Pedalling to a Steady Beat


At age 60, Martin W. feels like his heart is in great shape again after suffering for many years with an irregular heart beat called atrial fibrillation (Afib). His symptoms started about seven years ago while he was on a bike ride near his home in Ventura County. An avid cyclist who would pedal more than 100 miles per week, Martin made it a habit to wear a heart monitor to help push himself during workouts.


"At that time, I felt like I was in the best shape I've been since I was 30 years old," says Martin. "I was at the same weight I was when I was 30. I felt great. Life was great." But one day, while he was resting after his usual ride, Martin was shocked by what he saw on his heart monitor. His resting pulse was 178 heart beats per minute.


"Seeing that number scared me so much that my heart rate went up to 188 from all the adrenaline," Martin recalls. "I rode my bike into a nearby park and told the ranger what was happening and to keep an eye on me in case I passed out."


When his heart rate returned to normal, Martin rode home and  called a cardiologist. The diagnosis was atrial fibrillation.


Martin wore a heart monitor to push himself during workouts. one day it revealed something out of the ordinary.



Electrophysiologist  Dr. Brett Gidney


Atrial fibrillation is an irregular beating (arrhythmia) of the heart. Either the upper or both upper and lower chambers of the heart beat rapidly and that can lead to lightheadedness, palpitations, shortness of breath and tiredness. But some people can have atrial fibrillation and feel fine without any symptoms.


A normal heartbeat is about 70 beats per minute. But in a heart with atrial fibrillation, the upper chambers can race to 600 beats per minute. Physicians perform a test called an electrocardiogram to determine if a person has atrial fibrillation.


A steady heartbeat is controlled by electrical impulses that travel through the heart, first through the upper chambers, called the atria, and then through the lower chambers, called the ventricles. In order to reach the ventricles, electrical impulses must pass through the atrioventricular, or AV node.


Atrial fibrillation occurs when a storm of electrical impulses spreads through the atria in a chaotic and disorganized pattern, causing the atria to begin rapidly contracting. As a result, the ventricles may also begin contracting faster. When the heart is in atrial fibrillation, the body can't receive the blood and oxygen it needs, causing symptoms.


The chances of having atrial fibrillation are relatively high, states Dr. Brett Gidney, an electrophysiologist at Santa Barbara Cottage Hospital. Between the ages of 40 and 95 a person has about a one in of four chance that during their lifetime they will have the condition.


"This is an enormous health burden. And A-fib is the most common cause of stroke," Dr. Gidney says. While the exact cause of the condition is unknown, some factors that can contribute to it are high blood pressure, coronary heart disease, damage from a heart attack or surgery, sleep apnea, and aging.

Sometimes episodes can be triggered by substances like alcohol, tobacco, and caffeine. An episode may last just a few seconds, where a person is aware of a rapid heartbeat. Or episodes can last several minutes to all day long. Symptoms can appear once a year to everyday.


Even with mild symptoms, atrial fibrillation needs to be treated, or serious complications can develop. If left untreated, atrial fibrillation can cause blood clots that can lead to a stroke. Over time, a rapid heart rate can also weaken the lower chambers of the heart, causing other health problems.


For seven years, Martin tried various ways to manage his atrial fibrillation. He took prescription medications, which helped for a while but eventually lost their effectiveness. He also had two procedures involving ablation, one surgical and one by catheter, in which a small amount of heart tissue is scarred by a high- frequency current.


But his atrial fibrillation came back. Again he returned to using medications, but he was frustrated that he could not be cured of his condition.


Then Martin's doctor referred him to Dr. Gidney. Dr. Gidney (pictured) performs ablations using an advanced technique involving a next generation 3-D mapping system with magnetic navigation technology. A catheter is inserted into a special IV called a sheath and then into the femoral vein at the groin. Patients are only under a light anesthetic. Unlike other procedures that can take about seven hours, Dr. Gidney performs the procedure in three to five hours.


"The new technology allows the physician to track the catheter in the patient, similar to a GPS system," Dr. Gidney explains.


Dr. Gidney uses 3-D mapping and intracardiac echocardiography of the left atrium to perform pulmonary vein isolation using radio- frequency ablation to cure atrial fibrillation.


The simple explanation of the procedure: "It's like putting electrical tape around the four pulmonary veins of the heart so that the electrical signal (that causes the irregular heartbeat) can't get out," Dr. Gidney says.


He is one of only a few physicians in the region who performs this procedure, which can dramatically reduce and even cure atrial fibrillation while exposing patients to much less radiation than other ablation treatments.


"Here the average X-ray exposure is six minutes. In other places, the patient gets exposed to 45 to 50 minutes of X-ray," Dr. Gidney emphasizes.


Martin was very pleased with the results after having the ablation performed by Dr. Gidney in October 2010.


"I'm finally cured of my A-fib," said Martin, who is back on his bike and riding up to 50 miles per week. "I don't have to take medications for it anymore and I'm not restricted in my activities. Now I just have to work on losing some weight."


By Maria Zate | Photo by Glenn Dubock


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