Left Atrial Appendage Closure
By Laura Freeman
There have been big advances in electrophysiology since Chad Colon, MD, FACE, first became fascinated with the subject as a child while hanging out in his cardiologist father’s office and listening as his dad and the partners traded stories between patients.
“They were doing such interesting things, especially the electrophysiologists who seem to always be getting exciting new tools that allowed them to do more to help patient,” Colon said. “It was amazing. They could save lives and improve quality of life and send patients home the same day. They didn’t have to open up a chest or do a procedure that would take a long time to recover. With the right tools and skills, they could fix things like tachycardia and fibrillation in an outpatient procedure. I knew that’s what I wanted to do. I always wanted to be an electrophysiologist. I wanted to get my hands on those tools and learn how to use them to help people.”
Pursuing that dream took 12 years of preparation, medical school and advanced training. Now Colon has just completed his UAB fellowship in electrophysiology and in July he is moving into his own office at Cardiovascular Associates, joining the same practice where his cardiologist father has been working through much of his career.
“I’ll be taking on a complete range of electrophysiology cases, from younger patients who may be dealing with supraventricular tachycardia to rhythm disturbances that tend to be associated with aging or other heart conditions such as atrial fibrillation and ventricular tachycardia, Colon said.
He is launching his private practice as an electrophysiologist at an exciting time when a whole new generation of electrophysiology tools, devices and treatment options have become available.
Colon had a front row seat during his fellowship as UAB electrophysiologists helped to design, test and launch the new pulsed field ablation technology that has just become more widely available beyond the research university setting.
“Particularly in atrial fibrillation cases, pulsed field technology is a big step forward,” Colon said. “It improves effectiveness while reducing risks. We’ve also seen major advances in devices like pacemakers. Instead of patients having to live with a big bulge under their skin, modern implants are about the size of a c battery. We can put them where patients hardly notice them. And the batteries are made to last much longer.
“Another area where there have been big improvements is in atrial appendage closure devices. In atrial fibrillation cases, there is a double challenge. First, we have a rhythm problem. We have to stop the fibrillation and establish a steady, reliable blood flow. This we address with ablation, where we find the areas that are triggering the nerve impulses that cause the fibrillation, then we use the ablation capabilities to eliminate them. However, since this part of the heart is a direct route to the brain and other key organs, we also have to protect against the potentially deadly complication of clots that can cause strokes and other damage.
“Some patients are at higher risk than others from clots that actually form in the heart, usually coming from the atrial appendage when blood becomes backed up in the area when an abnormal rhythm isn’t allowing it to flow freely.
“As a precaution, most of these patients are on blood thinners to reduce the risk of clotting, but sometimes it isn’t enough. Some patients can’t tolerate the blood thinners. They may have a condition that puts them at risk of excessive bleeding, or they may have health issues that can only be treated with medications that can’t be given with a blood thinner. That’s when an atrial appendage closure device can be particularly helpful.”
In the anatomy of the heart, the atrial appendage is the area on the upper side that protrudes bit, giving the heart its distinctive shape. It doesn’t contribute a lot to the working action of the heart, and if it can be blocked off, blood won’t be able to back up into it to form a clot.
“The first generation of these devices tended to be stiff and difficult to fit,” Colon said. “The Watchman device, which is one of the most commonly used, now has its third generation design available and it is much more flexible. Fitting it into place is usually simple. Using a catheter, an electrophysiologist can guide the device into place, deploy it and make sure it is properly seated. With time, the body often covers it with a skin-like tissue that makes it almost like a natural part of the heart. It’s there, passively guarding against the formation of most of the clots that form in the heart and threaten the brain so the risks for a deadly stroke are reduced.”
Exciting advances in technology may have been what originally drew Colon to electrophysiology, but he says it’s the interaction with patients that is most fulfilling.
“I like taking the time to talk with my patients so they understand their condition, what we hope to achieve and how the technology works to solve the problem,” he said. “It’s really satisfying to be able to help improve their quality of life and often give them more years to enjoy life.”