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Dr. Jonathan Steinberg and his team at The Valley Hospital's Arrhythmia Institute are among the first in the country to test a new procedure offering hope for patients with atrial fibrillation. (Photo courtesy of The Valley Hospital)
Posted: Thursday January 17, 2013, 1:33 PM
By Jennifer V. Hughes - (201) Magazine

A new treatment for a common heart ailment could come to the U.S. after a groundbreaking study was published recently by doctors from Russia working closely with Bergen physicians.

The treatment is for atrial fibrillation, which affects 2.7 million Americans and causes an irregular heartbeat – a heartbeat that is either wildly too fast or drastically too slow. Patients feel terribly dizzy and weak and can run the risk of organ failure or stroke.

Standard treatment includes medication as well as cauterization or ablation of small areas of tissue in the heart with the belief that essentially killing the source of the electrical misfiring will stop it, says Dr. Jonathan Steinberg, director of the Arrhythmia Institute at The Valley Hospital in Ridgewood. He worked in tandem with the Russian doctors on the study.

In this new treatment, Steinberg says doctors insert a catheter into an artery in the groin, thread it to the kidney and ablate nerves in that organ. Physicians have long known that the arteries in the kidneys affect blood pressure, although they are not exactly sure how.

So what then connects the kidney to an irregular heartbeat? Steinberg says a likely possibility is that nerves from the renal artery in the kidney travel to the brain and connect to the sympathetic nervous system, which could be responsible for the heart's misfiring. Ablating the renal nerves is thought to work in the same way as ablating heart tissue: By killing the source of the misfiring, you stop the misfiring that leads to atrial fibrillation.

"By interrupting the activity in the nerves that excites cardiac electricity, we can favorably affect atrial fibrillation," Steinberg says. "It's sort of a remote control to affect the overall autonomic tone in the heart."

The new treatment is known as renal denervation, and it has had promising results so far, according to a study published by the American College of Cardiology in September by doctors including Steinberg and Dr. Evgeny Pokushalov of the State Research Institute of Circulation Pathology in Novosibirsk, Russia.

Those patients who had renal denervation in addition to standard atrial ablation were three times more likely to go for one year without an irregular heartbeat.     

The patients in the two-year-old study were Russian, and it was limited to 27 people. A larger study starting in early 2013 will enroll about 200 patients from six medical centers in the U.S., Russia and Europe. Steinberg estimates that if the study goes as well as doctors hope, the treatment could be used in the U.S. in one or two years.

While many Americans might think the Russian health care system antiquated compared to the U.S., Steinberg says that was not his impression during the times he traveled there to work on the research.

"There are pockets of great work over there," Steinberg says. "Their health care system has a lot of problems in reaching large swaths of their population. But there are institutions that are highly progressive and very advanced and very well funded by the government. Plus there are very smart, motivated scientists there, as well."

The Russian physician, Pokushalov, says it is crucial for doctors to collaborate across national borders.

"It increases the statistical power of clinical studies and it helps us avoid different biases that can arise," he says, in an email, adding that knowledge gained can be shared with doctors all over the world through studies like the one he published with Bergen County doctors.

"Our collaboration is like a cross-continental brainstorm, where you can find the best fruitful direction of thinking," Pokushalov says. "It is important to find the best treatment suitable for various populations all over the world."

A Patient's Story

For more than a decade, Chris Davis lived with atrial fibrillation. And for a while, surgical and medical treatments worked to give him relief from the irregular heartbeat that sometimes made his heart race and sometimes made it drag so slowly he was too scared to sleep.

"Pretty much I just had to live with it," says Davis, 63, a retired prison superintendent who lives in Orange County, N.Y.

Davis decided to undergo a relatively new procedure at The Valley Hospital in Ridgewood called FIRM, or Focal Impulse and Rotor Modulation.

Dr. Jonathan Steinberg, director of the Arrhythmia Institute at The Valley Hospital, explains it like this: For many years, doctors thought atrial fibrillation was caused by many electrical circuits misfiring all over the upper atrial chambers of the heart. They have come to understand that for each patient, the misfiring usually starts in the atrium or in the veins that empty into the atrium.

With FIRM, doctors find that location by using an electrical mapping catheter and then use a radio frequency cauterization tool to ablate or desiccate the tissue in that spot, usually about a nickel in size. By killing that small amount of tissue, it effectively blocks the source of the misfiring, Steinberg says.

Ablation has long been a traditional treatment for atrial fibrillation, but traditionally the locations are chosen because doctors believe they're generally good spots to choose – the doctor isn't targeting specific spots for each patient.

Valley Hospital is one of two facilities nationwide that perform the FIRM procedure and began doing it about a year ago. About a dozen patients have undergone the procedure.

Davis admits he was a bit reluctant to take part in something that is still relatively new, but he was more worried about what would happen if his condition continued to worsen.

"I was scared," he says, "but we're very active and I didn't want to be walking around with an oxygen bottle. So I said, 'Let's give it a shot.'"

Now, about nine months after the procedure, Davis says his heart is very rarely out of rhythm.

"Now I'm back to doing what I want to do," he says. "And that feels really good."

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