Arrhythmias of the heart such as atrial fibrillation, bradycardia, tachycardia, ventricular tachycardia, supraventricular tachycardia, and others can be easily treated in our electrophysiology lab with same day discharge. Our primary focus is the treatment of atrial fibrillation.
Initially, our team will help identify risk factors that contribute to the onset of Afib and offer options for personalized lifestyle modifications that might mitigate that risk or refer a patient to one of our interdisciplinary collaborators. For example, maintaining a healthy weight coupled with moderate alcohol intake can help one manage the frequency of Afib occurrences. There is strong evidence that patients with morbidity obesity benefit from combined care between an electrophysiologist and a weight loss surgeon to stop the progression or remodeling of the heart which contributes to the chaotic rhythm.
Personalized risk factor reduction in concert with a patient’s individual values and preferences are the pillars of our patient-centered approach. Dr. Laws believes that the more a patient understands Afib the more informed the patients decisions will be. Ultimately, a patient’s treatment and the medical recommendations will be based on communication, mutual understanding and shared decision making principles- all intended to improve your quality of life whatever- treatment option a patient chooses.
If the arrhythmia limits a patient’s activities of daily living, causing a patient to experience dizziness, syncope or fainting along with chest discomfort, rhythm or rate control medicine may alleviate these symptoms. Moreover, medicines may prevent progression of AFib like stopping the heart to change its physical features that promote the chaotic rhythm.
Beta blockers such as metoprolol and atenolol, calcium channel blockers such as diltiazem and veramil, and digoxins like digitals, slow the rapid unorganized heartbeat. The anti-arrhythmic drugs such as amiodarone, sotalol, flecainide, propafenone, dofetilide, ibutilide, quinidine, procainamide and disopyramide calm or steady the arrhythmia- like calming the ripples in a lake. Unfortunately, some of these medications have undesirable side effects. Through shared decision making our team monitors the side effects and offers options to various therapies for AFib
Anticoagulation or Clot Prevention Medications
AFib can increase a person’s chance of forming a clot which can lead to a stroke, Coumadin or warfarin are a vitamin K antagonist, meaning they reduce the protein and clotting factor caused by vitamin K. These medications require strict monitoring and are complex to administer. Newer anticoagulants are called direct oral anticoagulants such as rivaroziban, apixaban and edoxaban are the newer blood-thinning medicines. The newer family of medicines are more expensive; our team takes prescription pill cost into our shared decision making to determine the best blood thinner for our patients.
Non-invasive cardioversion is an option for patients that are not responding to arrhythmia medications. If a patient is experiencing symptoms while taking the previously mentioned drugs, Dr. Laws can physically stop the AFib by applying electricity to the heart in an attempt to reboot the rhythm.
Many patients with AFib may develop a dysfunction with their sinus node - the heart's organic pacemaker - causing a slow heart beat or bradycardia. Pacemakers will help treat the abnormally slow rhythm. Implantable cardiac defibrillators (ICD) are used to prevent the ventricular tachyarrhythmias which are often incompatible with life. The ICD can detect or sense the dangerous ventricular arrhythmia and shock the heart to stop the chaotic beat.
If a patient is not responding to the less invasive various treatment options, Dr. Laws can facilitate catheter based ablations such as radiofrequency, laser and cryo ablations. These procedures are used to physically block the undesirable chaotic rhythm in the pulmonary veins when lifestyle changes, medicines or the symptoms from drugs are not fixing AFib. Flexible tubes called catheters are inserted into the large blood vessels in your groin or upper thigh and strategically maneuvered into the heart into the pulmonary veins. During the early stages, the pulmonary veins are the primary source for AFib. Advanced imaging in our hybrid cath-operating room allows Dr. Laws to map the heart and identify the AFib energy source. Finally, we apply radiofrequency energy, cryo or freezing energy or laser energy depending on the patient's history and specific anatomy to the AFib origin to destroy small areas of the heart tissue where abnormal heart rhythms may start. Catheter ablations treat the AFib from the inside of the heart with procedures that are called endocardial or percutaneous (access to the heart through the skin) based ablations.
A minimally invasive open approach, sometimes called the convergent procedure is performed in patients who have exhausted all the previously mentioned treatments. Persistent AFib patients can be restored into the normal sinus rhythm with the hybrid approach. This procedure is performed in collaboration or together with Dr. Laws and a cardiothoracic (CT) surgeon team member. Initially, to get access to the heart, the CT surgeon will create a small window on the left side of the ribs and use a sophisticated video camera to assist with scarring or destroying the tissue on the back side of the heart where the AFib chaotic energy can start. Shortly after, patients return to complete the procedure with catheter ablating or destroying the tissue inside the heart with Dr. Laws. To date, this procedure is showing the best results for patients with persistent AFib or AFib that is stubbornly resistant to treatment.
Our comprehensive arrhythmia program facilitates targeted, patient-specific interventions for Left Atrial Appendage (LAA) management, or stroke prevention. Click here to learn more about these patient-centered options.
Our goal is to integrate a patient’s preferences and reduce the downstream negative outcomes such as heart failure due to structural remodeling and stroke.