Help for when the heart goes haywire

Michael Famiglietti is back in the gym after successful treatment for atrial fibrillation.

When most people think about heart disease — the number one killer of men and women in the United States — they picture the clogged arteries associated with a heart attack. But the heart — an amazing muscle that contracts and expands because of electrical signals — can develop rhythm issues that can be just as problematic.

“You can have abnormal heart rhythms from the top of the heart, called atrial arrhythmias, or from the bottom of the heart, called ventricular arrhythmias,” said Apoor Patel, MD, an electrophysiologist at LIJ Medical Center. Arrhythmias can cause the heart to beat too quickly or irregularly.

RENEGADE SIGNALS

Two years ago, Michael Famiglietti began noticing alarming symptoms during his daily 90-minute workouts.

“I was getting unusually tired, so I started taking my pulse,” said the former president and CEO of the YMCAs of Long Island. “At times, it was up to more than 200 beats per minute.” The average maximum heart rate is 160 beats per minute for someone Mr. Famiglietti’s age; he was 60 at the time and in top physical shape. Soon, Mr. Famiglietti stopped exercising. He also began noticing his heart race even when he was just watching TV or trying to sleep. “It was scary,” he said. “I knew something wasn’t correct.”

Mr. Famiglietti was diagnosed with atrial fibrillation and referred to Stuart Beldner, MD, the associate director of electrophysiology at North Shore University Hospital (NSUH).Atrial fibrillation, or “afib,” is the most common type of heart arrhythmia; according to the American Heart Association, afib affects 2.7 million Americans. Afib occurs when disorganized electrical signals within the heart cause its two upper chambers — the atria — to contract quickly and irregularly. In a healthy heart, the electrical signal that sets each beat in motion starts in the sinoatrial node, located in the right atrium. With afib, however, renegade cells cause the wires to get crossed. “The electrical signal starts in the left atrium 85 to 95 percent of the time,” Dr. Beldner said. As a result, blood pools in the atria rather than circulating to the bottom part of the heart like it should.

Afib isn’t life-threatening, but it can lead to potentially lethal complications. “When blood doesn’t move, it can clot,” Dr. Beldner said. “If blood clots and leaves your heart, it can go to the brain and cause a stroke.”

People with afib are two to eight times more likely to have a stroke, said Dr. Beldner. People with afib are also at increased risk for heart failure, a condition in which the heart can’t pump enough blood to meet the body’s needs.

ATRIAL FIBRILLATION ABLATION

Afib can develop over time because of high blood pressure, diabetes, coronary artery disease, mitral valve disease or structural damage from a heart attack — or for seemingly no reason, as in Mr. Famiglietti’s case. To treat afib, NSUH and LIJ Medical Center offer the latest in atrial fibrillation ablation, a minimally invasive technique to cure the arrhythmia or reduce its symptoms and resulting complications.

One of the most common afib ablation techniques — focal point-by-point radio-frequency catheter ablation — uses soft-ware to make a 3D anatomical map of the heart. An electrophysiologist then uses radiofrequency energy to heat the tissue where the left pulmonary vein meets the heart — destroying the abnormal cells causing the problem.

“Atrial fibrillation ablation creates an electrical roadblock where the pulmonary vein meets the heart to prevent triggering the unhealthy rhythm,” Dr. Beldner said. A newer variation of the procedure uses cryoballoon technology. During this procedure, the electrophysiologist inserts a tiny balloon through a catheter and inflates it at the opening of the pulmonary vein to destroy the cells that cause the abnormal heart rhythm.

Mr. Famiglietti is a textbook case for the procedure’s success. He underwent atrial fibrillation ablation with radiofrequency in February 2012. Since then, he has been symptom-free. Not only is he back to his regular exercise routine, but he retired from the YMCA organization and started a new restaurant venture with a group of friends

“The electrophysiology team is really cutting edge, and I’m so grateful,” Mr. Famiglietti said. “I feel like I have a new lease on life.”

TREATING VENTRICULAR TACHYCARDIA

Unlike afib, which originates inside the heart’s upper chambers, ventricular tachycardia (VT), another heart rhythm disorder, starts on the outside of the ventricles, which compose the bottom part of the heart. With VT, the heart beats so quickly that it can’t pump enough blood, which is a life-threatening situation.

Willie Murray, a New York City deputy sheriff, knows firsthand how frightening VT can be. In late September 2012, Mr. Murray rushed to LIJ Medical Center’s Emergency Department because of heart palpitations. “I couldn’t breathe, either,” said the 47-year-old Bronx resident. After undergoing numerous tests in the Cardiac Intensive Care Unit, Mr. Murray was diagnosed with VT and prescribed anti-arrhythmic medication. An implantable cardioverter defibrillator (ICD) was also inserted in his chest to shock his heart should it ever go into a dangerous ventricular rhythm.

Unfortunately, Mr. Murray continued to have heart palpitations, so an additional treatment was in order.

EPICARDIAL ABLATION

To treat VT, LIJ offers epicardial ablation, a state-of-the-art surgical technique that involves carefully destroying misfiring cells located on the surface of the heart’s ventricles. “Only a specific group of patients are candidates for this high-risk procedure,” Dr. Patel said. Mr. Murray was among them.

During the delicate surgery, the doctor inserts a needle under the breast bone to enter the pericardium, the sac that sur-rounds the heart. “Guided by computer-generated imaging, we put a catheter with electrodes into the pericardium and map the surface of the heart to find the origin of the arrhythmia,” Dr. Patel said.

Radiofrequency energy is then applied to destroy the misfiring cells on the heart’s surface. VT can develop as a complication from a heart attack or as a result of other types of heart disease that cause scar tissue, according to Dr. Patel. In Mr. Mur-ray’s case, the culprit was high blood pres-sure, which he controlled with medication.

After his epicardial ablation last April, Mr. Murray returned to work again and life got back to normal. “If I have palpitations, they happen only a couple of times a day and they’re barely noticeable,” he said. But flying was the true test. “After a defibrillator episode last December, I didn’t want to get back on an airplane,” he said. After all, the ICD was still in his chest.

“With an epicardial ablation, you still need a defibrillator as a back-up,” said Bruce Goldner, MD, director of electrophysiology at LIJ, who was part of Mr. Murray’s surgical team.

“Dr. Patel figured it out,” Mr. Murray said. “The epicardial ablation did the trick.”

IN CASE OF HEARTRHYTHM PROBLEMS

Call 911 immediately if you experience chest discomfort or shortness of breath, which can be signs of afib, VT or a heart attack.

Otherwise, see a doctor if you think you may have afib or VT. Symptoms include a rapid or irregular heartbeat, fluttering or “thumping” in the chest, anxiety, faintness or confusion, light-headedness or dizziness, fatigue when exercising and weakness.

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