In 2006, Eisenhower Board Certified Cardiologists/Electrophysiologists Andrew Rubin, MD, and Leon Feldman, MD, established the first atrial fibrillation ablation program in the Coachella Valley. With the recent addition of Board Certified Cardiologist Evangelos Diamantakos, DO, Eisenhower has become a leading center for atrial fibrillation in Southern California.
Ablation is a type of microsurgery where cardiac tissue can be minimally cauterized to disrupt the abnormal circuitry of atrial fibrillation. Incorporating three-dimensional mapping, CT scans and intra-cardiac ultrasound, Dr. Feldman and Dr. Rubin have had great success using ablation to treat patients with atrial fibrillation.
“Ablation can be used for people who have symptomatic atrial fibrillation who desire a cure for the rhythm rather than taking medications,” says Dr. Rubin. “Or for people who tried medications that have not worked or who can’t tolerate the medications. The success rate for complete cure is 70 percent. The likelihood of significant clinical improvement — one episode a year instead of eight episodes — is 80 percent.”
“We have one of the largest populations of healthier 80-plus people who would benefit from atrial fibrillation ablation,” adds Dr. Feldman. “With the addition of new mapping technology, our experience and expertise, we’re in a premier position to offer ablation as the best option.”
New mapping technology
All ablations require some form of mapping during the procedure to track the electrical information prior to ablation.
“We are now using new technology — the ultra-high resolution imaging and mapping system by Acutus™ called ACQMAP™,” says Dr. Feldman. “It allows us to almost instantly create three-dimensional heart anatomy using ultrasound, based on the tip of a catheter which has 48 ultrasound transducers. This means we can recreate the map within a minute to three minutes if the rhythm changes during the ablation, and track the new and altered arrhythmia. We’re able to trace the rhythm in real time, allowing us to adjust our ablation strategy.”
“The Acutus creates charge density mapping, acquiring 115,000 points of information per minute to target the more complex regions of an ablation procedure,” adds Dr. Rubin.
According to Feldman, the most concerning symptoms of atrial fibrillation are no symptoms. “There is a cohort of patients living with atrial fibrillation, from days to years, with no discernable symptoms and their first presentation is the worst outcome — a blood clot causing a stroke,” says Feldman. Twenty percent of strokes are caused by atrial fibrillation.
“It’s helpful when patients have symptoms because they’ll come in sooner for medical attention,” continues Feldman. “We can start them on the appropriate anti-coagulation therapy or offer them a Watchman™ device which eliminates the need for blood thinners, other than taking a baby aspirin.”
The Watchman device
The Watchman device falls under the topic of atrial fibrillation but rather than treating the rhythm problem, it is designed to prevent strokes which are a result of the abnormal rhythm. An alternative to taking blood thinners, the Watchman device is for people who are felt to be at increased risk for stroke, which is the vast majority of people with atrial fibrillation. It is a permanent heart implant that fits into the left atrial appendage (LAA) to permanently close it off and keep any blood clots from escaping.
“The procedure takes about one hour, under general anesthesia, and the patient goes home the next day,” says Dr. Rubin. “Six weeks after implantation, we perform imaging to confirm the device is properly seated in the LAA and that heart tissue has grown over the implant to form a barrier against blood clots.
“At that point, warfarin or whatever direct oral anticoagulation medication the patient is taking is stopped,” he says. “The patient takes aspirin and clopidogrel (Plavix®) for another four to five months, and then they switch over to aspirin alone on an ongoing basis.”
“We’re one of the first centers in the country to have the second generation Watchman device,” explains Dr. Feldman. “WatchmanFLX™ has an even better safety profile and improved implantation technique. More patients can be accommodated because there is a greater variety of sizes.”
For more information or to contact Eisenhower Desert Cardiology Center, call 760.346.0642 or visit EisenhowerHealth.org/DesertCard.