Better Health talks to US-board certified cardiologist and electrophysiologist Dr. Chotikorn Khunnawat about new and exciting innovative treatments for serious forms of cardiac arrhythmia – atrial fibrillation and bradycardia which also have been successful in the intervention of stroke and cardiac arrest. 
 

Atrial fibrillation and stroke

Two recent cardiac technologies help patients live a better life: Left Atrial Appendage Occlusion for potential interventions of  stroke in patients with atrial fibrillation and Leadless Pacemaker  Implantation for patients with bradycardia (abnormally slow heartbeat) to prevent syncope and cardiac arrest.

Cardiac arrhythmia is a defect in the electrical system of the heart, which controls the heartbeat. Normal heart rates range from 60 to 100 beats per minute. Cardiac arrhythmia causes the heart to beat irregularly. Severe  cardiac arrhythmia requires immediate  medical treatment to avoid serious complications including stroke, heart attack, low blood pressure, and cardiac arrest.

The most common form of cardiac arrhythmia, atrial fibrillation (AF), is life threatening  when the heart’s upper chambers quiver or  beat irregularly and faster than 350 beats per  minute. Causes of AF include old age, heart  disease, high blood pressure, obesity, and sleep  apnea. Over time, unmanaged AF enlarges the upper chamber. Younger adults with thyroid  problems are also susceptible to this disease.  

“Rapid and irregular heartbeats weaken the heart, which hinders blood circulation,”  says Dr. Chotikorn. “This uncirculated blood  gets stuck in the upper chamber forming a blood clot, especially in the left atrial appendage, a small, ear-shaped sac in the muscle wall of the heart’s top left chamber. The clot enters the blood stream and clogs blood vessels causing a stroke. Delayed circulation and blood pooling from AF increases the risk of stroke five-fold.”
 

Left atrial appendage closure to prevent stroke

Medical intervention can prevent strokes  and other complications in patients with  atrial fibrillation. Initially, doctors perform  a thorough diagnostic check to zero in on the exact cause and prescribe  medication to regulate heartbeat and reduce blood clot formation. The doctor has two options to prevent further blood clotting:

• Prescribe blood-thinning medication  such as aspirin, warfarin, and novel oral anticoagulant (NOAC) drugs
• Perform Left Atrial Appendage Closure procedure  

“Blood thinning medication helps  reduce stroke risk in AF, but many  patients cannot take it indefinitely  because of possible side effects,” says  Dr. Chotikorn. “Candidates for left atrial appendage closure may have very low  platelet  counts, liver failure, renal failure,  uncontrolled high blood pressure, and a high risk of brain or unidentified gastrointestinal bleeding, which prevents long-term anticoagulation.”  

“In left atrial appendage closure, the  doctor inserts a 27mm umbrella-like  device with a catheter through the vein  at the top of the thigh,” Dr. Chotikorn  explains. “The doctor guides the device  to the left atrial appendage and when  positioned withdraws the catheter,  allowing the device to plug and expand  to obliterate the space in the appendage.  Over time heart tissue grows and seals  the area permanently. The procedure takes only around 1-2 hours.” 

“Delayed circulation and  blood pooling from atrial  fibrillation increases the  risk of stroke five-fold.” Dr. Chotikorn Khunnawat

 

The leadless pacemaker, an alternative treatment for a slow heartbeat  

A slow heartbeat, also known as bradycardia, is atype of cardiac arrhythmia. Symptoms include dizziness,  fatigue, shortness of breath, weakness,  low blood pressure, fainting, and  cardiac arrest. If severe abnormal  cardiac electrical system malfunction  causes the condition, the doctor can  implant a pacemaker to prevent life-threatening cardiac arrest.  

“Pacemaker implants have been  in use for more than 50 years,” says  Dr. Chotikorn, “it’s inserted under the skin in the upper chest and has leads with sensors at one end. The sensors detect and control the heart’s electrical activity to ensure ample blood supply to the body.”  

Conventional cardiac pacemaker implants can cause several complications, such as hematoma (large bruise caused by bleeding after surgery), pocket infection, visible lump or scar, leads dislodgement and reduced mobility in the shoulder region where the pacemaker resides.

The new leadless cardiac pacemaker is an alternative to traditional  pacemakers for the treatment of bradycardia.  It’s a self-contained capsule that contains the pacemaker electronics,  battery, and leads. It’s 26mm long,  6.7mm in diameter and weighs 1.75  grams. The doctor inserts the device  through a catheter threaded through  a leg vein to the right ventricle of the  heart where it controls the heartbeat.  

“The leadless pacemaker is an  alternative for some patients who need single chamber ventricular pacing, such  as elderly patients or those with chronic atrial fibrillation,” says Dr. Chotikorn.  “After the procedure, patients can resume their daily routine with ease  and enjoy improved quality of life.  However, the leadless pacemaker is not appropriate for all cardiac arrhythmia patients. The doctor will determine whether someone is a candidate.”