If you ask Rob Patrawala, M.D., and Gregory Engel, M.D., to describe some of the best aspects of their work as Sequoia Hospital cardiac electrophysiologists (specialists in the heart’s electrical system), they talk with great pride about advanced treatments for patients with atrial fibrillation, a common type of heart arrhythmia (irregular heartbeat); about the hospital’s standing as one of the leading cardiac arrhythmia centers on the West Coast; and about research they’re undertaking that’s pushing the envelope in their field.
“In my many years of cardiology practice, atrial fibrillation patients are some of the most grateful,” says Dr. Patrawala. “A lot of these patients have been referred to us from far away, and their local heart doctors have tried everything—and they still are being tormented by this arrhythmia. In the vast majority of cases, we’re able to fix their atrial fibrillation problem and their quality of life goes up dramatically. Patients go from feeling horrible and having a horrible quality of life to feeling normal again.”
An estimated 2.2 million Americans are living with atrial fibrillation, dubbed “a-fib” by many physicians and patients. In this condition, abnormal electrical signals cause the atria, the heart’s upper chambers, to beat chaotically and rapidly. A-fib is the most common type of arrhythmia. Besides irregular heartbeat, its symptoms can include heart palpitations, dizziness, sweating, chest pain or pressure, fatigue, and shortness of breath. Worse still, a-fib can lead to serious medical conditions, such as stroke and heart failure.
Sequoia offers various a-fib remedies, customized to meet each patient’s needs. These include medication; cardioversion, which restores normal rhythm with electric-shock treatment; surgery and pacemakers; and ablation, which is the latest option and uses energy to destroy (ablate) abnormal heart tissue.
Ablation is highly effective in appropriate cases and can be accomplished without open surgery. In minimally invasive procedures, thin, flexible tubes (catheters) are threaded through blood vessels to reach the heart and target electrical trouble spots. “This approach removes many of the risks associated with open surgery,” says Dr. Engel. “We can treat the patient without having to go in and open up their chest. It leaves patients with much less discomfort, facilitates shorter recovery and accomplishes the same goals.”
Sequoia recently announced completion of over 1,200 a-fib ablations. “High volume is key for this procedure. There’s very good research to show that high-volume centers have the best results and the lowest rate of complications,” says Dr. Engel. “Atrial fibrillation is the most complex ablation we do. There’s a lot of technology involved (including 3-D computer mapping of the inside of the heart). Our team of specialists is very experienced and very skilled which is why we are one of the predominant referral centers on the West Coast.”
Sequoia’s success rate with ablation for paroxysmal a-fib (periodic episodes that can start and stop on their own) is over 90 percent. Even for patients with long-standing, persistent a-fib in which episodes last more than one year, more than 80 percent can have normal rhythm restored.
