New surgical treatment in Dubai to treat abnormal cardiac rhythms

Many people may have experienced a ‘fluttering’ heart, in which the heart skips a beat, or had occasional palpitations. These are fairly common and not serious, but when they occur frequently and for a long time, and affect the functioning of the heart, they can present a potentially serious health threat such as heart attacks.

A new surgical treatment is now available in Dubai to treat heart arrhythmia, which occurs when the heart beats irregularly and cannot pump blood effectively, putting vital organs such as the brain and lungs at risk and making patients vulnerable to heart attack and stroke. The causes of arrhythmia are not clearly understood and it is common amongst many populations, but only a small number of heart surgeons are able to carry out the new surgical procedure.

The new cardiac surgical procedure — called ‘thoracoscopic atrial fibrillation ablation’, in which heart tissue is burned using a catheter to leave scar tissue that creates new pathways for electrical impulses — restores the normal sequence of electrical impulses that trigger each heart beat. This is undertaken using minimally invasive surgery techniques, lowering risk and speeding up recovery. Heart arrhythmia, which can affect children and adults, had always been considered untreatable until recently.

The normal heart is a strong, muscular pump a little larger than a fist that pumps blood continuously through the circulatory system. The average heart beats — expands and contracts — 100,000 times and pumps about 2,000 gallons of blood every day. In a 70-year lifetime, an average human heart beats more than 2.5 billion times. The heart pumps blood to the lungs and to all the body’s tissues by a sequence of highly organised contractions of the four chambers. For the heart to function properly, the four chambers must beat in an organised way.

Abnormal heart rhythms

There are many kinds of abnormal heart rhythms that can occur in children and adults. The electrical impulses may happen too fast, too slowly, or erratically, causing the heart to beat too fast, too slowly, or erratically. As long as the electrical impulse is transmitted normally, the heart pumps and beats at a regular pace. In an adult, a normal heart beats 60 to 100 times a minute, but this can rise to 200 beats per minute due to arrhythmia. This means oxygenated blood can’t get to the areas that need it, causing symptoms such as dizziness and breathlessness, and blood may pool in the heart causing blood clots that can lead to heart attack or stroke.

The procedure

The thoracoscopic atrial fibrillation ablation surgical procedure involves deflating the lungs to access the heart. Two small incisions are made between the ribs and a telescope-like device with a camera (endoscope) is inserted into the lung to enable the surgeon to see what he is doing on a screen in front of him. The wand (catheter) that burns the heart tissue on the veins to scar them is inserted through the other incision.

The surgeon then inserts a special tool, which looks like a hair grip, to clip the left atrial appendage closed, so it is separated off from the heart. The clip stays inside permanently. The lung is then re-inflated and the procedure repeated on the other side of the heart so that more of the problem area can be covered and allowing the surgeon to create a thick barrier of scar tissue.

Dr Stephen Griffin, a British heart surgeon who recently joined the American Hospital Dubai, and who has performed the procedure hundreds of times in the UK, explains: “Heart arrhythmia was considered untreatable surgically until recently when the catheter ablation procedure was first developed but this was unsuccessful in around 40 per cent of patients, who would need a further procedure.

“This latest surgical procedure — thoracoscopic atrial fibrillation ablation — can cure the problem with one surgical intervention. Perhaps just as importantly, during the surgery we also remove the biggest risk factor for clots: The area of the heart called the left atrial appendage. By closing off this part of the heart, you reduce the risk of stroke. The operation takes around two hours. Arrhythmia is a common problem in the UK affecting around one per cent of the population and there are only around 10 surgeons performing this procedure in the UK.”

Arrhythmias can cause stroke — a cerebrovascular disease that affects the blood vessels supplying blood to the brain. Deprived of oxygen, brain cells in the affected area can’t function and die within minutes. The devastating effects of stroke are often permanent because dead brain cells aren’t replaced. The most common cause of stroke from an arrhythmia is atrial fibrillation which can cause blood clots to form in the atria (top chamber of the heart) where they can be pumped out of the heart, to the brain, blocking a blood vessel and causing a stroke.

asmaalizain@khaleejtimes.com