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Atrial fibrillation — new treatment offered at Rose

Dr Jason SperlingTHE CONVERGENT Procedure, a minimally invasive technique that restores normal heart rhythm to patients with advanced atrial fibrillation (AFib), is up and running at Rose Medical Center.

Rose is the first hospital west of the Mississippi to offer the Convergent Procedure, which has a success rate of 80% to 90%.

Dr. Jason Sperling, RMC’s director of cardiac surgery and medical director of cardiovascular services, began utilizing the procedure in tandem with two electrophysiologists in January, 2015.

Sperling and his team have used the Convergent Procedure on 10 patients with advanced atrial fibrillation “and patient satisfaction is through the roof,” he tells the Intermountain Jewish News.

Long-term effects of the procedure require study, he says.

Six million Americans are being treated for AFib, the most common cardiac rhythm disturbance doctors see in clinical practice.

Symptoms include palpitations, uncomfortable flip-flopping sensations in the chest, chronic fatigue, low exercise tolerance, shortness of breath during physical exertion and low motivation.

What may sound like appropriate age-related conditions are actually precursors of stroke and fatal cardiac events.

Persistent AFib is a major cause of strokes and heart attacks in the US, says Sperling, a cardiac surgeon for 11 years.

It is also associated with heart failure later in life and considered a major cause of vascular dementia.

“It’s so common that one in four adults above age 40 will develop AFib in their lifetime,” he says. “It’s really an epidemic.”

In the early stages of the disorder, treatment focuses on lowering blood pressure and normalizing the cardiac rhythm to an acceptable level.

“The good news is that people who can get on top of their general medical issues like high blood pressure and sleep apnea (another contributing factor) have a pretty good chance to prevent AFib,” Sperling says.

However, there are no medications that cure atrial fibrillation once it progresses to an advanced stage.

“For a lot of patients, these medications don’t work at all,” he says. “Doctors are limited to prescribing blood thinners to prevent stroke or just slow the heartbeat sufficiently so that people don’t feel like they’re running a marathon, which is very hard on the heart.”

Patients in the incipient stages of atrial fibrillation — who have symptoms for a few hours over the year — might be candidates for more invasive, catheter-based treatments “that work about 70% of the time,” Sperling says. “But it’s risky.

“Until a few years ago, patients in advanced AFib were told that nothing could treat the condition except open heart surgery.”

Now there’s an alternative that can restore normal heart rhythm and a quality of life that AFib sufferers no longer believed possible.

SPERLING WAS introduced to the Convergent Procedure, founded by nContact in 2009, at The Valley-Columbia Heart Center in Ridgewood, NJ, where he was employed by Columbia University.

During his New Jersey tenure, he and his team performed around 50 Convergent procedures “and perfected the safest and most efficacious version of the procedure,” he says.

Sperling was responsible for bringing the Convergent Procedure to RMC and the Western hinterlands of the US.

Like its name, which evokes a sci-fi film, the Convergent Procedure requires a leap of the imagination to grasp its intricate physiological foundations.

Sperling proves an amiable yet cardiac-embedded guide.

First, it’s important to highlight the relevance of the left atrium, one of the four chambers of the heart. This is where atrial fibrillation “lives,” and where the Convergent Procedure delivers its one-two therapeutic punch.

“Think of it this way,” Sperling says. “In advanced AFib, the pulmonary veins are the batteries of the circuit, and the back wall of the left atrium is the wiring of the circuit.”

The Convergent Procedure approaches from the inside and outside of the atrium heart chamber.

“In the early stage of AFib, if you can ablate (induce scarring in small areas of the heart that are causing the problem) in the opening of the veins as they join the chamber, you can treat the abnormal voltage, and that works very well,” he says.

However, this procedure is not recommended in cases of advanced AFib.

“If you have persistent AFib, the kind that you experience all the time, treating the veins alone will never do the trick,” says Sperling. “There’s something else going on in the area between the veins and the atrium chamber that must be targeted as well.

“The nuance of this procedure is that we now have a way to very broadly treat the area between the veins and the back wall of the left atrium.

“We do it in such a way that we can’t hurt anything else around the heart, and it does a great job ablating the back wall of the left atrium.”

Sperling and electrophysiologists Drs. Tom Svinarich and Christopher Stees perform cardiac ablation on a beating heart in the electrophysiology lab to produce scar tissue on the heart in order to block abnormal electrical signals.

“The approach is the one-two punch of external ablation on the back wall combined with internal ablation of the pulmonary veins, utilizing the best technologies,” Sperling says.

Patients never see an operating room, do not spend time in the ICU and typically return home two days after the procedure.

Insurance generally covers the cost.

Sperling says that the Convergent Procedure gained traction about five or six years ago, primarily in Europe. He estimates that approximately 4,000 procedures have been performed worldwide.

“At my clinic in New Jersey, we modified the technique and had the best outcomes in the nation,” he says.

SPERLING, WHO turns 44 in April, was born in Brooklyn and studied at the Yeshiva of Flatbush for 12 years. Fluent in Hebrew, he wore a kipah and donned tefilin every day for a few years.

“I’m well versed in all things Jewish,” he says. “I’m not a religious guy, but I’m confident I know more about the Torah, Talmud and Jewish law than the average person.”

Sperling is married and the father of two kids ages 14 and 12.

During medical school at SUNY Health Science Center at Brooklyn — “I served a life sentence in Brooklyn,” he laughs — Sperling knew that wanted to do something technical with his hands and “surgery made a lot of sense.

“From a physiologic and an exposure perspective, I would say that the heart is the easiest organ in the body to figure out.

“I have a propensity for engineering, and the heart adheres to very straight engineering principles.

“I always joke with family, friends and colleagues that I’m a really good heart surgeon but I should have been an engineer based on the way my mind works,” he says. “But this actually helps me a lot because I can explain things about the heart to lay persons that they can understand.

“The heart follows pretty simple rules.”

He was elected to SUNY’s medical society when he was a junior in medical school, a rare distinction, and then served as president.

Sperling did his medical surgery residency at the University of Maryland Medical System, a thoracic and cardiovascular surgery fellowship at the University of Virginia Health System and had a research fellowship in cardiac surgery at Harvard University-Boston Children’s Hospital.

He specializes in advanced mitral valve repair, aortic surgery and valve repair, the “David” Procedure — a special operation for patients with aortic root aneurysm — off-pump bypass surgery, thoracic aneurysms and the Convergent Procedure.

Sperling, whose 20th medical school reunion is around the corner, says he’s never sensed any mistrust toward the medical profession from patients.

“The important thing is for doctors to treat patients as regular human beings and not as a chart or number they have to get in and out of the office in 20 minutes,” he stresses.

“At Rose we develop close relationships with our patients, making sure they’re part of our family as opposed to people we know for a few minutes before closing the door behind us.”

ULTIMATE BENEFITS of the Convergent Procedure — like whether this relatively new technique permanently repairs atrial fibrillation — require additional long-term study.

However, based on his own evidence, Sperling is hopeful that it will offer a lasting resolution.

“Generally, AFib treatments fail within one year of the procedure,” he says. “But we’ve seen very little in the way of recurrence. This treatment should last a lot longer than anything that’s out there.”

Those undergoing the procedure at RMC are asked to participate in a clinical trial in which small microchips are implanted in the body to monitor the heart rate over a three-year period.

Despite the exacting degree of difficulty involved in the cardiac surgeries he performs, Sperling finds his work with AFib patients particularly rewarding.

“It’s immensely satisfying to help a patient with an aneurysm and fix his life,”he says.

“But I can tell you that in my 11 years as a cardiac surgeon, AFib patients are the most fulfilling to treat.

“After accommodating the disorder for so long, they don’t even recognize how limited they are now. AFib has slowed them down profoundly — yet they are otherwise capable of living terrific lives.

“Once their hearts are restored to normal rhythm, it’s amazing to see the effect our team has on them, and their quality of life.

“It’s very special for us.”

Copyright © 2015 by the Intermountain Jewish News



Andrea Jacobs

IJN Senior Writer | andrea@ijn.com


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