The nature of surgical heart arrhythmia repair is changing. A decade ago, outpatient heart surgery - much less noninvasive heart surgery - was unheard of. But thanks to medical advances, patients can be operated on in the morning and be back at work the next day.

Mind you, that's not always the case. But Dr. Brian Crandall, an electrophysiologist (a cardiologist specializing in arrythmias), believes that technology has offered new and exciting advances that promise better lives and recoveries for people with irregular heart rhythms.Crandall and fellow cardiologist Dr. Jeffrey Osborn will be featured during the monthly Deseret News/Intermountain Health Care Health Hotline Saturday. Although they can field other types of heart problem questions, the two men will focus on arrhythmias.

The irregular heartbeats can be mild or serious. Symptoms can range from none to palpitations and pounding in the chest. Someone may feel lightheaded and if the pulse is fast enough, may even faint. Shortness of breath and chest pains can occur.

The normal resting heart rate is between 60 and 100 beats per minute. It can go up significantly during exercise. The rule of thumb there is the heart rate should never be higher, with exertion, than 220 minus the age of the individual. If you're 50, 170 is the maximum heart rate.

Typically, Crandall said, arrhythmia is a "nuisance for someone. The prognosis is generally normal, and you're not going to die from it, but you don't feel good with it."

And sometimes arrhythmias can, indeed, be lethal if left untreated.

The heart is, by nature, wired. It's comprised of electrical pathways that conduct impulses, creating the heartbeat by signaling the muscle to expand and contract, moving oxygenated blood through the body.

Sometimes the wiring goes wrong, Crandall said. And while many arrhythmias require no surgical intervention, those that need it are simpler than in the past.

Take catheter ablation, a technique to cure fast heart rhythms. Catheters are run through veins into the heart, where they map the electrical pathways. A computer is used to help localize the pathways, which are then "burned" with radio frequency to correct the heart rhythm. Since the heart normally has an electrical pathway that conducts the heartbeat from the upper to the lower chamber, a short circuit, for example, can cause the heart to beat very fast. Medication may take care of it. Catheter ablation likely will, Crandall said. And because the surgery is noninvasive, the patient can go home and return to work very quickly.

It used to be an open-heart surgery. Now, it's completely closed and takes between one and four hours, depending on how hard it is to map the pathways.

Implantable defibrillators are another major advance, Crandall said. That's the treatment of choice for people who have had life-threatening ventricular fibrillation, in which the heart's lower chamber contracts in an uncoordinated manner so the pumping action virtually halts.

Implanting a defibrillator used to mean cutting the chest open, then placing patches around the heart to monitor it continuously. The device is now so small the chest doesn't have to be opened. The wire is fed through the subclavian vein into the heart. It monitors the heart continuously, and if someone goes into cardiac arrest or ventricular fibrillation, it delivers a shock to restart the heart. If someone has tachycardia - too-rapid contractions of the heart - it can "sometimes pace them out of it," Crandall said.

And the formerly weeklong hospitalization is now more likely to be overnight. "The devices are extremely reliable and effective at converting sudden-death arrests," he said. "Now instead of having to call paramedics and resuscitate someone in the field, the device takes care of it and they go on their way."



Health questions

Dr. Brian Crandall and Dr. Jeffrey Osborn, both cardiologists specializing in heart arrythmias, will be on hand to field telephone questions Saturday from 10 a.m. to noon at the Deseret News/Intermountain Health Care Hotline. The toll-free hotline number, 1-800-925-8177, can be called from anywhere in the Intermountain Region. All calls are confidential.