January 11, 2008

Keeping hearts in rhythm focus of new VHVI center

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Vanderbilt’s David Bearden, here working out at HealthPlus, found renewed energy after receiving treatment for his irregular heart rhythm. (photo by Dana Johnson)

Keeping hearts in rhythm focus of new VHVI center

Atrial fibrillation, an irregular rhythm of the upper chambers of the heart, affects more than 3 million people in the United States and is a major cause of symptoms like palpitations, shortness of breath, lightheadedness and even stroke.

David Bearden, associate director of Medical Supply Sourcing for Vanderbilt University Hospital, didn't know he had an irregular heart rhythm and had probably been living with it for years. He was diagnosed a year ago in Murfreesboro and was told he could live with the disorder by taking beta blockers and aspirin.

The beta blockers caused extreme fatigue for Bearden, who works out five times a week. He scheduled an appointment with Jeffrey Rottman, M.D., professor of Medicine and Pharmacology at the Vanderbilt Heart & Vascular Institute. They tried conventional therapy and cardioversion — an electrical shock delivered to the heart — but Bearden remained in persistent atrial fibrillation (AF).

At that point, he became a candidate for ablation, which applies various energy sources to the inside or outside of the heart to disrupt the electrical pathways responsible for AF. These energy sources range from cold (cryoablation) to heat (radiofrequency, high-frequency ultrasound, and microwave.)

“I immediately felt 20 years younger. It was amazing,” said Bearden, whose cardiac output has improved significantly since the ablation.

Next month will see the opening of the Vanderbilt Heart Center for Atrial Fibrillation (VHCAF), which will offer a multidisciplinary approach to treating this very common condition.

With a growing elderly population, it is estimated that more than 12 million Americans will be afflicted by this condition by the year 2050. Moreover, AF confers an average annual stroke risk of 5 percent, up to seven times the rate in the general population.

The center will bring together clinicians, researchers and nurses to better understand the causes of arrhythmia, apply state of the art therapies and use genetics to identify and tailor therapies in susceptible individuals.

“The unique nature of the collaborative environment between electrophysiology and cardiac surgery here at Vanderbilt gives us the opportunity to offer this service to our patients,” said Steve Hoff, M.D., assistant professor of Cardiac Surgery. “We believe this will allow us to provide the best possible care to our patients, and will assure Vanderbilt's place as a national leader in the treatment of atrial fibrillation.”

While drug therapy still remains the principal means of treating AF, non-pharmacologic management of cardiac arrhythmias has evolved dramatically over the past two decades, said Dawood Darbar, M.D., assistant professor of Medicine and Pharmacology and director of the Vanderbilt Arrhythmia Service.

“The application of radiofrequency catheter ablation techniques has had a dramatic impact on the approach to the treatment of a variety of cardiac arrhythmias, particularly on the management of atrial fibrillation,” he said.

Ablation can be performed in conjunction with other heart operations such as valve surgery or bypass surgery, or as a standalone procedure for patients like Bearden who do not have associated structural heart disease.

Data suggests that ablation is potentially a curative treatment for AF, Darbar added.

“We are one of the premier centers in the region performing catheter-based AF ablations. However, the availability of new devices and techniques means that ablations can also be performed with minimally invasive surgery.

“Instead of opening the heart, we can do it through a mini thoracotomy, which limits length of stay and complications and gets the patient back to a normal life within five days of surgery,” Darbar said.

Other important aspects of the VHCAF are research and education.

Vanderbilt investigators, along with others, have recently identified common genetic variants that identify individuals at increased risk of developing the arrhythmia and are now studying if these will also predict whether patients will respond better to certain therapies.

Other studies are looking at the effects of fish oil as a treatment for AF and blood thinners that do not require regular blood checks.

“People need to be informed. They are told to live with this and are not given any options when there are options for it,” Bearden said.

The Vanderbilt Heart Center for Atrial Fibrillation is scheduled to open in mid-February. For more information, please call 322-2318.