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Erie woman spends two decades battling abnormal heart rhythm By David Bruce / david.bruce@timesnews.com

Erie Times-News - 6/24/2017

WEB STORY

Susan Carey's 20-year fight with atrial fibrillation has included expensive drugs, powerful shocks, open-heart surgery and a new medical procedure.

Some of these efforts have worked at keeping her heart in rhythm, while others have not. But the 64-year-old Erie woman feels as good now as she has at any time since the early 1990s.

"I just returned from a three-week trip to Alaska, where we walked 12,000 to 15,000 steps a day," Carey said. "One day we walked 22,000 steps, so my heart must be in decent shape."

Atrial fibrillation is the most common abnormal heart rhythm, affecting at least 2.7 million Americans, according to the U.S. Centers for Disease Control and Prevention. It is a serious health concern because people with AFib are five times more likely than the average person to suffer a stroke.

The good news is that significant advancements in treating AFib have been made in recent years, allowing more patients like Carey to lead full, active lives.

"But the first step is getting diagnosed," said Kelly Hayes, M.D., a UPMC Hamot cardiologist who treats Carey. "People sometimes don't realize they have AFib because they don't have symptoms."

AFib occurs when the heart's upper chambers, called the atria, fail to contract in a strong, rhythmic way. Irregular electrical signals disrupt the normal rhythm between the sinoatrial and atrioventricular nodes.

Possible causes of AFib include heart disease, diabetes, sleep apnea and high blood pressure.

"Since the chambers don't contract properly, blood can pool in the heart," Hayes said. "Clots can then form because the blood isn't moving properly, and those clots can be sent to the brain and cause a stroke."

While some people never realize they have AFib, others may become lightheaded, short of breath or feel like their heart is racing out of control.

"It was like I had a lump in my throat and it would feel like my heart would skip a beat," Carey said. "Later on I would feel fatigued a lot, but I would just push through it."

Doctors initially prescribed Carey medication to slow her heart rate. They later added a blood thinner to reduce her risk of stroke and an anti-arrhythmic drug to keep the heart in rhythm.

The problem is that drugs alone only work about 40 percent of the time, Hayes said. By 2009, Carey's AFib was serious enough that she underwent three cardioversions, where an electric shock is given on the outside of the chest to put the heart back in rhythm.

It's similar to the shocks paramedics give to people in cardiac arrest.

"The problem with cardioversion is that it doesn't last for years," Hayes said. "It's a temporary way to put the heart back in rhythm."

Carey went to Cleveland Clinic later that year for a Maze procedure, in which incisions are made on the left and right atrium to create scar tissue. It's done to disrupt the abnormal electrical impulses.

But doctors discovered that years of AFib had damaged two of Carey's heart valves, so she also underwent open-heart surgery to repair them.

"I was in the hospital for 16 days and actually had to undergo another procedure because fluid had developed around my heart," Carey said. "They told me it would take a few months for my AFib to go away, and four months later it was gone."

Carey's heart remained in rhythm for seven years before the AFib returned in 2016. She met with Hayes, who recommended cryoablation.

Cryoablation is a procedure in which a cardiologist inserts a catheter through the patient's groin up to the heart. A small balloon attached to the end of the catheter fills with a cold liquid and is used to freeze small areas of the heart to block the abnormal electrical patterns.

"It creates a more extensive, complete lesion to correct AFib than radio-frequency ablation does," Hayes said, referring to a heat-based procedure more commonly used for AFib.

The procedure worked, correcting Carey's AFib to the extent that Hayes eventually took her off a prescription blood thinner. She only takes a baby aspirin to reduce her risk of stroke.

Her resting heart rate, which once measured more than 160 beats a minute when her AFib was active, is now in the mid-60s.

Doctors are reluctant to say anyone with AFib is ever cured, but Hayes said new procedures and drugs are helping correct patients' heart rhythms for long periods of time, even permanently.

"I'm hoping that this is it as far as my AFib is concerned," Carey said.

David Bruce can be reached at 870-1736 or by email. Follow him on Twitter at twitter.com/ETNbruce.