Contributed by Dr. Karl Crossen
A hundred years ago physicians trained to care for any patient, and it was commonplace for them to deliver babies, perform surgeries, see young and old alike and even do dental care. Nowadays, with so much knowledge and numerous technological advances, no one can be competent across so many fields. So, the era of specialization in healthcare continues to grow. Now there is even sub-specialization. For the practice of cardiology, that includes Electrophysiology, or EP, a cardiac rhythm speciality.
Today, there are literally millions of patients who can benefit from the expertise of an EP. Atrial fibrillation, where the upper chambers of the heart lose their pattern and simply race chaotically, is the single most common rhythm problem and affects more than five million Americans. Traditional treatments taught in medical schools in the past emphasized medications to control the rapid heart rates and associated symptoms. We know today that the medications available for this condition work effectively in only 10 to 20 percent of patients, and as a result, patients are often simply cycled from one ineffective drug to another over the course of months or years. This lack of success usually proves frustrating for both patients and their physicians. That trial-and-error approach is necessary since no physician can be certain that any drug, no matter what the condition, will work.
In the last 15 years techniques have become available using so-called “non-pharmacologic,” or non-drug, treatments that have been proven to be significantly more effective. An outpatient procedure called an ablation can be performed at minimal risk with success rates more than three times better than medications. For patients who fail to respond, even more advanced ablation techniques called hybrid ablation can be used. This utilizes the combined skills of a cardiovascular surgeon and EP and can overcome even years of failed rhythm control. When all else fails, an EP specialist can use pacemakers to eliminate the need for medications.
There is no cure for atrial fibrillation. It requires perpetual management just like diabetes or high blood pressure. Although some treatments may eliminate symptoms, atrial fibrillation is associated with a risk of stroke. Potent blood thinners, including several that have recently been developed to eliminate the need for monitoring interactions with food and other medications, can reduce that risk but only if the affected individual faithfully takes these often-expensive drugs. An EP can perform a procedure in many patients where a filtering device is placed inside the heart, protecting a patient from future strokes and effectively eliminating the need for strong anticoagulants. The procedure usually only requires a single intravenous catheter and takes about 30 minutes to perform.
Many other individuals may benefit from the expertise of an EP. Patients with recurrent fainting spells, intolerable skipping or palpitation and those with weakened hearts or with an implanted pacemaker or defibrillator can work with an EP who will work with their other physicians to manage their care.
Dr. Karl Crossen is a board certified cardiologist in Tupelo.