That’s what was happening to James Armond, 80, a retired field supervisor for the Southern California Gas Company, who was diagnosed with atrial fibrillation (AFib) 30 years ago. AFib is a heart rhythm disorder in which the heart’s upper chambers (atria) beat rapidly and chaotically, out of sync with the lower chambers (ventricles). Untreated, this condition can lead to blood clots in the heart, increasing the risk of stroke, heart failure and other heart-related complications, which makes timely diagnosis and treatment extremely important.
Over the years, Mr. Armond’s doctors managed his AFib primarily with medications, including beta blockers and calcium channel blockers to slow the abnormally rapid heart rate (tachycardia) that occurs during atrial fibrillation episodes. As he got older, however, Mr. Armond was less able to tolerate these medications.
“They just wore me out and I was really dragging,” he says. In fact, they caused his heart rate to go so low at times that he would pass out. “I’d try to exercise by walking in the park with my wife, but a quarter of the way I’d have to stop and sit down because I got so fatigued.”
“His fatigue really troubled me because he’d always been an energetic person,” says Mrs. Cheryl Armond, a retired registered nurse who had worked in a hospital telemetry unit caring for cardiac patients.
Mr. Armond went to see Board Certified Cardiologist Puneet Khanna, MD, who recommended that his patient wear a Holter monitor. This is a portable electrocardiogram that records the heart’s electrical activity continuously over a 24- to 48-hour period while the patient goes about his regular activities. It revealed that Armond’s atrial fibrillation was not under control.
“Fortunately, today we have a range of options for treating atrial fibrillation,” Dr. Diamantakos says. “The electrophysiology field has drastically changed over the years as new advances offer better outcomes with fewer side effects.”
Dr. Diamantakos met with the Armonds and explained all these options.
“We could do nothing, which was not an option for them, or reintroduce the medications he’d been on in the past, which was concerning because of the side effects he’d experienced and would require constant monitoring,” Dr. Diamantakos relates.
“We could also try antiarrhythmic medications or cardioversion, a medical procedure that can restore a normal heart rhythm by sending electric shocks to the heart through electrodes placed on the chest,” he continues. “Again, they didn’t want to deal with the potential side effects of pills, and there was still the possibility of a too-slow heart rate.”
Traditional ablation was also an option. In this minimally invasive procedure, a catheter is guided through a blood vessel to the heart, then radiofrequency energy is sent through the catheter to destroy tiny areas of heart tissue involved in the abnormal heart rhythm.
“But I pointed out that the success rate for this procedure in an 80-year-old with persistent atrial fibrillation is about fifty to sixty percent,” Dr. Diamantakos says, noting that success rates are higher in patients who do not have persistent atrial fibrillation such as Mr. Armond.
The final option is to consider a combination of AV (atrioventricular) node ablation with implantation of a biventricular pacemaker. The AV node is a secondary pacemaker in the heart that allows for the conduction of electrical impulses from the atria to the ventricles, controlling the heart rate. Ablating the AV node eliminates the rapid and irregular heartbeat that accompanies AFib.
A biventricular pacemaker carries electrical impulses to the right ventricle and the left ventricle of the heart to help control the timing of contractions between the two chambers, synchronizing the rhythm of the heartbeat.
After several discussions — often fueled by questions from Mrs. Armond, who was a fierce advocate for her husband — Mr. Armond opted for implantation of the dual chamber pacemaker in late September.
The difference in how he feels has been dramatic.
“I felt more energetic almost immediately,” he says. “It was great to get some relief, to feel alive again.”
“Atrial fibrillation can be a hard arrhythmia to manage because every patient doesn’t follow the same regimen,” Dr. Diamantakos says. “You have to tailor treatment to the individual patient’s unique medical situation and personal wants and desires. So you lay out all the options and help the patient make the most informed decision about what’s best to achieve the optimal long-term clinical outcome.”
“I know Dr. Diamantakos is busy, but he took his time, meeting with us multiple times to explain what we didn’t understand the first time,” Mrs. Armond says. “We felt safe with him.”
“I totally trust Dr. Diamantakos,” Mr. Armond adds. “I expect to spend the rest of my days on earth with him as my doctor.”
For more information or to contact Eisenhower Desert Cardiology Center, call 760.346.0642, or visit EisenhowerHealth.org/DesertCard.
