Southlake leads the way in atrial fibrillation ablation

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Imagine it’s 2 o’clock in the afternoon and you’re with your daughter at the park when you suddenly begin to feel light-headed. Your heart begins to race, pounding so hard that you develop chest pains. You think to yourself: “This is it. I’m having a heart attack.”

For Jim Andonov, a 53-year-old Mississauga resident, situations like this happened all too often. “It got to the point where I was avoiding normal, everyday activities out of fear of having an episode,” said Jim.

He is one of the 200,000 Canadians affected by atrial fibrillation (AF), the world’s most common heart rhythm abnormality. AF can decrease the heart’s pumping ability by as much as 30 per cent, and combined with a fast heart rate over a long period of time, can result in heart failure. It can also cause disabling symptoms, poor quality of life, and increase a person’s risk of stroke.

“It affected every aspect of my life. I’m a contractor so being physically limited is detrimental to my career.”

For individuals who suffer from AF, medication and lifestyle changes have been the only way to manage the condition. However, in 1999, ablation of AF was first reported, and the procedure has provided many patients with a cure.

Triggers for AF have been shown to frequently originate around the pulmonary veins. Energy can be used to ablate, or burn, around these four veins, which produces circular scars and blocks further impulses from triggering AF. Approximately 80 per cent of patients can be cured of their atrial fibrillation after ablation.

For Jim, managing his symptoms with medication wasn’t enough so he contacted Southlake Regional Health Centre’s cardiac team seeking long-term relief. Following a team consultation, he had an AF ablation on November 3, 2005.

According to Jim, this procedure is nothing short of a miracle.

“It’s given me my life back. There aren’t words to express the gratitude I feel.”

AF ablation is a relatively new procedure, so there are only a few centres that can offer this type of care to people like Jim. Southlake’s arrhythmia team performs approximately 100 to 150 procedures a year and has accepted referrals from across the GTA and Canada.

“We have an amazing team of people who are passionate about and committed to our patients. It drives us to seek out new and innovative ways to care for them,” said Dr. Verma.

Although ablating around the pulmonary veins is the traditional approach to performing the procedure, studies have indicated that other areas, called “hot spots” in the left and right atria can also be responsible for perpetuating AF. Targeting and ablating these “hot spots” has emerged as an alternative technique for ablating AF. The two techniques are used by electrophysiologists across the country but have never been compared in terms of patient outcomes.

Southlake is looking to lead a research effort, that will help answer for heart rhythm specialists, which technique is most effective in treating AF. Designed by Dr. Verma, the Substrate versus Trigger Ablation for Reducing AF (STAR-AF) study will include a randomized sample of patients who will undergo the procedure using one of three approaches – the traditional approach of ablating the pulmonary veins, the hot spot approach, and a hybrid approach that combines pulmonary vein with hot spot ablation. The study will examine which is best by assessing the patients’ success rates at six and 12 months post ablation.

In addition to being a “made in Canada” initiative, the STAR-AF study is unique because it is a multicentre study. Requiring the collaboration of professionals from each centre, Southlake will lead hospitals from Canada and Europe through the study, which aims to enroll 90 patients over a one-year period. With the design of the study complete, protocols are being prepared for submission to each participating institution for final approval.

“We are very eager to have the opportunity to reach beyond the boundaries of our community and have a positive impact on patient care in other parts of Canada and the world,” said Dr. Verma.

Southlake’s comprehensive cardiac care program offers arrhythmia, intervention, surgery and rehab services to the over one million people who live in York Region, Simcoe County and Muskoka.