When our hearts start to pound, we usually know why: Maybe we're in love. Or we're excited. Or we're just a bit over-extended.
But unbeknown to too many of us, sometimes that pounding feeling signifies that something has gone very wrong.
Atrial fibrillation, or AF, is a common rapid-heart-rhythm abnormality. It happens when disorganized electrical signals cause the heart's two upper chambers to contract quickly and irregularly, preventing blood from pumping through all four chambers of the heart as it should.
One of the most under-diagnosed, under-treated health issues today, AF can weaken the heart muscle, and increase the risk of heart failure and the risk of developing blood clots that could lead to stroke and death. Older people and people with diabetes, high blood pressure, heart failure, and hyperthyroidism are particularly at risk.
The condition affects approximately 2.2 million Americans. Unfortunately, many people are not familiar with an arrhythmia until it is too late. With so much emphasis on coronary artery disease, it can be surprising to learn that there is an entire electrical system also keeping the heart running.
We like to say that some cardiologists are the plumbers, working on the clogged pipes of the heart, while the cardiovascular surgeons are the mechanics, fixing the heart's problems surgically. And for some, like Hoag Heart and Vascular Institute's 13 cardiac electrophysiologists, they are the electricians.
Electrophysiologists are heart rhythm specialists who complete all of the training of a cardiologist, followed by extensive fellowship training in the field of electrophysiology, giving EPs a greater understanding of the diagnosis and treatment of cardiac arrhythmias. Cardiovascular surgeons are experienced and uniquely skilled in the surgical treatment of cardiac arrhythmia disorders.
For patients like businessman Sam Wolgemuth, it's good to know that Orange County residents have access to all cardiac specialties and to a leading cardiac center designed for his condition.
Sam had just chainsawed a fallen tree on his vacation property in Wisconsin, when his chest became very uncomfortable. It wasn't painful, and he knew it wasn't a heart attack. Yet, he had never heard of AF and didn't know what he was experiencing.
Luckily, he called his cardiologist, Dr. Mahnaz Behboodikhah. The doctor knew exactly what was wrong. After trying a variety of medications to control the condition, Behboodikhah told Sam about two procedures available to stop AF: the non-surgical catheter ablation treatment and a minimally invasive surgery called Mini-Maze.
In catheter ablation treatment, an electrophysiologist performs a "mapping" of the heart's electric impulses to uncover the source of the abnormal heart rhythm. Once located, radiofrequency energy is used to destroy the abnormal tissue and correct the condition.
The Mini-Maze surgery, which Sam chose to undergo at Hoag, uses video-assisted image guidance technology to allow a surgeon to navigate uniquely designed surgical instruments through small keyhole incisions on each side of the chest. The surgeon then performs a precise surgery directly on a patient's beating heart.
Performed in fewer than 2 percent of hospitals in the United States, the Mini-Maze shows strong evidence of eliminating atrial fibrillation in nine out of 10 patients who receive this treatment option. That has been the case for Sam.
In the three years since he had the Mini-Maze, Wolgemuth has been able to return to work and an active lifestyle without complications or medication.
So now when Sam's heart starts to pound, he knows why. And it isn't atrial fibrillation.
- Aidan A. Raney, M.D., is program director of Hoag Cardiovascular Surgical Services and the James & Pamela Muzzy Endowed Chair in Cardiovascular Surgery.