Latest treatments for irregular heartbeat can replace medications
In 2019, it didn’t necessarily surprise Jim Halff that he was diagnosed with atrial fibrillation, a heart arrhythmia that causes the upper part of the heart to beat faster than the lower part, resulting in an irregular heartbeat. After all, afib is extremely common.
According to the Centers for Disease Control and Prevention (CDC), 9% of people 65 or older have afib, and the risk of acquiring it is even higher for people with preexisting heart conditions, like Halff.
While the condition can be silent, arrhythmia is often characterized by an uncomfortable fluttering in the chest, shortness of breath, dizziness or lethargy. Medication can resolve symptoms and reduce the risk of stroke. But for Halff, who is now 77 and lives in West Los Angeles, the initial medication management, which included blood thinners, didn’t give him the relief he desired.
“These were very, very strong medications, and my life completely changed,” he explains. “I started retaining liquid and I basically had zero energy. It was overwhelming, just complete malaise.”
Halff, who was born in the Netherlands, has been married to wife Malihe for 45 years. The two enjoy travel and walks, especially at the beach. And he’d always loved going to the gym. Feeling as lethargic as he did on the medications was “like a death sentence,” he says.
Out of desperation, Halff, a semiretired real estate broker, eventually went searching for different medical care. He visited a health care provider at Providence Saint John’s Health Center, who recommended he reach out to Shephal K. Doshi, MD, director of cardiac electrophysiology and pacing at Providence Saint John’s and director of cardiac electrophysiology research at Pacific Heart Institute.
Providence Saint John’s has a long tradition of pioneering advances in cardiovascular care, and Dr. Doshi is among those leaders. He specializes in solving a variety of problems stemming from arrhythmia and particularly focuses on nonpharmaceutical treatments.
A Candidate for Ablation
Halff had received an aortic heart valve replacement years before and finally sought out treatment that could get him off arrhythmia medications. Less experienced surgeons ruled him out for an atrial fibrillation ablation, a small surgical procedure that fixes an irregular heart rhythm by scarring tissue in the heart to disrupt faulty electrical signals.
Not Dr. Doshi, though. An ablation, using the state-of-the-art 3D mapping systems at Providence Saint John’s, was all in a day’s work for him. But Halff’s afib fix was indeed a bit more involved.
Dr. Doshi determined he’d also need a Watchman, a tiny medical device inserted into the left atrial appendage, a small ear-shaped sac in the muscle wall of the top left chamber of the heart. The device works as a kind of filter to prevent blood clots that can lead to stroke, explains Dr. Doshi. If successful, it can eliminate the need for prescription blood thinners.
“While ablation can fix atrial fibrillation, the Watchman device is revolutionary for the patient who cannot take blood thinners; and it can reduce the risk of stroke,” says Dr. Doshi, who was one of the national principal investigators for the device when it was launched in 2017 and is now one of the nation’s most experienced implanters of the device.
Halff ended up undergoing three separate procedures. First was the ablation. During that procedure, Dr. Doshi noticed that Halff’s mitral valve was leaking severely, so another Providence Saint John’s team later inserted a clip to fix the valve. Halff’s last procedure was the Watchman.
“None of this was really that big of a deal,” says Halff. “There was almost no pain or discomfort, and I went home the very same day as the procedure.”
Advanced in Treating Arrhythmias
Dr. Doshi says that in addition to the procedures Halff had, he’s also pleased with the improvements in pacemakers that are suitable for other types of patients. In particular, the Micra, a tiny pacemaker, is advancing arrhythmia care. Pacemakers treat patients with electrical blocks, a condition in which the electrical signals in the heart are fully or partially blocked, often due to heart conduction disease. Without treatment, the heart can beat dangerously slow.
“This device was commercially released in just the last three years, and we’ve become a leader in implanting this new type of pacemaker,” he says. “It’s the size of a vitamin capsule and can be implanted without surgery.”
The Micra is inserted through a vein in an outpatient procedure. It does not require general anesthesia, and the pacemaker battery can last a full decade. All of the procedures are covered by Medicare.
Dr. Doshi, who has published research in the top peer-reviewed academic journals, including The Journal of the American Medical Association, Lancet, Circulation, Journal of the American College of Cardiology and many others, says he gets enormous pleasure from this work.
“There are very few things in medicine and cardiology which can be cured, and I feel very lucky to be a specialist in the field of electrophysiology, where we have the understanding and technology to cure many heart rhythm disorders. These disorders impact so many people.”
Afib alone affects roughly 5 to 7 million people in the United States. Only one-third of the people who have it are unaware or aren’t receiving treatment, he says. Symptoms can include a heart that races or flutters, as well as fatigue. A doctor may diagnose silent afib by conducting an electrocardiogram test.
“Whether it’s that you’re not aware of the problem or it’s that you don’t want to treat it because you don’t like a medication’s side effects, you can be at high risk for a stroke,” says Dr. Doshi, whose main aim is to raise awareness of the relatively simple procedures that are now available to resolve these conditions and potentially eliminate prescription medications. He says there are many patients who could both feel better and drastically reduce their risk of a potentially debilitating stroke and heart failure.
For Halff, the small surgical fixes meant he could dispose of his medications. In fact, his blood pressure normalized along with his heartbeat, and Halff was actually able to eliminate the high-blood-pressure medication he was taking. He now takes only a daily over-the-counter aspirin to stave off coronary disease. In his mind, he was brought back to life.
“There’s just no comparison,” says Halff, who praises not just the doctor’s skill but also his bedside manner. “He really looks out for his patients and takes the time to explain everything. Now I’m back to my normal self. In my opinion, Dr. Doshi saved my life.”