Jon Davies of Edmonton used to hike mountains and play a lot of squash, and by his early 50s both had slipped out of his life. He put it down to age and a desk job, while his wife, Nora, noticed that he was often tired and sleeping a lot.
The real cause turned out to be his heart, and two doctors at St. Michael's Hospital in Toronto have now developed a new treatment for people like him. Their approach targets atrial fibrillation, or AFib, the most common type of irregular heartbeat. It pairs robotic surgery on the outside of the heart with a catheter procedure on the inside, as Global News reported on October 25.
Key takeaways
AFib affects about one to two per cent of people, and it raises the risk of stroke three to five times.
The usual treatments are medication or catheter ablation, which creates tiny scars that block faulty electrical signals.
The new approach treats the outside of the heart robotically first, then the inside with a catheter a few weeks or months later.
Dr. Paul Angaran says long-term success could reach 70 to 80 percent for people with long-standing, persistent AFib.
A referral is simple to arrange, though the surgeon behind the approach says too few people know it exists.
What makes this two-step treatment different?
The two-step treatment starts on the outside of the heart. In the first stage, Dr. Gianluigi Bisleri, who directs minimally invasive and robotic cardiac surgery at St. Michael's, uses robotic tools to create scar lines on the heart's outer surface. He told Global News that the robot gives surgeons more dexterity, a better view, and the ability to treat broader areas of the heart.
Once those outer scars have healed, which takes a few weeks to a few months, Dr. Paul Angaran, the hospital's cardiac arrhythmia director, finishes the work from the inside with a standard catheter ablation. Bisleri describes the combination as a Canadian first. For people with long-standing, persistent AFib, Angaran said the long-term success rate could reach as high as 70 to 80 percent.
That figure is the team's own estimate, and the report did not say how long the team followed its patients, so it is best read as an encouraging early signal. Davies, one of the first patients, had the robotic stage in September and is due back in Toronto for the catheter stage in the coming weeks. Minimally invasive heart surgery is being tested elsewhere in Canada too, including bypass surgery that spares the breastbone.
Robotic surgery treats the outside of the heart first, then a catheter procedure treats the inside once the scars have healed
Why does the usual approach fail some patients?
The usual approach to AFib is medication, a procedure called catheter ablation, or both. In an ablation, doctors pass thin wires from the groin up into the heart and create tiny scars around the pulmonary veins, the large vessels that carry blood from the lungs into the heart. They make those scars by heating the tissue or by freezing it, and the scars block the stray electrical signals that knock the heartbeat out of rhythm.
The procedure works well for many people, though Angaran told Global News that it is not effective for everyone. Davies was one of the people it could not help. His doctors told him his heart had enlarged so much that treating it surgically no longer made sense, so the plan was to stay on blood thinners, and a second opinion gave him the same answer.
Could your tiredness be a heart rhythm problem?
The part of Davies's story most people will recognize is how ordinary it felt. AFib often looks nothing like a dramatic movie scene, and for many people it shows up as fatigue, shortness of breath, and a slow loss of the activities they used to enjoy. If your energy has dropped without a clear reason, or your heart flutters, races, or thumps out of step, an irregular heartbeat is one explanation worth ruling out.
A heart rhythm check is quick, and the usual test, an electrocardiogram or ECG, records the heart's electrical activity in a few minutes. People with AFib have three to five times the risk of the kind of stroke caused by a clot, according to the Heart and Stroke Foundation, which is why a diagnosis matters even when symptoms feel mild. Many flutters turn out to be harmless. Our guides to heart palpitations and what they usually mean and a heart that races for no reason can help you sort out which ones deserve a closer look.
How do you ask for a second opinion?
If you were told years ago that nothing more could be done, a second opinion is worth asking for, because AFib care keeps changing. Davies found this option by searching online, and the St. Michael's team says the referral itself is simple even though awareness is still low. You can read about the heart rhythm service at St. Michael's Hospital and bring what you learn to your own doctor.
Get your rhythm checked. If the symptoms above sound familiar, ask a family doctor or walk-in clinic for a pulse check and an ECG, and learn how to check your resting heart rate at home in the meantime.
Ask about newer options. If you already have AFib and treatment has stalled, ask your cardiologist whether a combined approach like the one at St. Michael's could suit you.
Request a referral. The St. Michael's team sees patients by referral, so ask your doctor directly if you think you might qualify.
Protect the basics. Keep your blood pressure in range, limit alcohol, and take any blood thinner exactly as prescribed, and our guide to why your blood pressure numbers keep changing can help with the first part.
Know the emergency signs. Chest pain, fainting, sudden weakness on one side, trouble speaking, or a drooping face need emergency care, so call 911.
Frequently asked questions
How do doctors find an irregular heartbeat?
Most of the time a doctor picks up an irregular heartbeat with a simple pulse check and an electrocardiogram, or ECG, which records the heart's electrical signals in a few minutes. Because AFib can come and go, a doctor may also suggest a portable monitor that you wear for a day or longer to catch an episode.
Who can get the two-step treatment?
The St. Michael's team aimed the approach at people with long-standing, persistent AFib that the usual treatments have not controlled. Patients need a referral from their doctor, and the team says arranging one is simple. Your cardiologist can tell you whether your type of AFib and your overall health make you a reasonable candidate.
Why are blood thinners part of heart rhythm care?
When the upper chambers of the heart quiver instead of squeezing, blood can pool and form clots that may travel to the brain. That is why AFib raises the risk of stroke three to five times. Blood thinners lower that risk, which is why doctors stress taking them exactly as prescribed, even on days you feel fine.
Your next step
If your heartbeat or your energy has felt off, you do not have to wait for it to explain itself. The Medimap Health Hub has more on heart health, and you can find a family practice near you or book a walk-in clinic visit to get your heart checked this week.
Disclaimer: This article is for general information only and is not medical advice. It does not replace a conversation with a doctor or other qualified health professional who knows your history. If you think you are having a medical emergency, call 911 or go to the nearest emergency department.
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