VCU Pauley Heart Center Renowned for Care of Afib Patients

Although every case of atrial fibrillation is different, many begin the same way.

“My patients will tell me, `I feel washed out. I don’t have any energy,’” said Dr. Jay Koneru, assistant professor of medicine, Division of Cardiology and Electrophysiology at the VCU Pauley Heart Center.

In addition to fatigue, patients may feel a fluttering or pounding in the chest, dizziness, lightheadedness, or shortness of breath.

According to the American Heart Association, about 2.7 million people in the U.S. suffer from atrial fibrillation. The condition can lead to heart failure and is one of the leading causes of stroke. It’s marked by an irregular and rapid heartbeat in the atria, the upper chambers of the heart. The condition affects the organ’s ability to pump blood efficiently, leading to pooling in the atria. At the root of the problem are abnormal electrical signals in the heart.

Dr. Kenneth Ellenbogen and Dr. Jay Koneru

Up to 10% of individuals over the age of 75 will develop the condition. In addition to age, the following are considered risk factors: previous heart attack; congestive heart failure; leaky valves; coronary artery disease, or inflammation near the heart; high blood pressure or diabetes; thyroid, lung or other illnesses; high levels of caffeine or alcohol use; sleep apnea. Afib may occur sporadically or be a chronic condition.

VCU Pauley Heart Center’s Atrial Fibrillation Program offers innovative treatments and cutting-edge research to patients under the direction of renowned physicians Dr. Kenneth Ellenbogen, Chair of Cardiology and Dr. Vigneshwar Kasirajan, Interim Chair of the Department of Surgery and Chair of Cardiothoracic Surgery.

Following appropriate treatment, afib rarely causes serious or life-threatening problems. The comprehensive, interdisciplinary program at VCU begins with diagnosis and extends to a full range of treatments, including medication management; implantation of cardiac assist devices such as pacemakers; cardioversions to shock the heart back into a normal rhythm; catheter-based ablations to disable the areas causing the fibrillation; and surgery, including minimally invasive options.

“We probably have one of the largest centers in the U.S. in terms of both the EP [electrophysiology] component and the surgical treatment of afib. The departments have a unique collaborative relationship,” said Dr. Kasirajan.

VCU’s afib program has gained widespread recognition for its expertise and innovation with ablative techniques. “We are one of the preeminent institutions in the world for atrial fibrillation ablation,” said Dr. Ellenbogen. “We have a track record of over 15 years in ablation and have pioneered—and continue to pioneer—the use of new tools and techniques.”

Dr. Jay KoneruThe center has, for instance, performed over 8,000 radiofrequency catheter-based ablations, which involves applying a burst of heat to destroy the tissues that cause the abnormal electrical signals. Pauley’s specialists can also freeze the problematic tissue areas through a newer procedure, cryoablation. They are also exploring cryoballoon ablation in clinical trials.

Other new advances at Pauley include the LARIAT procedure (see sidebar) and, soon, Topera’s FIRMap™ 3D, multipolar catheter which places an expandable wire “basket” over the heart. The structure conforms to the shape of the heart’s contours and contains 64 evenly spaced electrodes that record its electrical activity. The images are analyzed through Topera’s RhythmView™ 3D Electrophysiological Mapping System. Pauley will also be one of the few centers to begin using the WATCHMAN®, a device that is implanted in the opening of the left atrial appendage to help prevent strokes.

According to Dr. Koneru, “While there is currently no cure for atrial fibrillation, there are effective treatments.”