Ask the Doctor at Saint John’s: New Minimally Invasive Treatments Help Prevent Stroke

Q: I have an abnormal heartbeat, putting me at increased risk for stroke. Are there any new treatments available?

By Shephal Doshi, M.D., cardiologist and director of cardiac electrophysiology at Saint John’s Health Center

Not all arrhythmias, or irregular heartbeats, are life threatening. But the most common type -- atrial fibrillation -- affects about 2.8 million Americans and can cause heart damage and stroke.

Fortunately, phenomenal new technology has helped us develop minimally invasive procedures for treating A-fib. I’m very excited about the way the field is changing.

At Saint John’s we’re involved in two new clinical studies to treat patients with A-fib. A-fib occurs when the top chambers of the heart (the atria), short-circuit or misfire, quivering instead of beating.

This causes the bottom chambers to beat erratically and pump lower than normal volumes of blood. When blood doesn’t completely pump out of the heart, it pools in a pocket of the heart and clots form. These clots can travel to an artery in the brain and cause a stroke.

Patients with A-fib who are untreated have nearly a 5 percent risk of stroke every year.

To prevent these blood clots, a blood-thinning medication (warfarin) has been used for years, but this only reduces the risk of stoke by 70 percent. One of the new procedures we’re investigating uses a plug-like device to seal off that pocket. We use a catheter to deploy the plug to where the blood pools. It acts as a filter initially then seals over after about 45 days.

This new device is appropriate for those patients on warfarin. Once the device has sealed off the pocket, patients can go off this blood-thinning medication. The outpatient procedure takes about 30 minutes and is covered by Medicare. Patients spend the night in hospital for observation and go home the next day.

Saint John’s is one of 50 places in the world participating in this clinical trial, currently in the top 5 sites in the world with experience with this procedure, and the top site in the Los Angeles area. The oldest patient who has had this procedure is 94 years old.

Another new technique we’re performing is called endoscopic catheter ablation. We recently performed it for the first time in the United States right here in the Saint John’s cardiac electrophysiology laboratory. We were able to help a 58-year-old patient who felt very unwell from his A-fib.

The procedure involved inserting a slender catheter into a vein in the patient’s right leg, threading it up into his chest, then into a large vein in his heart. A tiny camera at the end of the catheter allowed us to see inside the atrium.

For the first time, using this endoscopic video camera, we were able to locate the problem area. We released several bursts of laser energy on the target area, destroying the abnormal tissue while causing no significant damage to surrounding healthy heart muscle. The patient spent only one night in the hospital.

I’m optimistic that both of these new procedures will prove safe and effective treatments for patients with A-fib.

Shephal Doshi, M.D., is a cardiologist and director of Cardiac Electrophysiology at Saint John’s Health Center. For more information about Dr. Doshi and other Saint John’s services, please call (310) 829-8990 or visit the website at www.stjohns.org. For a physician referral or a second opinion, please call 1-888-ASK-SJHC.

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