David DeLurgio, MD, Professor of Medicine at Emory University School of Medicine and Director of Electrophysiology at Emory St. Joseph’s Hospital talks about atrial fibrillation and his current study.
Interview conducted by Ivanhoe Broadcast News in May 2018.
When it comes to atrial fibrillation could you tell us what that is and is it common in this country?
Dr. DeLurgio: Atrial fibrillation is the most common arrhythmia affecting patients in the developed world. It is an irregular rhythm, it emanates from the top chambers of the heart called the atria and it produces a very irregular heart rate often very rapid. Unfortunately it produces a lot of symptoms. The most common are a sense of palpitations and that the heart is not beating properly. But more importantly it can cause stroke and is one of the major causes of stroke. And additionally it can cause the progression of heart failure in some patients. It is a common problem, we estimate that there are approximately five million Americans currently suffering from atrial fibrillation. Some studies have suggested that the lifetime risk of having at least one episode of atrial fibrillation is one in four.
That’s very high, can it happen to anyone at any age? Can it affect anyone at any age?
Dr. DeLurgio: Atrial fibrillation is very common and typically is not seen in children. But as we age naturally our risk of atrial fibrillation goes up. We have noticed that when you hit age sixty your risk of atrial fibrillation starts to accelerate dramatically. However, we do see even younger patients with atrial fibrillation sometimes in their twenties, thirties and forties.
Does it always require treatment?
Dr. DeLurgio: Some cases of atrial fibrillation are milder than others. In general when we see a patient with atrial fibrillation we have to make some major decisions. Number one, is this patient at risk of a stroke? If so, we’ll typically treat that patient with a blood thinner and there are many common blood thinners which have shown to be effective. Some patients require additional medications to control their heart rate and in some cases ablation is a good answer.
Have you seen many cases where the patients Afib is not affected by the medication and some of the other treatments?
Dr. DeLurgio: We have several medications available to help control atrial fibrillation, unfortunately overall they are only effective in about fifty percent of patients. And even in those patients they’re often semi-effective and sometimes produce side effects. What happens is that many patients progress from trying medications to needing a more advanced type of therapy. And that’s where ablation can come in for many patients.
Talk about ablation and what this procedure is and then talk about the study you’re doing here at Emory.
Dr. DeLurgio: Sure. Atrial fibrillation comes in different types. Early on atrial fibrillation may be paroxymical and that means that it comes and goes. Patients may feel the arrhythmia then it may resolve and it may come back. Other types of atrial fibrillation are more progressed and we call that persistent atrial fibrillation and sometimes long standing persistent atrial fibrillation. Persistent atrial fibrillation can be more difficult to treat, it can be more difficult to treat both with medicines or with ablation. Now ablation is an intervention designed to try to markedly decrease the chance of having recurrent atrial fibrillation. Typical forms of ablation involve catheters that are inserted through the veins of the leg to the interior of the heart and then we either freeze or burn specific areas within the heart that are causing the atrial fibrillation or causing it to be perpetuated. What we’ve found is that for patients with persistent atrial fibrillation that technique alone is not particularly effective. While better than medications it still has a success rate that is approximately sixty percent. We’re interested in a procedure that can us a much higher success rate than that. In order to avoid repeat procedures or continued symptoms on the part of the patient.
So what are you doing here at Emory St. Josephs that you’re finding to be a better more successful procedure with ablation?
Dr. DeLurgio: Approximately three years ago we embarked upon a hybrid atrial fibrillation ablation program. Now hybrid refers to combining different aspects of a procedure to try and improve the results. The hybrid atrial fibrillation ablation I’m referring to is called the convergent AF ablation procedure. And it uses a special catheter designed to be introduced in to the sac around the heart to ablate certain areas and then we combine that with a more standard transvenous approach where we enter the heart from the vessels of the leg and treat the heart from the inside. We have found in our preliminary work that the hybrid approach seems to be much more effective for patients with persistent or tough to treat atrial fibrillation.
You are the lead investigator of a clinical trial here at Emory, talk about the trial. Is it outside of Emory as well and how many patients have you all treated?
Dr. DeLurgio: Currently there is a randomized control trial going on that I’m leading throughout the nation. We have twenty six centers in the US and actually three centers in the United Kingdom as well. We have enrolled a hundred and thirty out of our projected one hundred and fifty three patients. And the idea is to compare this hybrid approach to a more standard transvenous approach. Now what we have found preliminarily in trails proceeding this randomized trial is that the hybrid approach appears to be more effective. However, it’s very important to have very carefully controlled randomized data to answer this question scientifically and thoroughly. The trial will probably be completing its enrollment in the next few months and then all those patients will be followed for a whole year as we access their response to therapy. We hope to be able to present data including a written journal article that will show the effectiveness of this procedure.
This success rate so far that you have seen with this procedure; what have you seen and also the recovery for the patient. How does it differ from the procedures that you were doing previous to this?
Dr. DeLurgio: The hybrid procedure is a little more involved than the standard procedure we’re talking about. It does involve the participation of a cardiothoracic surgeon. He introduces a small catheter under the sternum. The catheter is inserted in this small area and is allowed to be introduced in to the sac around the heart. Now the benefit of the procedure is that addition allows us to get a more durable and long lasting ablation. When we combine the two procedures together we believe that we’ll have a more durable procedure that can provide relief from symptoms hopefully permanently but at least over a very long period of time. Now what we’ve found is that patients will have to stay in the hospital a little bit longer. A standard procedure is usually considered an overnight hospital stay but we keep our patients after the hybrid procedure for two to three days to make sure that everything is going smoothly. We also limit activity at home after the procedure to allow for a complete recovery and patients are typically off work for a week or two if they have a vigorous type of job. What we’re finding is that the results are meeting our expectations so far. Of course we have to wait for the results of a randomized trial to know for sure. But preliminarily in our first one hundred patients that we performed outside of the trial we’re finding that at least ninety percent of the patients have near complete or complete eradication of their arrhythmias. And we have to put that in the context or realizing that all these patients were in continuous twenty four seven atrial fibrillation prior to the procedure. Some for months and years.
So they can go back to being active, going to the gym. If they’re active people to begin with they can go back to that?
Dr. DeLurgio: One of the main reasons to do an atrial fibrillation ablation is to restore quality of life. Of course we hope for many ancillary benefits like reduction in medications and we hope that we can even reduce the risk of stroke. But we know for sure that quality of life can be improved. So we’re trying to help our patients return to active lifestyle, normal travel, normal work, exercise. We hope to help them lose weight when that’s necessary and improve other aspects of their care. It’s part of a whole picture of management of a patient with a heart condition.
Are you still enrolling patients in the trial?
Dr. DeLurgio: The converge IDE clinical trial is still enrolling patients and we have a web portal as well as access through the Emory website to gain information about that trial. Many patients are candidates and I would encourage any patient who is interested to visit our website or to make contact with their doctor. Of course atrial fibrillation mandates some sort of treatment. We must at least access your stroke risk and make sure that is controlled. We like to treat your symptoms and you may be a candidate for ablation.
Not everyone is a candidate?
Dr. DeLurgio: Not everyone needs it.
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.
If you would like more information, please contact:
Mary Beth Spence, Emory Healthcare PR
678-843-5850
Marybeth.spence@emoryhealthcare.org
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