Joyce Cook, of Bethel, is back in her lab at University of Bridgeport after the resolution of her a-fib symptoms.

Getting to the heart of the matter

In hindsight, Joyce Cook, 69, of Bethel was having symptoms of atrial  fibrillation, or a-fib. Though she did not experience some symptoms associated with a- fib – such as heart palpitations, swelling, chest pain or shortness of breath – she was exhausted and unable to garden, her favorite pastime.

Atrial  fibrillation is the most common type of heart arrhythmia. Arrhythmia causes the heart to beat in an irregular way, affecting the heart's blood flow. Cook's a-fib was discovered by her primary care physician during a routine physical exam.

Cook was immediately referred to cardiologist Adam Schussheim, MD, of Northeast Medical Group's (NEMG) Cardiac Specialists.

First, Dr. Schussheim tried to restore normal heart rhythm by using various medications. Next, he performed an electrical cardioversion, a procedure that uses a small electrical shock to reset the heart rhythm to normal. As can often happen, however, the arrhythmia soon recurred.

Dr. Schussheim then referred her to electrophysiologist Murali Chiravuri, MD, of NEMG's Cardiac Specialists for possible treatment with cryoablation, a procedure now offered at Bridgeport Hospital.

In cryoablation, a liquid nitrogen-based coolant system is sent through a balloon catheter to isolate the pulmonary veins where electrical signals begin, rather than resistive heating, as used in traditional radiofrequency ablation (RFA) procedures.

This freezing around the vein can block the erratic signals that cause a-fib from spreading to the rest of the heart from the pulmonary veins.

"Many patients will go in and out of a-fib, but Joyce was in early persistent a-fib," said Dr. Chiravuri. "Her a-fib was very difficult to control, but I knew she would be an excellent candidate for cryoablation."

The surgical time with cryoablation is shorter than with RFA and patients have a quicker recovery time. In addition, cryoablation has shown to be more effective in patients for which drug therapy has failed.

On Aug. 9, Dr. Chiravuri and his team conducted cyroablation on Cook. This marked the first such procedure at Bridgeport Hospital.

"By treating patients with the most advanced technology, we are better able to manage their atrial  fibrillation to improve their overall quality of life and significantly reduce a- fib symptoms," said Dr. Chiravuri.

Since Aug. 9, Bridgeport Hospital has performed 48 cryoablations.

"A-fib is the most common heart rhythm disorder, but it is also often undertreated. Many patients and providers are unaware of therapeutic options such as cryoablation," Dr. Chiravuri said. "Since a-fib patients have up to five times higher risk of stroke and an increased chance of developing heart failure, these options are worth exploring for any patient with a-fib."

Cook stayed overnight at the hospital and was discharged the next day. Eight months later, she still raves about her experience at Bridgeport Hospital.

"The care I received was superb. From the time I entered the hospital and saw the first nurse, there was a level of professionalism, caring and a human interaction that I hadn't seen at other hospitals," explained Cook. "I felt like I was the only individual that they were looking after, even though there were other people in the cardiac unit."

Other physicians certified to perform cryoablation at Bridgeport Hospital are NEMG's Robert Winslow, MD, and Adam Lottick, MD.

Cryoablation is just one of many advanced treatments performed at Bridgeport Hospital, where diagnosis and treatment of cardiovascular diseases helps patients who have heart attacks, coronary artery and valve diseases, congestive heart failure, arrhythmias, cardiomyopathy and congenital heart disease.

Another highly specialized treatment is transcatheter aortic valve replacement, or TAVR, an alternative to a traditional valve replacement.

Transcatheter aortic valve replacement (TAVR) Bridgeport Hospital opened a special hybrid operating room in May that will extend the capabilities of cardiologists, cardiothoracic surgeons and vascular surgeons on a variety of procedures.

In addition to cryoablation and abdominal aortic aneurysm repair, TAVR is performed in the new hybrid OR. TAVR is one of the methods used to treat aortic stenosis, or narrowing of the aortic valve.

During a TAVR procedure, instead of a traditional open heart surgery, an interventional cardiologist and cardiothoracic surgeon work together to place a tube into the femoral artery that allows a new valve to travel through the patient's arterial system – the blood vessels that carry blood from the heart to the organs. The valve is then placed inside the existing valve, where it is ballooned into place or takes shape and begins to work.

"TAVR has numerous advantages over surgical aortic valve replacement, especially in older or high-risk patients. TAVR is less invasive and avoids cardiopulmonary bypass and general anesthesia," said Edward Tuohy, MD, interventional cardiologist with NEMG's Cardiac Specialists.

In addition, TAVR patients have a shorter hospital stay and quicker recovery.

Bridgeport Hospital recently introduced a new method for performing a TAVR procedure, using conscious sedation.

"Conscious sedation allows a patient to breathe on his or her own while in a twilight sleep. The anesthesiologist can vary the level of sedation during the procedure. this type of sedation allows the patient to recover more quickly after the procedure than general anesthesia," said Victor Mejia, MD, NEMG cardiologist.

With the advent of TAVR and especially conscious sedation, patients who were not considered candidates for a traditional valve replacement via open heart surgery may now have a viable treatment option.

Such was the case for Jack Wilson, 78, of Bridgeport. Along with aortic stenosis, Wilson suffers from advanced kidney disease. He was in and out of the hospital due to shortness of breath and a cough. Before conscious sedation was available, Wilson was not a candidate for TAVR.

"Due to his heart failure and kidney dysfunction, he progressed to need dialysis," said Dr. Mejia. "But since his TAVR, his kidney function has improved and he no longer needs dialysis."

"the shortness of breath has faded away," said Wilson. "I am feeling good. I have been feeling good since the second day after I had the procedure."

"He had the valve replacement on February 14," said Virgie, his wife of over 50 years. "He is walking more. Before, he was short of breath when he walked to the car, but now he is doing well. He walked two blocks yesterday!"

Other patients who might now benefit from the new hybrid OR are those who were previously not good candidates for TAVR procedures because their femoral arteries were too small to insert the valve.

"In the hybrid OR, we can explore using an artery in the arm to deliver the valve to the heart. We are now able to help so many more patients," said Dr. Mejia.

In addition to Drs. Tuohy and Mejia, Umer Darr, MD, a Yale Medicine cardiac surgeon, also performs TAVR procedures at Bridgeport Hospital.

As with most problems with the human body, prevention is a good measure.

"To avoid any heart disease, it is important to have a good diet, exercise and avoid tobacco. You should also know your blood pressure and cholesterol numbers. the risk factors for an abnormal heart valve are similar to those of artery blockage, and if caught early, less invasive interventions offer better outcomes," said Dr. Tuohy.

If you would like more information about the cardiac services offered at Bridgeport Hospital, visit the heart and vascular section of the website.