Clinician-to-Clinician Update Clinician-to-Clinician Update

Leading Edge, Minimally Invasive Procedures for Cardiac Arrhythmias

October 2014

Cardiac arrhythmias are common in the U.S. adult population. Treatment options for arrhythmias include antiarrhythmic medication, pacemakers, implantable cardioverter defibrillators, cardiac resynchronization therapy, and catheter ablation. At University of Minnesota Heart Care, our specialists have been instrumental in driving innovation in the cardiac arrhythmia care, and we have the only physician training program in cardiac electrophysiology in the Twin Cities.

Our team has devised specialized catheters and advanced three-dimensional mapping systems to help better localize where abnormal rhythms originate, increasing the success of catheter ablation procedures. In addition, the Heart Care program has the added capabilities of robot-assisted surgery and peripheral circulatory bypass to increase the effectiveness and safety of complex ablations, improving outcomes for your patients. Some of the conditions that can be successfully treated with catheter ablation procedures include supraventricular tachycardia (PAT), accessory pathways, atrial fibrillation, atrial flutter, ventricular tachycardia, and frequent symptomatic premature contractions that are drug-refractory or drug-intolerant. The team also pioneered the use of cardiac resynchronization therapy, a technique especially beneficial for patients with refractory heart failure, in the Twin Cities area.

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Innovations In Care

Our cardiac arrhythmia clinical care program is complemented by priority clinical and basic science research with a focus on syncope and cardiac resuscitation.

Certain arrhythmias can dramatically increase the risk of stroke, heart failure, and sudden cardiac death. One of these is atrial fibrillation (AF), which affects an estimated three to five million Americans.1,2 A goal of AF treatment is to reduce the risk of stroke, which could be five times higher in patients with AF than in those without AF. The first-line approach to reducing the risk of stroke in patients with AF is anticoagulation with warfarin, Pradaxa, Xarelto or Eliquis.3 However, these drugs carry the long-term risk of bleeding.

Because more than 90% of thrombi in patients with AF originate in the left atrial appendage (LAA)4, a cutting-edge, minimally invasive procedure that excludes the LAA from circulation, called LARIAT™, has been developed and approved by the FDA. During the LARIAT™ procedure, two magnet-tipped guidewires are used to place the LARIAT™ Suture Delivery Device over the LAA. The device is then closed under transesophageal echocardiographic guidance, sealing the LAA. A successful LARIAT™ procedure eliminates the main source of AF-related stroke without open heart surgery, while avoiding potentially serious side effects associated with blood-thinning medication. On the leading edge of these developments, University of Minnesota Heart Care specialists were among the first in the Twin Cities area to perform the LARIAT™ procedure.

References

  1. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370-5.
  2. Colilla S, Crow A, Petkun W, et al. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013;112(8):1142-7.
  3. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014 Mar 28. doi: 10.1016/j. jacc.2014.03.022.
  4. Johnson WD, Ganjoo AK, Stone CD, Srivyas RC, Howard M. The left atrial appendage: our most lethal human attachment! Surgical implications. Eur J Cardiothorac Surg. 2000;17(6):718-22.

When to refer

Patients with the following symptoms may be referred:

  • Palpitation or heart racing
  • Dizziness or Presyncope
  • Syncope
  • Unexplained fatigue, dyspnea or chest pain
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