When medication is not enough

Editor’s Note:  Vanderbilt has long been a regional referral center for ablation treatment of SVT. Recently it opened a comprehensive program to treat atrial fibrillation, the most common arrhythmia in clinical practice.

Jessica Pasley
Published: October, 2007

Andrea Boyce’s heart started racing more than 20 years ago, when she was 17.

Andrea Boyce and Dawood Darbar, M.D., Ph.D.
Photo by Anne Rayner
“I could… see my heart beating through my skin,” says Boyce, of Owensboro, Ky. “I would get a headache and start sweating and have a pain down my left arm.”

Boyce eventually was diagnosed with supraventricular tachycardia (SVT), a condition that caused her heart to speed up to 220 beats per minute.

Although her episodes were not frequent, the intensity of her symptoms prompted her doctor to put her on medication, which made her extremely tired and did not prevent the episodes. She continued to have them at least once or twice a year.

“When your heart rate was as fast as mine, all you are thinking about is—am I going to have a stroke or a heart attack? It was very frightening,” she says.

So Boyce asked for ablation, which uses high frequency radio waves to “short-circuit” the abnormal electrical impulses in the heart.

A thin tube or catheter is usually inserted into the femoral vein in the groin and threaded up to a key point in the abnormal circuit in the heart. A burst of radiofrequency energy is delivered to the area to destroy the tissue and prevent the arrhythmia. Patients generally can go home the day after the procedure.

“Catheter ablation therapy has been around for 20 years, but it has only come into prominence in the ’90s,” says Dawood Darbar, M.D., Ph.D., director of the Arrhythmia Service at Vanderbilt University Medical Center who performed Boyce’s ablation this winter. “It is increasingly becoming the first line of therapy for many forms of arrhythmias.”

“People like Dawood, who perform this procedure, are the only cardiologists who are allowed to use the word cure,” adds Dan Roden, M.D., an internationally known expert on arrhythmia at Vanderbilt. “In many cases the likelihood of a recurrence is very, very low. Everyone else in the field of cardiology just fights back disease.”

“It’s amazing,” says Boyce, who has not had an episode of tachycardia since her procedure. “I was talking to the technician who did my heart ultrasound before the procedure and he was telling me that 15 to 20 years ago it was unheard of to fix electrical parts in the heart unless it was a life-or-death situation.”

Another ablation patient who had good results is Bobby Page of Bowling Green, Ky.

Ten years after first heart attack in 1983, Page began experiencing abnormal heart rhythms that increased his risk of sudden cardiac death. Over the next few years, five defibrillators were implanted under the skin of his chest to shock his heart rhythm back to normal.

“You never did know when it was going to hit you,” says Page, a retired truck driver. “They warned me that the shock could throw me to my knees. It never knocked me down, but it has rattled my cage pretty many times. It felt like somebody hitting me in the shoulder blade with a sledge hammer.”

Page, who also has other health concerns including congestive heart failure, poor circulation in his extremities and damage from his heart attack, says he was afraid to leave the house for fear his defibrillator would “go off.”

After the most recent device, implanted in late 2006, gave him a series of shocks to rescue him from abnormal heart rhythms, his doctors at Vanderbilt decided to try ablation therapy. Page said he has not had any trouble since.

There is still a chance that arrhythmias will recur. But for patients like Page and Boyce, the procedure has meant a new lease on life.

“Before having this done I was very cautious about most of my activity for fear I would trigger the episodes,” Boyce says. “Now I feel much more comfortable trying things.”

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