Northwest Health | SUMMER 2009 By Rhenda Meiser

Treatment for heart disease has improved rapidly in recent years, so we thought we'd ask experts at Group Health medical centers about some of the latest techniques. Of course the first thing they told us was that it's always better to avoid getting heart disease, rather than treating it once you've got it.

BACK TO: Northwest Health index

"Modifying your risk factors by eating right, maintaining a healthy weight, exercising, and not smoking is probably the most cutting-edge approach in cardiovascular disease," says Chuck McQuinn, MD, vascular surgeon at our Capitol Hill Campus in Seattle.

Have You Taken Your Health Profile Yet?

This online questionnaire, which assesses your health status, can help you get started. Then work with your personal physician to evaluate your risk for heart disease, decide which screenings — such as cholesterol checks — are needed and discuss any lifestyle changes to consider.

If concerns arise about your risk for heart disease, or about suspicious symptoms, your personal physician will likely order some tests or refer you to a cardiologist. Group Health offers all the typical diagnostic tests for heart disease — treadmill testing, echocardiography, nuclear medicine, ultrasound, CT scans, and MRIs — at our larger medical centers.

Treatment might include lifestyle changes, medication, or both. And, when needed, our skilled cardiology specialists can perform a variety of minimally invasive procedures to treat specific heart conditions. These alternatives to open heart surgery result in reduced pain, scars, and postoperative recovery time.

Cardiac Electrophysiology

What it treats: Abnormal heart rhythms. The right atrium of the heart serves as a natural pacemaker — sending electrical signals that tell the heart to pump blood. These signals can become abnormal in some people, causing arrhythmias (irregular heart rhythms) and atrial fibrillation (irregular and often rapid heart rate).

Treatment techniques: Catheter ablation is one way to treat cardiac arrhythmias. During ablation, a doctor inserts a thin, flexible tube into the heart, via an artery in the groin. "Using three-dimensional mapping systems, we can actually recreate the geometry of the heart," says Michael Belz, MD, Group Health electrophysiologist. "Like a fighter jet locking in on its target, the program assigns coordinates to the landscape of the body so we know precisely which tissue is causing the abnormal heart rhythms."

A special machine is then used to deliver energy through the catheter to burn and kill the abnormal tissue in the heart and disconnect the pathway of the abnormal rhythm. For simple arrhythmias, the ablation procedure has a 95 percent cure rate, takes about an hour, and the patient usually goes home the same day.

Belz was one of the first physicians in the Northwest to perform ablations for atrial fibrillation. It's the same concept and procedure used on arrhythmias, but it covers a greater area and takes longer, he says.

"Instead of a single burn, we give anywhere from dozens to hundreds of burns," he says. The procedure takes three or four hours and requires an overnight stay in the hospital. It's generally successful, but patients may require more than one session.

Belz also pioneered an electrophysiological technique for treating patients with a failing heart muscle. This procedure involves implanting a biventricular device that improves the heart's pumping ability.

Endovascular Surgery

What it treats: Narrowing blood vessels — which are usually caused by the buildup of fatty deposits on the walls of the vessels — and aneurysms. An aneurysm is a weak area in the blood vessel that bulges like a balloon and can burst if it gets too big. In the last 30 years, the occurrence of abdominal aortic aneurysms has increased threefold. The aorta is the main vessel carrying blood from the heart to the rest of the body.

Treatment techniques: Angioplasty uses a balloon-tipped catheter, inserted into an artery or vein, to open blocked vessels. Stenting, which may be performed with angioplasty, is the insertion of a small tube into the vessel to keep it open.

McQuinn performs angioplasty on vessels in the abdomen and legs. He also repairs aortic aneurysms and operates on blood vessels in the arm so patients with kidney failure can get dialysis.

"Over the last 10 years, new devices — implanted using minimally invasive techniques — have improved treatment of abdominal aortic aneurysms," he says. "Not all patients are candidates for the new devices, but our success rate with stents and balloon grafts is very high, partly because we screen our patients very carefully."

Interventional Cardiology

What it treats: Damaged heart muscles and arteries that are clogged.

Treatment techniques: Interventional cardiologists Nathan Green, MD, and Scott Haugen, MD, implant closure devices to repair holes in the heart, and metal stents to open blocked blood vessels.

They also perform heart catheterizations to check for blockage — including a newer "transradial approach" that involves inserting a catheter at the wrist, rather than the leg vessel. "This reduces bleeding and can speed recovery," says Green.