Arterial Fibrillation associated with Alzheimer’s disease and dementia – Ablation therapy cures the AF, but has other MAJOR side effects that are GOOD

If you have known anyone with AF or someone suffering with either dementia or Alzheimer’s, then this procedure seems like a GREAT option.  The procedure is invasive, but your not sliced open.

I believe that this is a great advance in AF and senior mental health.

If you have ever had a heartcath, it looks like the same type of procedure.  The only difference is that once they get in the heart they apply electricity to the area to restore the proper beat.

Diagram of heart. The electrical impulse begins at the Sinoatrial (SA) Node, located in the right atrium. The electrical activity spreads through the walls of the atria and causes them to contract. The AV node is located between the atria and the ventricles and acts like a gate that slows the electrical signal before it enters the ventricles. This delay gives the atria time to contract before the ventricles. His-Purkinje Network - this pathway of fibers sends the impulse into the muscular walls of the ventricles and causes them to contract.

Ablation of AF reduces risk of Alzheimer’s disease and dementia:

Denver, CO Treating atrial fibrillation (AF) with radiofrequency catheter ablation significantly reduces the risk of Alzheimer’s disease and reduces the risk of developing all forms of dementia, according to the results of a new study [1]. In addition to these findings, researchers showed that catheter ablation reduced the risk of mortality and stroke at three years [2].

“The good news from this study is that if you can potentially get rid of atrial fibrillation, not only does it make patients feel better, but it might also have a significant benefit as far as the long-term rates of stroke, helping to prevent premature death, as well as to reduce the risk of dementia and Alzheimer’s disease,” lead investigator Dr John Day (Heart Institute of Intermountain Medical Center, Salt Lake City, UT) told heartwire.

The researchers presented the results of the study, which included 37 908 patients from the Intermountain Medical Center, here at the Heart Rhythm Society 2010 Scientific Sessions. The same researchers previously established a link between Alzheimer’s disease, dementia, and AF, with recently published results showing that AF is a powerful predictor of subsequent Alzheimer’s disease [3]. Day explained that among patients who develop both AF and Alzheimer’s disease, the rate of cognitive decline is rapid and mortality rates are very high.

“With the current study, we wanted to ask: What happens if we intervene?” he said. “Can we change these long-term outcomes?”
Data from the Intermountain Medical Center

Among the 37 908 patients included in the analysis were 4212 consecutive patients who underwent AF ablation, 16 848 age- and sex-matched patients with AF who were treated with best medical therapy, and 16 848 age- and sex-matched controls without AF.

After three years of follow-up, Alzheimer’s disease, documented by a neurologist who assessed patients with cranial imaging, developed in 293 patients. The rate of Alzheimer’s disease and all forms of dementia, however, was significantly lower among patients who underwent catheter ablation.

Rates of Alzheimer’s disease and dementia at three years

End point
AF, no ablation (%)
No AF (%)
AF, ablation (%)
p
Alzheimer’s disease
0.9
0.5
0.2
<0.001
Other dementia
1.7
0.7
0.4
<0.001
Mortality
23.5
8.7
6.0
<0.001
Stroke
4.7
2.4
2.2
<0.001

“When we looked at the three-year outcomes, what we found was that the rate of Alzheimer’s disease and all forms of dementia was reduced in the patients who had undergone a catheter-ablation procedure,” said Day. “In fact, the rates we saw were similar to those that you’d see in patients who never had atrial fibrillation to begin with. There was a statistically significant difference between ablation patients and AF patients treated with best medical therapy.”

Mortality and stroke rates were significantly lower among the ablation patients. To heartwire, however, Day said that clinicians are eagerly anticipating the results of Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA), a study that will involve up to 3000 patients followed for an estimated five years. The primary end point of the trial is total mortality; secondary end points are other cardiovascular events.

“That study just launched, and we’re still four or five years away from seeing those results,” he said. “Until that study is available, these data are really the best we have.”
Possible mechanisms of ablation benefit

Asked about the mechanisms by which catheter ablation might reduce the risk of Alzheimer’s disease, Day noted that AF could compromise cerebral perfusion, and by eliminating it, catheter ablation might improve overall hemodynamics. He also said there could be an inflammatory connection, with both AF and Alzheimer’s disease associated with high levels of C-reactive protein. By increasing inflammation, AF might accelerate the inflammation-mediated progressive cognitive decline. Finally, he said, AF might cause subclinical strokes, with microscopic emboli undetected by MRI leading to the development of amyloid plaque that characterizes Alzheimer’s disease.

“It’s purely speculative, but this study shows that if we can potentially get rid of atrial fibrillation altogether with catheter ablation, we might be able to change the long-term outcomes,” said Day. “It certainly could raise the question that if you have atrial fibrillation and medication isn’t working, maybe we should move toward a potentially curative procedure earlier, rather than spinning our wheels for years with medication.”

Here is the procedure from an OHIO Clinic:

What is catheter ablation?

Catheter ablation is a type of treatment for cardiac arrhythmias. During ablation, a doctor inserts a catheter (thin, flexible tube) into the heart. A special machine delivers energy through the catheter to tiny areas of the heart muscle that cause the abnormal heart rhythm. This energy “disconnects” the pathway of the abnormal rhythm.

The ablation procedure also can be used to disconnect the electrical pathway between the upper chambers (atria) and lower chambers (ventricles) of the heart. The type of ablation performed depends upon the type of arrhythmia.

What types of rhythms are treated with this procedure?

Normally, the heart’s impulses travel down an electrical pathway through the heart. The atria and ventricles work together, alternately contracting and relaxing to pump blood through the heart. The electrical system of the heart is the power source that makes this possible. Each electrical impulse causes the heart to beat.

Catheter ablation can be used to treat:
  • AV Nodal Reentrant Tachycardia (AVNRT): an extra pathway lies in or near the AV node, which causes the impulses to move in a circle and reenter areas it already passed through.
  • Accessory Pathway: Extra pathways can exist from birth that connect the atrium and ventricles. The extra pathway causes signals to travel back to the atrium, making it beat faster.
  • Atrial fibrillation and atrial flutter: Extra signals originating in different parts of the atrium cause the atria to beat rapidly (atrial flutter) or quiver (atrial fibrillation).
  • Ventricular tachycardia: a rapid, potentially life-threatening rhythm originating from impulses in the lower chambers of the heart. The rapid rate prevents the heart from filling adequately with blood so that less blood is able to circulate through the body.
How can I be evaluated for the procedure?

If you are currently being treated outside of Cleveland Clinic, please call the Miller Family Heart & Vascular Institute Information & Resource nurse toll-free at 866.289.6911 or 216.445.9288. The nurse can offer options for evaluation at Cleveland Clinic. Or call Cardiology Appointments at 216.444.6697 or toll-free at 800.223.2273 ext. 46697.

If you already are a patient of Cleveland Clinic and are receiving treatment for your arrhythmia, talk to your cardiologist about whether catheter ablation is an option for you.

Evaluation

To determine if catheter ablation is an appropriate treatment, a thorough evaluation will be performed, which may include:

  • A review of your medical history
  • Complete physical examination
  • Electrocardiogram (ECG)
  • Echocardiogram (Echo)
  • Holter monitor test
  • Other tests as needed

After the evaluation, the doctor will discuss your treatment options and together, you will determine if you are a candidate for this procedure.

How successful is catheter ablation in treating arrhythmia?

The success rate varies for each type of catheter ablation. Many variables also affect the potential success of the procedure. Please discuss the success rate of your proposed ablation procedure with your physician.

Are there any risks?

The catheter ablation procedure is generally very safe. However, as with any invasive procedure, there are risks. Special precautions are taken to decrease these risks. Your doctor will discuss the risks of the procedure with you.

Before the procedure:


What tests are performed?

If you take Coumadin, the results of your INR test (a blood test to evaluate blood clotting) must be within a suitable range before the procedure can be performed.

Should I take my medications?
  • Usually you will be instructed to stop taking Coumadin (warfarin) three days before the procedure.
  • Your doctor may also ask you to stop taking other medications, such as those that control your heart rate or aspirin products.
  • Do not discontinue any of your medications without first talking to your health care provider. Ask your doctor which medications you should stop taking and when to stop taking them.
  • If you have diabetes, ask the nurse how you should adjust your diabetes medications and/or insulin.
Can I eat?
  • Eat a normal meal the evening before your procedure. However, DO NOT eat, drink or chew anything after 12 midnight before your procedure. This includes gum, mints, water, etc.
  • If you must take medications, only take them with small sips of water. When brushing your teeth, do not swallow any water.
What should I wear?
  • Remove all makeup and nail polish before coming to the hospital.
  • Wear comfortable clothes. You will change into a hospital gown before the procedure.
  • Please leave all jewelry (including wedding rings and watches) and other valuables at home.
  • The clothing you are wearing that morning will be returned to the person who accompanies you or placed in a locker.
What should I bring?
  • You will not need a robe or toiletries when you first arrive. Your family member can keep these items to give you after the procedure.
  • Bring your prescription medications with you, but do not take them without first talking to your health care provider.
  • You may bring guided imagery tapes or music and the appropriate player to listen to before the procedure.
What happens when I arrive?

Before the procedure begins, a nurse will help you get ready.

  • You will lie on a bed and the nurse will start an IV (intravenous line) in a vein in your arm. The IV is used to deliver medications and fluids during the procedure.
  • A medication will be given through your IV to make you feel drowsy. You may fall asleep at times due to the sedation.
  • Your neck, upper chest, arm and groin will be cleansed with an antiseptic solution, and the catheter insertion site(s) will be shaved. Sterile drapes will be placed to cover you from your neck to your feet.

During the procedure:


Where is the procedure performed?
Picture of an electrophysiology lab

The catheter ablation takes place in a special room called the EP (electrophysiology) lab.

Will I be monitored?

The nurse will connect you to several monitors that will check your heart rhythm and your body’s responses to any arrhythmias during the procedure. The nurse will constantly assess you during the procedure.

How does the doctor insert the catheters?

After you become drowsy, the doctor will numb the catheter insertion site(s) by injecting a medication.

  • The doctor will insert several catheters through a small incision into a large blood vessel (in your groin, neck or arm, depending on the type of ablation procedure being performed). Sometimes, it may be necessary to use both an artery and a vein.
  • A transducer is inserted through one of the catheters so intracardiac ultrasound can be performed during the procedure. The ultrasound allows the doctor to view the structures of the heart on an external monitor.
  • The catheters will be advanced through the blood vessels to your heart. After the catheters are in place, the doctor looks at a monitor to assess your heart’s conduction system.
  • The doctor then uses a pacemaker-like device to send electrical impulses to the heart to increase the heart rate. If your arrhythmia occurs during the procedure, the nurse will ask you to describe the symptoms you feel.
  • The doctor uses the catheters to locate the area or areas where the arrhythmia is originating. Once the area is located, energy is applied through the catheter to stop the abnormal impulses.
  • Once the ablation is complete, the electrophysiologist uses monitoring devices to observe the electrical signals in the heart to ensure that the abnormal rhythm was corrected.
What will I feel?
  • You will feel an initial burning sensation when the doctor injects medication in the catheter insertion site.
  • You may feel your heart beating faster or stronger when the doctor uses the pacemaker device to increase your heart rate.
  • You may feel some discomfort or a burning sensation when the energy is applied. It is important to remain quiet, keep very still and avoid taking deep breaths.
  • If you are feeling pain, ask your doctor or nurse to give you more medication.
  • During the procedure, you will be asked to report any symptoms, answer questions or follow instructions given by your doctor.
How long does the procedure last?

The catheter ablation procedure may last from 4 to 8 hours.

After the procedure:


What should I expect after the procedure?
  • The doctor will remove the catheters and apply pressure to the insertion site to prevent bleeding.
  • You will need to stay in bed from 1 to 6 hours after the procedure to prevent bleeding. You’ll need to keep your legs still during this time.
  • No stitches are needed. A small sterile dressing (bandage) will cover the insertion site.
  • Keep this area clean and dry. Notify your doctor or nurse right away if you have redness, swelling or drainage at the procedure site.
  • You can remove the bandage after you go home.
  • During your recovery, you will be placed on a special monitor, called a telemetry monitor. Telemetry consists of a small box connected by wires to your chest with sticky electrode patches. The box displays your heart rhythm on several monitors in the nursing unit. The nurses will be able to observe your heart rate and rhythm.
Will I have to stay in the hospital?

Your doctor will determine if you need to stay overnight in the hospital. Some patients are discharged the same day, while others stay overnight in the hospital after the procedure.

When will I find out the results?

After the procedure, the doctor will discuss the results of the procedure with you and your family.

How will I feel after the procedure?
  • You may feel fatigue or chest discomfort during the first 48 hours after the procedure. Please tell your doctor or nurse if any of these symptoms are prolonged or severe.
  • You may experience skipped heartbeats or short episodes of atrial fibrillation after the procedure. After your heart has healed, these abnormal heartbeats should subside.
What instructions will I receive before I leave the hospital?

Your doctor will discuss the results of the procedure and answer any questions you have. You will receive specific instructions about how to care for yourself after the procedure including medication guidelines, wound care, activity guidelines, pacemaker care and maintenance, and a follow-up schedule.

Will I be taking new medications?

You may need to take an antiarrhythmic medication to control abnormal heartbeats. You will receive the necessary prescriptions and medication instructions from your doctor. Ask your doctor if you can continue taking your previous medications.

Will I be able to drive myself home?

No. For your safety, a responsible adult must drive you home. We request that your ride be ready to take you home by 10:00 a.m. on the morning of your discharge day.

http://my.clevelandclinic.org/heart/services/tests/procedures/ablation.aspx

Advertisements

One Response to Arterial Fibrillation associated with Alzheimer’s disease and dementia – Ablation therapy cures the AF, but has other MAJOR side effects that are GOOD

  1. Dana Stone says:

    Before buying any kind insurance – DETERMINE THE AMOUNT OF COVERAGE YOU NEED.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: