Curing the Troubled Heart; Dr. Marrouche¿s Passion
The Result: An Upbeat and Healthy Atrial Fibrillation Program
“Six years ago when I would talk to patients about a cure rather than a drug treatment for atrial fibrillation, people thought I was crazy,” recalls Dr. Nassir Marrouche, director of the University of Utah Hospital’s Atrial Fibrillation Program. “Now, those critics are sending their family members to me.” Marrouche chuckles, momentarily interrupting the passionate flow of words; he is a man clearly head-over-heels in love with the heart.
Marrouche’s “cure” is to use catheter-based ablation, which involves using a catheter to cauterize portions of the heart where abnormal electrical pulses are setting off irregular heartbeats. Marrouche helped pioneer this procedure with pivotal research (resulting in more than 70 published research papers over the last 7 years) and a depth of experience that makes him one of the top experts in the field. He has performed more than 1000 procedures. As of 2006, the American Heart Association and the American College of Cardiology implemented ablation of Atrial Fibrillation into their guidelines.
Atrial fibrillation (“afib” for short) is a condition that creates a quivering heart or abnormal beating because the hearts two small upper chambers quiver instead of beating effectively, allowing blood to pool or clots to form. Some 2.5 million Americans suffer from this and with age the likelihood of developing it increases significantly. “About 10 percent of the world population has afib who are over 77,” says Marrouche. “As we live longer, we’ll see more of it.” While aging is the number one cause, genetics and injury to the heart cells from the likes of leukemia, heart attacks, or inflammation (triggered by smoking, drinking, stress) can also bring it on. Around two percent of the population younger than 60 years suffers from this disease as well.
Many people chalk up their symptoms simply as the effects of aging, which might include palpitations, heart pounding, chest pain, shortness of breath, tiredness, or headaches. For patient Jim Daily, 69, when climbing 12 stairs left him struggling for his breath, he knew he needed help. He had been treating his atrial fibrillation for eight years with medication, but eventually the drugs stopped working and his heart was functioning at less than 12 percent.
“It’s like I got a second chance at life,” says ablation patient Daily, who was cheerful despite limping around on a sore knee from falling off his bike—something he couldn’t do before.
Marrouche discourages treating afib with medications, stating that one to eight percent of patients will suffer from the side effects of medication and that eventually the drugs will fail. “A lot of patients come to us because they are sick of dealing with the side effects that come with meds,” says Jessiciah Windfelder, MS, APRN, who works with cardiovascular patients and coordinates the Atrial Fibrillation Program.
Marrouche points out to his patients (who may travel from as far as Canada, New York, and Europe) that an improved quality of life is just one of the reasons to undergo ablation. Choosing medication or a pacemaker-based treatment will not cure afib but may temporarily suppress it. Marrouche adds that a significant percent of afib patients who receive these treatments will suffer from a stroke, in 30 percent the heart muscle will fail, and fatalities overall will increase by two-folds.
The Path To A Cure: Research
A break through in his research eight years ago lead Marrouche to believe atrial fibrillation could be cured. While researching another type of arrhythmia at the University of San Francisco, he and his colleagues helped discover that afib originates on the left side of the heart and specifically from the vessels that bring the blood from the lungs to the heart, known as the pulmonary veins
“From that day forward, I was not interested in healing but rather in curing afib,” says Marrouche, with the conviction of a promise. In 2002, further research revealed that ablating outside the pulmonary veins, not inside of it, improved the outcome significantly—success in patients went from around 45 to 85 percent.
For 6 years, Marrouche refined his ablation skills and research at the Cleveland Clinic, working with one of the best medical teams in the world, centralizing the research and helping establish the first atrial fibrillation clinic in the country there. A year ago, he left the Cleveland clinic for Utah to help spearhead the U’s own Atrial Fibrillation Program.
“The U opened up more possibility to further afib research with all the other types of research already going on here,” says Marrouche,
Although Marrouche is prudent about keeping standards tight as ablation procedures become more common, he wants it to be available to more people. One thing that will do this will be to provide medical practitioners with improved imagery technology. Progress in this area has already changed many lives for the better.
Currently, 2-D, real-time imagery are both accessible via Intracardiac ultrasound known as Intracardiac echocardiogram. Previously x-rays had been used, inhibiting accuracy. The recently formed, Utah Center for Atrial Fibrillation Research, is a conglomeration of different schools within the U that are collaborating to develop 3-D, real-time imagery technology using Magnet Resonance Imaging (MRI). Marrouche believes this technology is 2 to 3 years away. “Only the U has the science, technology and the talent to make this happen—this heavily influenced my decision to come here.”
While Marrouche performs ablation on 9-10 patients a week, he wants to increase this to 25 weekly to be able to decrease the U’s 3-4 month waiting period for ablation procedures. The 2 1/2 hour procedure, in well-trained hands, has decreased significantly allowing Marrouche to see more patients. Eight years ago it took 10 to 12 hours, and still does in some places according to Marrouche.
All of the U’s afib ablation patients wear heart monitors for three months to track their progress. This is reassuring to the patient and aides in research.
With 90 percent of Marrouche’s patients arrhythmia free and off heart medications within three months of the ablation procedure bodes well for the U’s Atrial fibrillation Program. [And for everyone else involved, well all the happy endings are…heart warming. ]
Heart Felt
Marrouche jokes that he is a hopeless romantic, so he was drawn to study the heart. “Actually, I’m a very impatient guy and I like to see quick results –and with heart treatments you often see patients recover right before your eyes.
Patient Randy Kirton, 61, chairman of a healthcare company and an admitted Type A, would agree; he returned to work a day after the ablation procedure. “My heart is back in rhythm and I have more energy and need less sleep now,” says Kirton, who was planning on having the procedure done at the Cleveland clinic when his research lead him to Marrouche. “I tend to cross-examine physicians to make sure I’m getting all the information I need and they don’t always like it.” Kirton adds, “Marrouche on the other hands over his power point presentation to me that he shares with colleagues. I found him to be very sympathetic to my condition and progressive.”
