Michael Hoskins, M.D., an electrophysiologist at Emory University in Atlanta, Georgia, talks about how researchers are testing a new combination of procedures to eliminate atrialfibrillation.
Interview conducted by Ivanhoe Broadcast News in March 2017.
With Afib, atrial fibrillation, what’s happening in the body?
Dr. Hoskins: Atrial fibrillation or Afib as it’s sometimes called is the most common sustained abnormal rhythm. Patients can experience that as either shortness of breath or fatigue, or sometimes racing heartbeats or rapid heartbeats.
Is it possible to have Afib without any symptoms at all?
Dr. Hoskins: Of course, some people do not know that they’re in Afib and they can be asymptomatic.
How common is it?
Dr. Hoskins: Afib is the most common abnormal rhythm and about five million Americans have atrial fibrillation.
Is this something that is life threatening?
Dr. Hoskins: Afib itself is not life threatening but one of the major consequences of Afib is an increased risk of stroke. Stoke can cause a lot of different health problems and can be life threatening.
What is the standard treatment for someone with Afib?
Dr. Hoskins: Usually atrial fibrillation is treated with medications for first line therapy. Patients that still have Afib despite medicines often will often undergo a procedure called catheter ablation which is a procedure where we insert catheters in to the body to try to eliminate atrial fibrillation.
How is that done, is it essentially short circuiting pulses, if you could explain a little bit about what’s happening with the ablation.
Dr. Hoskins: Ablation is done by using catheters that go through the groin in to the heart and then we either freeze cells or burn cells that are involved in atrial fibrillation to try to eliminate the rhythm.
Talk to me a little bit about some other treatment options that are a little newer for Afib. For example, the lariat, the aMAZE trial.
Dr. Hoskins: We know from past data that the left atrial appendage is important in stroke in atrial fibrillation and we’re now learning that it’s also important in the abnormal rhythm itself. The aMAZE trial is designed to eliminate that left atrial appendage not only to prevent strokes but also to reduce the arrhythmia itself.
How is it done?
Dr. Hoskins: That procedure is done by using a catheter both through the groin and on the outside of the heart. The way we get to the outside of the heart is a small catheter under the rib cage. That catheter has a small suture or stitch on the end of it that goes around the left atrial appendage and cinches the appendage much like a hefty cinch sack.
It’s called the lariat, is there a reason for that name?
Dr. Hoskins: The lariat comes from the appearance of the device which looks much like a lasso or a lariat.
You are essentially catching the left portion of the chamber then?
Dr. Hoskins: With the lariat device we actually go around the appendage itself and cinch it off with the suture and that eliminates it from the circulation. Eventually the left atrial appendage necrosis or withers away and then it’s no longer involved in the generation of the arrhythmia.
Is there any risk to the patient of having that portion of the heart chamber withering away?
Dr. Hoskins: We have not seen any long term problems with eliminating the appendage.
Who would be a really good candidate?
Dr. Hoskins: The aMAZE trial is targeting patients with what we call persistent atrial fibrillation or people who have been in atrial fibrillation for at least a week at a time. We are not looking at patients who are in what we call permanent atrial fibrillation where the physician has decided that atrial fibrillation is there to stay.
It’s a different treatment for those who are in permanent Afib?
Dr. Hoskins: Yes.
Tell me a little bit more about the trial. Are you looking to just investigate the device?
Dr. Hoskins: The aMAZE trial is designed to look at patients with persistent atrial fibrillation and see if eliminating the left atrial appendage will reduce the amount of atrial fibrillation that the patient has.
Is it still ongoing right now?
Dr. Hoskins: This trial is ongoing currently and still enrolling patients and the patients that we have enrolled so far have done very well and have had dramatic symptom improvement.
What kind of a difference have your patients mentioned after having undergone this procedure?
Dr. Hoskins: When patients are in atrial fibrillation their symptoms can be very debilitating. And when we can restore normal rhythm for a prolonged period of time the quality of life for those patients goes up dramatically.
What’s the length of the trial, I know you said you’re still enrolling them, when would you anticipate that there would be some data?
Dr. Hoskins: It will probably be several years before we have final data from this trial.
How many patients did they enroll?
Dr. Hoskins: About six hundred.
Do you know how many sites?
Dr. Hoskins: Thirty sites.
In terms of the patient Janet that we’re going to talk to tomorrow are you able to speak to her case at all? She was in Afib ninety nine percent of the time. She said it was really an issue with her.
Dr. Hoskins: She was in atrial fibrillation all the time before entering the trial. After her procedure she has not had any atrial fibrillation for the past five months. Her quality of life has dramatically improved.
When you’re talking about quality of life what kind of things are patients not able to do when this is going on?
Dr. Hoskins: Some of the biggest impacts on patients are fatigue and shortness of breath. If we can eliminate those two things patients feel dramatically better.
Is there anything I didn’t ask you that you want to make sure that people know either about the aMAZE trial or about Afib?
Dr. Hoskins: The treatment for patients with atrial fibrillation is patient specific. It’s very important for patients to sit down with their physician and discuss what treatment options are best for them.
You did mention someone who is in permanent Afib would not be a candidate for this. There are options for those patients that are in permanent Afib?
Dr. Hoskins: When patient is in permanent atrial fibrillation or have been in atrial fibrillation for many years often we focus on controlling the heart rate. That can be done either with medications or with a procedure that includes the use of a pacemaker to control the heart rate.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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