Treating Cardiac Arrhythmias with Catheter Ablation

Rhythmic sequence of the heart beat is controlled by the precise generation and flow of electrical impulses. Any disruption in the functioning of the heart’s electrical system causes the heart to beat abnormally. A condition characterised with irregular heartbeats or abnormal heart rhythm is called cardiac arrhythmia (dysrhythmia). Depending on the rate of heart beats, dysrhythmia is categorised into bradycardia (too slow heartbeat) and tachycardia (too fast heartbeat).  

[PCI Live Case on Monday 13 April, 2015, 14:30-15:30 GMT] 

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias. In atrial fibrillation, erratic signals flood the atria and override the normal sinus rhythms resulting in abnormally higher and rapid heartbeats.  AF is associated with coronary heart disease and considered a major reason for embolic stroke. Some of the common symptoms of atrial fibrillation include dizziness, palpitations, weakness, fatigue, sweating and chest pain. Electrocardiogram (ECG), stress test, electrophysiology and other diagnostic tests are performed to confirm the presence of arrhythmia. Management of arrhythmias is all about heart rhythm control and cutting down the risks of stroke.  Lifestyle changes, medications, catheterization procedures and surgical treatments are preferred by cardiologists in treating arrhythmias.

Heart rhythm control drugs are chosen on the basis of medical history and analysis of symptoms.  Since these medications can be risky, it demands constant monitoring during its course. Sodium-channel or potassium-channel blockers are typically used as the heart rhythm controlling medications. On the other hand, catheter ablation is a medical procedure performed in the electrophysiology lab to treat arrhythmias. During ablation, radio frequency energy is passed to the catheter in order to scar the problematic areas. Approval of therapeutic thermocool Smarttouch Catheter is an innovative step in treating arrhythmias. Clinically approved therapeutic thermocool Smarttouch Catheter integrated with contact-force sensing technology will guide the electrophysiologist in destroying the problematic area without any further complications. Evaluating the symptoms and detecting the causes is essential to devise the right treatment for arrhythmias.

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What Is Hyperlipidemia?

Soft and waxy lipid cholesterol has gained a maligned status these days. However, it is essential for building and maintaining cellular membranes, hormone synthesis and other vital body functions. Since these fat molecules don’t dissolve in the blood stream, they need a special transportation system to travel through the human body and that is why it is mixed with the protein particles, known as lipoproteins. Lipids are mainly classified into triglycerides, total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and very low density lipoprotein (VLDL). Excess calories consumed through food is converted to triglycerides and stored in fat cells, but on the other hand LDL and HDL are produced by the liver. Low-density lipoprotein is considered as the ‘bad cholesterol’ because it contributes to the plaque formation and fatty deposits of blood vessels. However, high density lipoprotein is known as the ‘good cholesterol’ as it picks up the excess LDL cholesterol from the arteries and takes it back to the liver for processing.

A condition with abnormally higher or lower levels of lipid concentrations in the blood stream is known as dyslipidemia. Why it is a risky factor? Patients with higher levels of bad cholesterol are at increased risk of coronary heart disease and stroke. Cholesterol deposits in the coronary arteries leads to  reduced supply of blood  to the heart, resulting in myocardial ischemia or angina. Opting for the effective dyslipidemia treatment is essential for restoring the body’s metabolic process efficiently. Major causes of abnormal changes in lipid profile include unhealthy lifestyle and eating habits. Most of the physicians advise dietary and lifestyle modifications as the first step of an effective dyslipidemia treatment.

Hyperlipidaemia, also known as hyperlipoproteinemia is a subset of dyslipidemia. Characterised by an excess amount of lipids in the blood stream, hyperlipidaemia slows down the metabolic functions of the body. Elevated levels of fats in the blood stream speed up the plaque accumulation which further leads to narrowing of arteries. As mentioned above, the first line of defence against the risky hyperlipidemia is opting for a healthy lifestyle. However, in some cases, medications are prescribed by the physicians to treat inherited forms of risky hyperlipidemia. Correlation between hyperlipoproteinemia and coronary vascular diseases has been proved by the researchers. So it is essential to treat this critical condition as early as possible to stay away from the risk of heart disease, stroke and other health implications.

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Stroke Prevention In Atrial Fibrillation Guidelines

A normal heart beat occurs whenever there is a coordinated progression of electrical impulses. Sinoatrial node (SA node), also known as the heart’s natural pacemaker sends out the electrical impulses which will make the atrium and ventricles contract and push blood throughout the body. Any disruption to this electrical impulse generation and transmission results in symptomatic heart valve disease treatment, abnormal heart rhythms and is termed asarrhythmia. In some cases, the erratic impulses are produced by any other heart muscle in the atria that overrides the functioning of the heart’s natural pacemaker. This leads to the fibrillation of atria, further resulting in excessively higher or abnormal heart rates and the condition is termed as atrial fibrillation (AF) or AFib. Evaluating the symptoms and seeking the right atrial fibrillation treatment is essential to reduce the risks of stroke and heart failure.

Erroneous electrical signals sent from the atria leads to the disorganized contractions of heart chambers.  Irregular contraction of atria and ventricles leads to an abnormally faster heartbeat thereby reducing the heart’s efficiency and performance. Moreover, the chaotic rhythm in the atria causes disturbances in the blood flow. This sometimes leads to blood clot formation, which can travel to the brain, resulting in stroke. People with AF are at a higher risk of having embolic stroke and heart failures. That is why it is always recommended to opt for the most helpful form of right atrial fibrillation treatment.  AFib patients with higher or moderate risk of developing a blood clot are prescribed with medications, catheter-based procedures or surgery. Stroke prevention in atrial fibrillation is possible only by cutting down the chances of blood clot formation.

Depending on the level of risk and assessment of your symptoms, anticoagulant medicines are prescribed by the physicians. Vitamin K antagonists have been used as the standard therapeutic option for stroke prevention in atrial fibrillation patients. Warfarin, dabigatram, rivaroxaban and apixaban are some of the commonly used blood thinning medicines. Preventing the abnormalities in heart rate is also important for the symptomatic heart valve disease treatment. Depending on the severity of Afib episodes, underlying cardiac issues and the symptoms, the physician will determine the best risk stratification strategy.

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Aortic Valve Implantation for Valvular Heart Diseases

The human heart has four valves – mitral, tricuspid, aortic and pulmonary. The main function of these heart valves is to ensure the one-way blood flow throughout the heart’s chambers. Mitral and tricuspid valves take control of flow of blood into the ventricles. Pulmonary valves allow blood flow to the pulmonary artery. Whereas, aortic valve allows the blood flow from left ventricle to aorta - a major artery that carries oxygen-rich blood throughout the body. Flaps of the valve tissues shut and open according to the contractions of the atria and ventricles, thereby preventing the chance of backward leakage. But whenever there is damage in the valve tissues, it will affect the whole blood flow system of the heart leading to severe complications. Heart valve disease occurs due to valvular stenosis or valvular insufficiency organic and functional mitral regurgitation.

An obstruction in the blood flow to the heart due to the narrowing of valves is called valve stenosis. Tissues of the valve flaps become stiffer or thickened due to the stenosis, which further cuts down the blood supply and reduces the performance of the heart. Whenever the valve doesn’t close tightly, there will be a backflow of blood and it is known as regurgitation (valvular insufficiency). Organic and functional mitral regurgitation is a case in point. Valvular heart disease can be congenital or acquired. In most cases, the congenital valvular disease involves pulmonary or aortic valves, whereas the acquired disease involves aortic or mitral valves. Angina, shortness of breath, dizziness and excess fatigue are some of the main symptoms of valvular heart diseases. Both the stenosis and leakage issues can lead to severe cardio vascular events and complications. Advanced aortic valve implantation procedure is a preferred surgical approach to treat valve stenosis and regurgitation.

Advanced aortic valve implantation is an open heart surgery procedure during which the damaged aortic valve is removed and replaced with a prosthesis. Aortic valve balloon valvuloplasty and transcatheter aortic valve implantation (TAVI) are minimally invasive treatment alternatives available for managing valvular diseases. Even after the valve implantation, the physician will advise the patients to follow some medications. Oral anticoagulants are prescribed to prevent the risks of valve-associated thrombosis and strokes. Evidencebased vitamin k antagonist guidelines are followed by the physicians for the antithrombotic and thrombolytic therapy for patients with artificial valves.

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Treating Atrial Fibrillation with Vitamin K Antagonist Therapy

Blood to the heart muscles is supplied by the coronary arteries and the entire pumping process is controlled by the heart’s electrical conduction system. Any disruption to the electrical signal transmission affects the blood flow and functioning of the heart. Whenever there is an obstruction in the blood supply, the heart muscles become starved of oxygen and nutrients, which leads to more chest pain or discomfort.  Atrial fibrillation (AF) is one of the common heart conditions characterised with excessively higher or abnormal heart rates. Moreover, it also increases the risk of blood clots causing stroke or life-threatening congestive heart failures. That is why it is highly recommended to seek treatment for AF at the right time.

Atrial fibrillation is categorised into paroxysmal, persistent and permanent depending on the degree and frequency of AF episodes. Diagnostic tests and accurate evaluation of symptoms is essential to devise the right treatment method. Atrial fibrillation has strong associations with other serious cardiovascular diseases such as congestive heart failure, hypertension and coronary artery diseases. Treatment options for AF include medical therapy, catheter ablation and insertion of pacemaker. Drug treatment is often preferred to prevent the risk of stroke or to control the heart rhythm. Patients with permanent AF are at an increased risk of stroke and thromboembolism. Oral anticoagulation common vitamin K antagonist therapy (VKA) is the standard medication prescribed for AF patients with moderate or high risk of stroke.  Also known as blood thinners, this medication demands regular blood tests to monitor its interactions. Some of the common vitamin K antagonist therapy medications include warfarin, apixaban, dabigatran and rivaroxaban.

Catheter ablation is another procedure to treat AF, where the source of erratic signals is destroyed using high-frequency radio waves. Having an artificial atrial fibrillation pacemaker fitted below the skin near the collar bone is another option to maintain the normal heart rhythm. A pacemaker is a small device that consists of a pulse generator and lead wires. Implantation of an artificial atrial fibrillation pacemakeris a minor surgical procedure that is typically done in an electrophysiology lab. Right after the implantation, the device takes over the job of sinoatrial node (SA node) and helps the heart beat regularly. Treatment for atrial fibrillation is decided on the basis of the patient’s symptoms, underlying cause, overall health condition and other factors.

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