An irregular heart rhythm threatened to turn Lana Van Alstine into a “cardiac cripple.” But the 62-year-old had plans—to bike, camp, kayak and play with her five grandkids.
That’s why she was eager to become the first patient in Michigan to make use of an innovative technology to find and treat sources of atrial fibrillation.
“I’d like a few more summers,” she said.
“A lot more summers,” said her husband, Bill.
With the new system, “we hopefully will have a better chance of curing patients who have more advanced disease,” said Andre Gauri, MD, the section chief of cardiac electrophysiology at the Spectrum Health Fred and Lena Meijer Heart Center.
The technology, the Topera 3D Mapping System, offers new hope for many people with atrial fibrillation, the most common form of irregular heart rhythm, he said.
When it’s in rhythm, there’s such a calm that comes over me. That’s what I’m really praying for.
The condition, commonly called AFib, affects between 2.7 million and 6 million people nationwide, according to the Centers for Disease Control and Prevention. It occurs when the upper chambers of the heart fail to produce an effective, regular contraction.
Many people with atrial fibrillation don’t realize they have it. For those who do, symptoms include heart palpitations, lightheadedness and extreme fatigue.
The condition also raises the risk of blood clots, stroke and heart failure. It is the cause of 750,000 hospitalizations a year and contributes to 130,000 deaths in the U.S.
Unpredictable and scary
Van Alstine, a retired teacher’s aide and school secretary who lives in Big Rapids, Michigan, has endured an erratic heart rate for most of her life. She first noticed symptoms at 18 and doctors diagnosed her at 23.
For the next 40 years, she took medication to control her atrial fibrillation and prevent blood clots.
But it disrupted her life in many ways. Her heart would suddenly race at unexpected times. It happened while she slept, while she shopped for groceries, as she kayaked in the middle of a lake and as she worked in an elementary school.
It happened as she rode a bike on a wooded trail.
“When you’re all alone, it’s really, really hard to wait for the heart to slow down and get back on the (bike),” she said.
Although she tried to stay active, the erratic heart rate often left her exhausted by the end of the day. And she struggled with anxiety about whether the atrial fibrillation would lead to an early death.
In July 2014, she had her first ablation procedure, in which the pulmonary veins of her heart were cauterized to stop the electrical disturbances.
“That is what works in the vast majority of patients with AFib,” Dr. Gauri said.
But the heart arrhythmia returned two months later. Van Alstine underwent cardioversion—a shock to the heart—four times. Each helped for a short while.
“But then it was back again. It was kind of defeating,” she said.
A map of the heart
Dr. Gauri explained that as atrial fibrillation progresses, it involves more than just the veins of the heart.
“There are certain rotors—areas of fibrosis or scar—within the atrium of the heart that can propagate atrial fibrillation,” he said.
The Topera mapping system helps pinpoint those sources. Using a catheter fed through a vein in the groin, the cardiologist sends a basket into the heart’s upper chambers.
In the atrium, the basket expands to a spindly circle, about 2 inches wide. Its eight wires—called splines—contain electrodes that collect data from inside the heart. The data is analyzed to create a map of each atrium and any electrical hot spots.
Dr. Gauri showed a screen in the operating room that displayed a black-and-white moving image taken during Van Alstine’s procedure. In the upper corner lay a greenish blue spot, which indicates the location of a rotor.
Dr. Gauri used the information to locate that spot on Van Alstine’s heart and cauterize it.
The mapping system is used in each atrium and typically finds three to six rotors. On Van Alstine, Dr. Gauri found and treated four rotors.
Research has shown patients who have had rotor ablation with the system have a 70 to 80 percent chance of being arrhythmia-free a year later, Dr. Gauri said.
“It’s not perfect,” he said. “But in atrial fibrillation, that’s really good.”
The Topera mapping system was approved by the Food and Drug Administration in 2013.
For patients living with atrial fibrillation, Dr. Gauri said the treatment can mean a big difference in quality of life.
Until recently, patients were referred to hospitals out of state for the procedure.
“Now, we don’t have to send patients away anymore,” he said.
Lana and Bill Van Alstine are hopeful the ablation will open the door to a full and active summer with their five grandsons. And they hope it will usher in a long period of a normal heart rate.
“When it’s in rhythm, there’s such a calm that comes over me,” she said. “That’s what I’m really praying for.
“Hopefully, this will be a life-changing experience.”