Atrial fibrillation is topic of hotline

When someone has atrial fibrillation — and millions of Americans do — the heart quivers instead of contracting properly, pumping blood poorly and wearing itself out. Blood may pool and can lead to clotting that triggers a stroke. It's also a leading cause of heart failure.

While the heart early on tends to slip back into a normal rhythm on its own or medication helps control it, when atrial fibrillation becomes persistent, eventually more drastic treatments are needed.

The common heart arrhythmia, which is often referred to as "a-fib," is the subject of Saturday's Deseret News/Intermountain Healthcare Hotline. From 10 a.m. to noon, interventional cardiologists Dr. Brian Crandall and Dr. John Day, both of Intermountain Medical Center, will answer phoned-in questions. Call 800-925-8177. You can also e-mail hotline@desnews.com and a sampling of them will be answered online Friday.

People age 40 have a 1-in-4 chance of developing atrial fibrillation at some point, says Crandall. It sometimes makes headlines when someone like George H.W. Bush is diagnosed with it. At one point, after surgery, Bill Clinton had it briefly.

When medication no longer works, there are effective treatments, including catheter ablation and a "Mini-Maze" surgery.

With catheter ablation, a catheter explores the heart's electrical pathways, and the short-circuits that are causing the problem are turned off by cauterizing them with radio frequency energy.

"Ablation continues to get better," Day says. "The technology continues to improve and the technique is safer and more effective." Intermountain research showed that "drawing" rather than "dabbing" at the heart tissue during ablation works best and reduces collateral damage to tissue. Robotic technology is also starting to come online. In most patients, the procedure eliminates the arrhythmia and patients may be able to stop using their heart medications. Ablation patients typically go home with a couple of little bandages after an overnight hospital stay.

Crandall says that better mapping techniques using complex 3-D systems have made it feasible to do procedures inside the heart much less invasively. And a new robotic stereotaxis system promises even better precision. That will be available for a-fib cases once the Food and Drug Administration approves a new catheter.

Another option is called a Mini-Maze, creating scar tissue to change the pathways and short-circuit errant electrical signals in the heart.