As Afib becomes a ‘new epidemic’ in health care, advances in imaging technology are key for less invasive treatment

This story first appeared in the April 2024 edition of Healthy You, a quarterly health publication and Gazette special section.

Treating a relatively common heart condition becomes simpler, quicker and safer when doctors can see what they’re doing.

“You can visualize the structures you’re looking at,” said Dr. Richard Kettelkamp, interventional cardiologist and medical director of cardiovascular services at St. Luke’s Heart Care in Cedar Rapids. “Because you can see them directly, you can avoid open-heart surgery. The skills of these imaging cardiologists have developed in line with these new procedures that are less invasive. One couldn’t happen without the other.”

Those advances in imaging technology are key to less invasive treatment of atrial fibrillation, commonly referred to as Afib.

About 12.1 million Americans will have AFib by 2030, according to the Centers for Disease Control. The condition can cause an irregular heartbeat leading to congestive heart failure, and people with Afib have a five-times-greater risk of stroke.

“It’s very prevalent as the population gets to retirement age, and even more so as people get into their eighties,” Kettelkamp said.

“Afib is becoming this new epidemic in health care in the United States,” said Dr. Paari Dominic, director of electrophysiology and medical director of University of Iowa Hospitals and Clinics’ electrophysiology lab. “Twenty-five percent of us will have Afib in our lifetime after 40 years of age.”

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Most often caused by changes to the heart’s tissue or the electrical impulse that prompts the heart to beat, Afib makes the heart’s upper chambers — the atria — to beat irregularly and out of synch with its lower chambers (the ventricles). A person with Afib often experiences a quicker, pounding heartbeat, shortness of breath or light-headedness.

Milder cases are usually treated with medications, but more serious instances call for surgical intervention. The procedure, called atrial ablation, applies heat or freezing cold to create tiny scars in the heart, blocking the irregular signals. Some patients may receive a new aortic valve. A tiny clip may be implanted to help the heart’s atrial valve to close more completely, or a device that acts as a filter to prevent clots from entering the bloodstream, potentially triggering a stroke.

Ablation once entailed a hospital stay.

“When we started doing this in the mid-1990s, ablations used to take six hours, maybe eight hours,” Dominic said. “Patients had to get admitted to the hospital for a day, maybe two days, and there were a lot more complications.”

The use of catheters — small-diameter surgical tubes — to deliver heat, cold or tiny devices is a less invasive procedure, and more recent developments in imaging technology have made most ablations a quick outpatient procedure.

“In many of these procedures, you couldn’t do it without advanced imaging,” Kettelkamp said. “It’s essential for the success of the procedure.”

“We used to have to use x-rays for the whole thing,” said Dr. Talha Farid, a St. Luke’s cardiology specialist. “That was pretty time-consuming, with a lot of radiation and a lot of time in the lab.”

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Conventional x-rays often required the use of an iodine-based solution to make the patient’s heart structures discernable, leading to complications as the kidneys processed the liquid.

Cardiac specialists now apply electrophysiology to measure the heart’s electrical activity, delivered via catheter to blood vessels that enter the heart. An echocardiogram uses sound waves to track blood flow through the heart and its valves. Sensors are attached to the patient’s chest and sometimes their legs to check the heart rhythm.

“It’s a fancy ultrasound of the heart” is how Kettelkamp describes the process. “It can show the heart in three dimensions. It’s bouncing soundwaves off (heart) structures. I can see what the valve looks like in three dimensions, which is really helpful when you’re trying to put a little clip in the same spot.”

Real-time imaging simplifies the surgeon’s task, and making repairs via catheter opens the procedure to a wider range of the population.

“A lot of people who couldn’t have that procedure because they weren’t good candidates for surgery can now have a lot more years of life,” Kettelkamp said.

“Now it can be done in an hour and a half,” Dominic said of the ablation procedure. “Medicare actually cut down the physician reimbursement for the procedure because the physicians aren’t spending as much time on it.”

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St. Luke’s new Nassif Heart Center will include a new electrophysiology lab, and the facility is renovating its existing lab.

“Both should be running late spring,” Kettelkamp said. “We’ll have a new hybrid surgical lab opening sometime in 2026. That’s the place here these advanced procedures are done. There will be more access and imaging.”

Further advances are on the horizon. Pulse-field administers a series of microsecond high-amplitude electrical pulses, avoiding tissue damage from heat or cold. Four-dimensional imaging will make the ablation procedure even more precise.

“We’re looking forward to that,” Dominic said.