Simple Diagnosis - Complicated Solution

The UNC Center for Heart and Vascular Care collaborates with specialists in the Raleigh area to provide care for the most complex heart cases. (This feature was originally published in UNC Health Care's Well Magazine, Winter 2014 issue)

By Stephanie Soucheray-Grell

Written for UNC Health Care

Wednesday, February 26, 2014

Craig Wilkins was feeling tired, breathless and in need of a vacation. Although he attributed his tiredness to too many long and hectic hours at the office, the 56­-year­-old decided to see his family doctor in Cary, N.C., before leaving for a family trip.

Craig was otherwise healthy and had no history of heart disease, but his doctor discovered he had atrial fibrillation, a condition that can cause the heart to race, sometimes beating hundreds of times in one minute. These episodes, called tachycardias, were making Craig feel fatigued.

He said my heart was beating a mile a minute, that’s why I was so tired. My heart was wearing me  out.

An estimated 12 million people will have atrial fibril­lation by 2050, according to the Centers for Disease Control and Prevention. Atrial fibrillation is a type of arrhythmia that causes the heart to beat irregularly. It can be genetic or caused by scar tissue on the heart, diabe­tes, high blood pressure or  stress. An  aging  population, an increased survival rate following heart attacks and ris­ing rates of heart disease mean more Americans will be entering their 60s and 70s with arrhythmias, which are a leading cause of stroke and cardiac events, and can dra­matically alter a person’s quality of life.

For some, atrial fibrillation is annoying but not life threatening. For Craig, the condition had gone undetected for so long that he had developed congestive heart failure. “I was shocked when the doctor told me how serious it was,” says Craig.

Initially, Craig was given a course of blood thinners to prevent clots that could be lethal, followed by a cardio­version, an electrical shock to the heart, to reset the heart­ beat back to normal. Though this worked initially, his heart eventually returned to the abnormal heartbeat. After several attempts at cardioversion, Craig’s doctor tried anti­ arrhythmia  medication.

“They put me in the hospital and used a powerful anti­ arrhythmia drug,” says Craig, who stayed in the hospital for three days as doctors watched his heart.Two days after he was released, he returned to work and passed out at his desk.

Craig Wilkins“Two days out of the hospital and my heart not only went out of rhythm but went into a life­ threatening rhythm, and I passed out cold at my desk. I came around as my co­workers were reading the instructions on the defibrillator paddles.”

Because his heart kept falling out of rhythm despite several  attempts  to  regulate  it  with  electric  shock  and medications,Craig’s cardiologist referred him to Paul Mounsey, MD, FACC, director of electrophysiology at UNC Hospitals.

Working Together to Provide Top-Notch Care

UNC Health Care is on the cutting edge of treating complex arrhythmias. Now, specialists from Wake Heart & Vascular Associates, Rex Heart & Vascular Specialists, and the UNC Center for Heart and Vascular Care are joining to create the UNC Heart & Vascular Network.

“We are going to establish a network in Raleigh that enables patients and physicians to work together in Wake County for patients who have difficult-to-treat arrhythmias,”says Andy Kiser, MD, chief of the Division of Cardiothoracic Surgery. “This is a collaborative effort between the best doctors in the region. Our idea is to bring the service closer to the people so patients don’t have to travel so far to find collaborative care.”

Dr. Mounsey says opening the UNC Heart & Vascular Network will help many patients remove the barriers that block their access to the best care for their conditions.

“Half of our patients come from Wake County,” says Dr. Mounsey, “and many patients—both new and referrals—have to make a 60-mile round-trip drive to see us in Chapel Hill. What we’re looking for in the new network is to offer our services of highly complex procedures. Arrhythmias are a public health issue, and we’re seeing more patients in need of these services every year.”

Complex Solutions for Complex Arrhythmias

Treatment for arrhythmias typically includes medication called beta blockers, which help slow the heart down, or pacemakers, which are small implanted devices that keep the heart’s rhythm regulated with small electric shocks to the heart. For patients like Craig whose arrhythmia was not corrected with initial treatment options, surgery may be necessary to reset the heart’s rhythm. 

Kiser and Mounsey
Andy Kiser, MD (left), with Paul Mounsey, MD Courtesy Donn Young

Dr. Mounsey performed a cardiac ablation on Craig’s heart. In an ablation, doctors thread catheters through the arteries to the heart and use radiofrequency to destroy the damaged heart tissue causing the atrial fibrillation. Ablations are often successful, but in Craig’s case, a flutter continued even after the procedure. A second ablation was performed, but the location of where the flutter was originating meant ablation could not correct it.

Dr. Mounsey then collaborated with Dr. Kiser to perform the Convergent Procedure.

Traditionally, surgeons, like Dr. Kiser, have created scar pat- terns to disrupt the circuitry that causes atrial fibrillation arrhythmia, while electrophysiologists, like Dr. Mounsey, have performed ablations. With the Convergent Procedure, Drs. Mounsey and Kiser work side by side using miniature cameras, small catheters and electrodes to map out an individualized pattern that will work to reestablish normal rhythms in each patient.

Drs. Mounsey and Kiser have been performing the procedure since 2011, and they recently completed their 100th surgery. They have an 80 percent success rate, which is extremely high for complex arrhythmias.

Five years after Craig’s initial atrial fibrillation diagnosis and a year and a half after having the Convergent Procedure, he says his health is excellent. “I can’t believe how bad I used to feel,” says Craig. “I have energy and a desire to do things now.”

Craig felt so good, he left his IT job behind and made a career change, opening The Meat House, a neighborhood butcher and grocery franchise in Raleigh and Cary.Warning Signs

 A Coordinated Effort

Shah from Rex
Sidharth Shah, MD Courtesy Bryan Regan
Craig’s  case  is  a  good  example  of  the  patients  who  will benefit most from the UNC Heart & Vascular Network. Patients who live in the Raleigh area and their primary care physicians will have access to a group of cardiologists and services in their local communities, and for the most complex  cases, they  will  have  access to the leading research, technology and specialty care available at UNC Health Care.

With the creation of this new network, Drs. Kiser and Mounsey will work alongside Sidharth Shah, MD, a cardiac electrophysiologist in Raleigh. Dr. Shah performs cardiac ablations and works with cardiac devices, such as pacemakers and cardio defibrillators, and his work is closely associated with research opportunities and clinical trials.

“In the past we had to send our patients who were in the UNC or Rex system to other centers,” says Dr. Shah. “Now, we can keep them close to home.”

 


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