New Canadian procedure could revolutionize AFib treatment

A new Canadian approach to treating a common heart rhythm condition could change the game for patients who deal with atrial fibrillation or AFib.

AFib is considered the most common arrhythmia and occurs in the upper chambers of the heart.

Affecting one to two per cent of the general population, the irregular heartbeat can cause symptoms such as shortness of breath and fatigue, but can lead to severe consequences such as stroke or heart failure.

Fatigue caused Jon Davies of Edmonton to suspect something was wrong.

“I used to go mountain hiking and played a lot of squash and then that sort of quickly went away as I got into my early 50s,” he told Global News in an interview. “I just figured it was old age and having a desk job and not enough exercise maybe.”

His wife, Nora, said he was often tired and would sleep a lot.

He was eventually diagnosed with atrial fibrillation, but when speaking about treatment options he was left in shock.

“They told me that my heart had enlarged so much that it wouldn’t make sense for them to treat it surgically, so that’s when they said you’re going to stay on blood thinners,” Davies said.

Until this year, he said he’s had to accept the “status quo,” adding he got a second opinion with the same result.

People with AFib often receive treatment either through medication or with what’s known as “catheter ablation.”

“Patients are usually sedated or put to sleep entirely and we put little tubes in the groins and we pass wires into the heart, cross over to the left side of the heart and what we try and do is kill the tissue around the pulmonary veins,” said Dr. Paul Angaran, cardiac arrhythmia director at St. Michael’s Hospital in Toronto.

The process involves creating tiny scars in an area of the heart, according to the Mayo Clinic. During AFib, faulty signals can tell the heart to beat irregularly. The scars prevent those faulty signals from reaching their target.

“Typically we burn, so we use energy sources that overheat the tissue and sometimes we can use energy sources that freeze the tissue,” said Dr. Gianluigi Bisleri, the director of minimally invasive and robotic cardiac surgery at St. Michael’s Hospital. “But either way, we create these scars that become permanent and stop the irregular heart rate.”

But Angaran said not everyone with AFib will see such a treatment be effective.

Angaran joined with Bisleri to develop a new approach for helping people with AFib.

The result is a two-part robotic technique using ablations from outside the heart and then going inside using a catheter technique.

“It allows us to not only use the robotic technologies which give us more dexterity, more ability to reach and see the heart, but also to treat broader areas of the heart with the ablation,” Bisleri said.

Using both minimally invasive robotic surgery and catheter technology is a Canadian first, Bisleri said.

Patients interested in the procedure must be referred to Bisleri and Angaran, but the former told Global News while a referral is simple there isn’t enough awareness of their approach.

Patients need to wait a few weeks or months between each procedure, with Angaran noting doctors want patients’ scars on the outside to have healed before they proceed with the internal procedure.

One of their first patients was Davies, who learned about the procedure by searching online.

Davies had the first part of the procedure, the robotic technique, in September and is expected to return to Toronto in the coming weeks for the catheter ablation.

“It’s nice to be able to potentially, you know, take that diagnosis and direct it in a much more human, in a way that, you know, appreciate much more than the alternative,” he said.

Angaran told Global News that in patients with long-standing persistent atrial fibrillation, the long-term success rate through this approach could hit as high as 70 to 80 per cent.

—with files from Global News’ Katherine Ward

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