Pioneering new treatment for erratic heartbeat - Surgeons burnt my heart to make it beat in time

February 2011

Around 600,00 people in Britian suffer from atrial fibrillation - an erratic heartbeat. Untreated, it can lead to a stroke.

Simon Peters, 44, an abattoir manager from Pollington, near Doncaster, was one of the first Britons to undergo a pioneering treatment for the condition at Spire Hull and East Riding Hospital.

From The Patient:

One Sunday two years ago, I woke up ­gasping for breath. I was diagnosed with asthma in my 20s, so I assumed I was having an attack and grabbed my inhaler.

But as the week wore on I was ­sweating a lot and felt breathless and tired. So, on the next Friday, I went to ­hospital. Within ten minutes of ­arriving, I’d had an ECG, a test to check my heart activity.

The doctor told me my pulse was 200 beats a minute — it’s only meant to be between 60 and 80. He explained I had atrial­ ­fibrillation — an abnormal heartbeat and said it was caused by the veins near my heart firing off random electrical ­signals, causing it to beat too quickly.

When my doctor said it could lead to a heart attack or stroke, I was ­horrified — I’m married with five ­children and I want to see them grow up.

I was sent home with drugs to try to ­regulate the rhythm. But they didn’t work for long. Just 24 hours later I was rushed back to hospital, where doctors tried to get my heart beating ­normally again. Over the next six months I had more attacks.

The ­doctors tried a range of treatments, such as sending electric shocks to my heart. But ­nothing seemed to help. I’d been off work for six months and was ­constantly gasping for breath.
Then my consultant said a surgeon called Mr Steve Griffin had just introduced a new ­procedure that had a 90 per cent ­success rate. When I met him, he explained he could burn the veins that were sending the signals. The tissue would scar and stop these ­signals getting to my heart. Better still, he could remove the bit of my heart that made me more likely to have a stroke. The treatment wasn’t ­available on the NHS — but my bosses were so worried that they offered to pay for it.

So I had the operation last year under general ­anaesthetic. I was worried beforehand, as I’d been told if it didn’t work my ­condition would worsen — I’d never work again and could lose my home.
When I woke up I was attached to lots of wires and tubes, and it hurt when I coughed because my lungs had been deflated.

But ­everything had gone well. The next morning I took my first few steps and I felt so much better. I was discharged after six days and was back at work within a fortnight. I’ve been fine since. I have my life back — I can take the kids out on weekends and catch up with friends I haven’t seen for ages. I can’t talk enough about how great this treatment is.

From The Surgeon, Mr Steven Griffin - Consultant Cardiothoracic Surgeon:

Atrial fibrillation affects one in 100 Britons. Normally, our heartbeat is controlled by our ‘inbuilt pacemaker’, the sinoatrial node. But with atrial fibrillation, the pulmonary veins (which deliver blood from the lungs to the heart) interfere with this, firing off their own random signals, as well.

As a result, the atria — the upper chambers of the heart — only ­partially contract, but they do so rapidly (up to 200 times a minute, compared to the ­normal 60 to 80). This means oxygenated blood can’t get to the areas that need it, causing symptoms such as dizziness and breathlessness.

Blood can pool in the atria, increasing the risk of clots. Left untreated, this can cause a heart attack or stroke.

Most people develop atrial ­fibrillation in their 70s, as the heart atria develops wear and tear. However, in some cases such as Simon’s, there is no obvious cause.

The first line of treatment is beta-blockers and amiodarone to regulate the heartbeat. A ­procedure called cardioversion, which applies electric shock treatment, is also widely used. There’s also a treatment where wires are inserted via the groin into an artery and threaded up to the heart to direct shocks at the atria.

But in recent years, catheter ­ablation has become popular. This involves threading a wire from the groin to the heart to burn the veins.

However, 40 per cent of these treatments will need to be redone. I’m confident this new technique, thoracoscopic atrial fibrillation ablation, can cure the problem on the first attempt.

It has been developed in the U.S. over the past five years and it involves creating scar tissue with a wand — but we can be much more precise with the area we burn. When you reach the heart from the groin, the wire burns the veins from inside the heart.

But blood in the heart tends to dampen the effects of the heat, so less scarring will be achieved. By going in through the chest we can clamp those veins outside the heart and burn them directly, ­creating a better ­barrier.

Best of all, in the ­surgery we also remove the ­biggest risk factor for clots, the area of the heart called the left atrial appendage — it’s like a sleeve stitched up across the end and in ­people with atrial fibrillation, blood can pool in it then clot. By closing off this part of the heart, you reduce the risk of stroke. It’s ­useless, so it’s safe to remove. The operation takes around two hours.

With Simon under anaesthetic, I turned him on to his side and deflated his lung with a breathing tube in his mouth, in order to gain access to his heart.

I then made two small ­incisions in between his ribs and inserted a telescope-like device into the lung to enable me to see what I was doing on a screen in front of me.

The wand that burns the ­tissue on the veins to scar them goes through the other incision.
Next, I inserted a special tool, which looks like a hair grip, to clip the left atrial appendage closed, so it’s separated off from the heart. The clip stays inside permanently.

I then re-inflated the lung, turned Simon on to his left side and repeated the procedure, so that more of the problem area can be covered and we provide a thick barrier of scar tissue.

Patients generally go home the next day — Simon stayed a bit longer — and should be fully back on their feet after four or five days.

This procedure has been so ­successful in the Netherlands that it’s now the first-line treatment for atrial fibrillation.

A handful of surgeons are performing it in Britain, but this number is increasing. 

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Surgeons who perform this new heart ablation procedure at Spire Hull and East Riding Hospital 

Mr Steven Griffin, Consultant Cardiothoracic Surgeon

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