MEDICAL NEWS
Doctor's Orders Alap Shah, M.D. is a cardiologist specializing in cardiac electrophysiology at the CottonO’Neil Heart Center, 929 S.W. Mulvane Street, in Topeka. He is board certified in internal medicine, cardiology, and cardiac electrophysiology. He is available for patient consultations in Topeka and Manhattan. To schedule an appointment with Dr. Shah, please call (785) 270-4000.
Q: What is cardiac Alap Shah, M.D., Cotton-O'Neil Heart Center 929 S.W. Mulvane Street, Topeka
electrophysiology?
Dr. Shah: Cardiac electrophysiology is a branch of cardiology that specializes in heart rhythm disorders. Most of my work involves treating patients with either a very fast heart rate or a very slow heart rate. A common cause of a fast heart rate is atrial fibrillation. As an electrophysiologist, I have specialized training to offer a variety of individualized, treatment options for atrial fibrillation, including an invasive procedure called ablation to cure the abnormal heart rhythm.
Q: Can you tell us more about atrial fibrillation and how it is treated? Dr. Shah: Atrial fibrillation, or afib, is the most common heart rhythm problem worldwide. With afib, the top chambers of the heart beat extremely fast and cause the bottom chambers of the heart to beat fast as well. A lot of people think the brain tells the heart when to beat. However, the heart has it’s own little brain called the sinus node. It is located in the top chamber of the heart and tells it when to beat. When someone gets afib, instead of that sinus node telling the heart when to beat, hundreds of spots in the top chambers start competing with one another and ignore the sinus node. That disorganized, very fast beating of the top chamber is called atrial fibrillation.
There are two strategies a doctor can use to treat afib. The first is called rate control and the second is called rhythm control. With rate control, we use medications to make sure the bottom chambers of the heart do not beat fast and allow the patient to stay in afib. In half of our patients, this is all that is needed to control their symptoms. In the other half of patients, either the drugs are not effective in controlling the heart rate or the drugs produce too many side effects. For these patients, we think about rhythm control. Rhythm control means keeping a patient’s heart in a normal rhythm and out of afib. There is no difference in how long patients will live or how they do long term whether they do rate control or rhythm control. It is a matter of which will work best for a given patient. Once it is decided to use rhythm control, there are two options. The first option is to use drugs called anti-arrhythmic drugs. The second option is a procedure called an ablation. An ablation is an invasive procedure. The procedure is done from the veins in the groin. This allows us to place wires or catheters into the heart, find the abnormal areas that cause afib, and burn them. Burning has a fancier name when used to describe treatment of abnormal heart rhythms, called ablation. It is important for a patient and physician to have a conversation about the advantages and disadvantages of having an ablation procedure. Ablation does not work in everyone. It works in about 70 percent of people. These patients are free of the symptoms that affected their quality of life, which is the ultimate goal. In the other 30 percent, there are probably too many areas that are abnormal causing the afib. For this 30 percent, an approach that includes a pacemaker can be effective in controlling their symptoms. A new electrophysiology lab has recently opened in the Stormont-Vail Surgical Suites with the most up-todate technology, including a feature designed to minimize radiation exposure to the patient. The labs consist of two procedural suites designed to perform diagnostic, therapeutic, and interventional electrophysiology and pacing procedures and a procedural treatment room for performing transesophageal echocardiography, Cardioversion, and tilt table procedures. Steven Seals, M.D., is the medical director for the electrophysiology and pacing program. Other cardiac electrophysiologists and pacing specialists include: Alap Shah, M.D.; Thomas Doyle, M.D., FACC; and James Hurtig, M.D. – Tami Motley
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