New Directions

At 6 feet 3 inches tall and 245 pounds, professional bodyguard Leonard Lucas is not easily intimidated. He protects celebrities, sometimes in arenas where there are hundreds of overzealous fans. He knows how to keep things calm. At least he did, until one day in October 2009, when he experienced something he could not control.

Lucas was watching television at his home in Bowie, Md., when his heartbeat accelerated. “I felt like I was running a race sitting down,” he says. Two hours later his heart was still racing. Lucas went to the hospital and was diagnosed with atrial fibrillation (A-fib), a potentially dangerous condition affecting more than 2 million Americans. 

A-fib originates with the heart’s natural pacemaker. In a healthy heart, the pacemaker sends electrical impulses that cause the heart to contract, sending blood from upper chambers, or atria, to the lower chambers, and from there back out to the rest of the body.

With A-fib, these electrical signals become erratic, throwing off the timing of the cardiac cycle and causing the upper chambers to beat irregularly and so fast—up to 600 times per minute—they appear to quiver. Complications can include heart failure as well as the formation of clots, which can lead to stroke.

For Lucas, whose livelihood depends on his strength and his health, this diagnosis was a blow to both, but also a blow to his professional well-being.

Medication initially slowed his heart rate, but the atrial fibrillation returned with a vengeance, resulting in as many as 35 to 40 episodes a day. Lucas was exhausted. “I run 10 miles a day, but I never felt as tired as I felt during that time,” he says.

When medications failed to restore Lucas’ normal heart rhythm, his cardiologist, Dr. Michael Carlos of Laurel, Md., recommended a catheter ablation, a complex, invasive cardiac procedure in which catheters are inserted into the veins in the legs, and then threaded into the heart. Using fluoroscopy, heat is used to destroy the sites where the rapid heartbeats originate. The procedure has a 70-80 percent success rate in stopping symptomatic atrial fibrillation.

Lucas was referred to Pirooz S. Mofrad, MD, a cardiac electrophysiologist who performs catheter ablations at Suburban Hospital, one of the few hospitals in the Greater DC and Maryland area equipped for these complex procedures. Dr. Mofrad uses three imaging technologies during catheter ablation:

• State-of-the-art three-dimensional electroanatomical mapping that tracks the position of the catheters within the “shell” of the heart, records the electrical activity of the heart, and shows where heat was being used to ablate the rapid heartbeats.
• Fluoroscopy, to see the catheters under X-ray;
• Intracardiac ultrasound, to image the interior of the heart and to provide another real-time visual of the catheters in the heart.

The electroanatomical mapping enabled Dr. Mofrad to place the catheters precisely at the source of the erratic electrical impulses. Applying heat, he burned away those triggers, stopping the atrial fibrillation and restoring Lucas’ normal heart rhythm.

“There were no complications, and he was up and walking the next day,” Dr. Mofrad says, calling Lucas’ outcome “typical.”

Mr. Lucas reports that he’s had no more episodes of atrial fibrillation, is back to work and running again.

At Suburban Hospital, in the Orkand Center for Interventional Cardiology, A-fib can be treated in a number of ways depending on a patient’s response to treatment:

• Medications such as amiodarone, digoxin and beta blockers atenolol or metoprolol.  Blood thinners also may be prescribed to prevent clots.
• Electrical cardioversion employs electric shock to correct the abnormal heart rhythm.
• Catheter ablation uses catheters threaded into the heart to destroy the tissues causing the A-fib. 
• Operative ablation (Maze procedure) is performed on patients undergoing open heart surgery.