New robotic and catheter procedure offers hope for Canadians with atrial fibrillation

TORONTO · Doctors in Toronto have pioneered a new two-part procedure for treating atrial fibrillation, a common heart rhythm disorder. The technique combines minimally invasive robotic surgery with a catheter ablation, a first for Canada. Atrial fibrillation, or AFib, affects one to two per cent of the population and can lead to stroke or heart failure. The new approach was developed by Dr. Gianluigi Bisleri and Dr. Paul Angaran at St. Michael's Hospital. They aim to improve outcomes for patients with persistent forms of the condition.

"It allows us to not only use the robotic technologies which give us more dexterity, more ability to reach and see the heart, but also to treat broader areas of the heart with the ablation," Bisleri said. The procedure starts with robotic surgery to create ablation scars on the outside of the heart. Weeks or months later, after the external scars heal, doctors perform a catheter ablation inside the heart. Angaran said this combined method could achieve long-term success rates of 70 to 80 per cent for patients with long-standing persistent AFib.

Jon Davies of Edmonton is one of the first patients to undergo the new treatment. He was diagnosed with AFib after experiencing severe fatigue. "I used to go mountain hiking and played a lot of squash and then that sort of quickly went away as I got into my early 50s," Davies told Global News. "I just figured it was old age and having a desk job and not enough exercise maybe." His wife, Nora, said he was often tired and would sleep a lot. Initial consultations told him his heart was too enlarged for surgical treatment.

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"They told me that my heart had enlarged so much that it wouldn't make sense for them to treat it surgically, so that's when they said you're going to stay on blood thinners," Davies said. He accepted that status quo until this year, even after a second opinion yielded the same result. Davies learned about the new procedure through his own online research. He underwent the robotic portion of the surgery in September and is scheduled to return to Toronto soon for the catheter ablation.

Traditional catheter ablation for AFib involves threading wires through the groin to the heart. "Patients are usually sedated or put to sleep entirely and we put little tubes in the groins and we pass wires into the heart, cross over to the left side of the heart and what we try and do is kill the tissue around the pulmonary veins," Angaran explained. The process creates tiny scars that block the faulty electrical signals causing the irregular heartbeat. However, Angaran noted that not all patients see effective results from standard ablation alone.

Bisleri said the robotic technology provides greater precision for the external part of the procedure. "Typically we burn, so we use energy sources that overheat the tissue and sometimes we can use energy sources that freeze the tissue," he said. "But either way, we create these scars that become permanent and stop the irregular heart rate." Patients must be referred to Bisleri and Angaran for the treatment, though Bisleri said awareness of the option remains low. Davies said he appreciates the new possibility. "It's nice to be able to potentially, you know, take that diagnosis and direct it in a much more human, in a way that, you know, appreciate much more than the alternative," he said.

With files from Global News