynthia received slowed her heart rate, and her heart rhythm spontaneously converted back to normal," said Dr. Bowman. "The next step would be to identify the potential cause of her AFib through a series of tests, and then formulate a plan to manage her condition. Cynthia became my patient on that admission ― it was back in 2019 ― and we scheduled her first visit to my office."
Understanding atrial fibrillation
Anyone can develop AFib, but there are several factors that increase the risk. Such factors include underlying heart disease, a family history of AFib, high blood pressure, hyperthyroidism, sleep apnea, obesity, aging, asthma and the overconsumption of alcohol, among others.Cynthia had a history of high blood pressure, and upon further evaluation was found to have sleep apnea. She was also in her late 60s ― another risk factor. Dr. Bowman placed his new patient on a blood thinner to prevent stroke, and an antiarrhythmic to control her heart rhythm. Both medications are commonly prescribed to treat AFib. She remained on her blood pressure medicine.
Over the next several years, Cynthia’s episodes of AFib became increasingly more frequent and bothersome. After experiencing an episode during a trip to New Orleans that prevented her from participating in the group’s activities, she became more concerned. In March 2023, Dr. Bowman recommended that Cynthia schedule a consultation with his colleague, cardiac electrophysiologist Colin M. Movsowitz, MD.
Considering the next step
For many individuals, their AFib is well controlled with medication. For others, medication alone is not enough, and intervention may be the next step.
"Think of the heart as a coordinated pump, with a clock that synchronizes the upper chambers of the heart ― the atrium, with the lower chamber ― the ventricle," explained Dr. Movsowitz. "The cells within the heart are supposed to listen to the master clock, but sometimes, there are rogue cells that don’t listen, and they send electrical impulses they shouldn’t. This is what causes arrhythmia. Medications to treat AFib are meant to suppress those cells from sending impulses, but they aren’t always successful."
Individuals with AFib can experience palpitations, shortness of breath, lightheadedness and/or chest pain. Furthermore, when the heart is not beating properly, blood clots can develop in the left upper chamber which may travel to the brain, causing stroke.
"When medications aren’t preventing rhythm abnormalities, or in cases when the patient isn’t tolerating the prescribed medications, we consider a procedure called radiofrequency ablation," said Dr. Movsowitz. "It’s a complex but highly effective procedure that uses heat energy ― or small burns ― to create scarring around the rogue cells in the heart to isolate them, thus preventing them from sending faulty electrical impulses that cause the heart to beat out of rhythm."
After spending a few weeks considering this option, Cynthia scheduled her ablation procedure with Dr. Movsowitz for June 2, 2023. She arrived at Paoli Hospital at 7 a.m.
Radiofrequency ablation treatment
The interventional and electrophysiology labs at Paoli Hospital, which opened in March 2022, offer the most sophisticated diagnostics and advanced treatment available. Here, a highly trained team of specialists perform interventional, cardiac catheterization and electrophysiology procedures in a dedicated space designed meticulously for these treatment approaches.
"I was wowed by all the exciting technology and the sheer number of experts in the procedure room," said Cynthia. "They helped me clearly understand everything that was going to happen. I recognized this procedure was serious and involved, but I felt very comfortable. I knew I was in good hands."
During an ablation procedure, the patient is put to sleep. Thin, flexible wires called catheters are inserted through the groin area and threaded up into the heart. Advanced magnetic imaging and ultrasound are then utilized to create a three-dimensional model of the patient’s heart. This enables the electrophysiologist to visualize the inside of the heart while navigating the ablation wire, making small burns in the specific area triggering the arrhythmia. The procedure typically takes three to four hours.
Cynthia came through with flying colors and was back at home by 5:30 p.m. that evening.
Today, Cynthia is enjoying retirement following a successful career in pharmaceutical quality and compliance that took her to New Jersey, New York and Massachusetts. Settled now in West Chester, she spends her time gardening, flyfishing, spoiling her rescue dog Keily, and visiting her vacation home in New Hampshire. Now age 71, she continues to take oral medications for her AFib and sees Dr. Bowman every six months for follow-up. And she reports that she is feeling great.
Recognizing AFib
AFib affects six million people in the U.S. Approximately 30% of those affected do not experience any symptoms.
This’s why, said both Dr. Bowman and Dr. Movsowitz, it’s critical to visit your physician for ongoing wellness checkups, and know how to monitor your blood pressure and pulse. Highly recommended are smart watches and other personal devices that monitor your heart rhythm and additional vital signs.
"If you feel symptoms such as palpations, dizziness or shortness of breath, go to the ER or Urgent Care to get an electrocardiogram (EKG)," said Dr. Bowman. "Listen to your body, and if you’re feeling unwell, seek care. AFib is a common cause of stroke, but when detected earlier, it’s highly treatable. I’m urging everyone to get their heart rhythm checked."
Next steps:
Make an appointment with Andrew R. Bowman, MD
Make an appointment with Colin M. Movsowitz, MD
Learn more about heart and vascular care at Main Line Health
Unlocking the benefits of ablation therapy for atrial fibrillation