Doctors Get Miami Firefighter Back on Front Line After Afib

Catheter Ablation an Effective Treatment for Atrial Fibrillation

When an alarm sounds at the Miami-Dade County firehouse where Mark Watson is stationed, his heart starts racing as he leaps into action. It’s a normal sensation for a firefighter paramedic who faces hazardous situations virtually every day. But when Mr. Watson started noticing his heart racing at home – particularly when he was just relaxing or even sleeping – he knew it was definitely not normal and it was time to seek help.

Before, when he had one of these episodes, he could write it off to whatever he was doing at the time. “It always happened when I was outside working or if I was doing something that could easily explain why I was feeling lightheaded or dizzy,” says Mr. Watson. “But then I had an episode during the middle of the night that woke me up. It was pretty obvious that something was wrong.”

(Watch now: What is atrial fibrillation, or Afib? What causes it? Who’s at risk? See how experts at Miami Cardiac and Vascular Institute cured a Miami firefighter with Afib, returning him to work so he can keep saving lives. Video by Michael Justiz.)

The 49-year-old Miami native, who was born at Baptist Health Baptist Hospital and now lives in Brickell a short distance from his firehouse, drove himself to the emergency department at Baptist Health South Miami Hospital. Doctors there diagnosed him with atrial fibrillation, or Afib, and urged him to follow up with a cardiologist after treating his symptoms.

What is atrial fibrillation?

Afib is the most common type of abnormal heart rhythm, or arrhythmia. Mario Pascual, M.D., an electrophysiologist with Baptist Health Miami Cardiac & Vascular Institute who specializes in diagnosing and treating heart rhythm disorders, says that during Afib, the heart receives electrical signals causing its upper chambers, or atria, to contract in a disorganized fashion, causing the atria to fibrillate or quiver.

Mario Pascual, M.D., an electrophysiologist with Baptist Health Miami Cardiac & Vascular Institute 

“The disorganized signals are then transmitted to the heart’s lower chambers, or ventricles, causing them to contract irregularly and oftentimes quickly, and the contraction of the atria and the ventricles is no longer coordinated,” explains Dr. Pascual. “As a result, the amount of blood pumped out to the body will vary with each heartbeat and the ventricles may not be able to pump blood efficiently to the body.”

The U.S. Centers for Disease Control & Prevention (CDC) estimates that in 2030, more than 12 million people in the United States will be diagnosed with the condition, which is responsible for more than 26,500 deaths each year.

Particularly at risk for Afib are people over age 65, those who are of European descent, and those with underlying heart disease, high blood pressure, thyroid problems, excessive alcohol use, sleep apnea, and certain lung disease. Men are also more likely to be diagnosed with Afib than women.

In recent years, cardiologists have been seeing Afib in younger and younger patients such as Mr. Watson, who was 47 when he was first diagnosed with the condition. If left untreated, patients with Afib are more prone to developing blood clots that can possibly dislodge and shoot off to the brain, causing a stroke.

Mr. Watson’s cardiologist advised him to lose weight, exercise more and drink less in order to lessen his risk of Afib episodes, which he did promptly. The physician also felt Mr. Watson would be a good candidate for a catheter ablation, also known as radiofrequency ablation, and referred him to Dr. Pascual at Miami Cardiac & Vascular Institute.

Treating atrial fibrillation, or Afib

Atrial fibrillation can be treated either with medical therapy that suppresses the electrical issue causing the arrhythmia, says Dr. Pascual, or with a procedure intervention known as a catheter ablation, which targets the abnormal heart tissue that is the underlying cause of the arrhythmia.

“When Mr. Watson first saw us, he was definitely on the younger side of a patient with atrial fibrillation and he wasn’t having too many episodes – maybe one or two a year,” Dr. Pascual recalls. He cautioned his patient that AFib at some point becomes more progressive, meaning that the number of episodes Mr. Watson would have and their duration would probably increase over the next year or so.

While medications can help regulate the electrical issues within the heart causing the Afib, “they’re not a long-term solution – especially for younger patients like Mr. Watson,” Dr. Pascual says. Other ways of treating Afib include a catheter ablation, in which a catheter is inserted through a vein in the groin up to the heart where it can destroy the damaged tissue causing the rapid and irregular heartbeats.

Benefits of catheter ablation in treating Afib

Catheter ablation uses radiofrequency energy similar to microwave heat to destroy the defective heart tissue. “The benefit of ablation is that you’re actually going into the heart to address the causes of AFib, as opposed to just taking medications and allowing it to continue to progress,” says Dr. Pascual.

Destroying the affected tissue helps restore your heart’s regular rhythm, says the American Heart Association (AHA), adding that “catheter ablation destroys the abnormal tissue without damaging the rest of the heart.” Both the American College of Cardiology and the Heart Rhythm Society consider catheter ablation to be a first-line therapy for patients with Afib.

Dr. Pascual says that the best outcomes result if the time from diagnosis to ablation is less than one year. “Mr. Watson and I talked about the importance of recognizing when it is the right time to proceed with the ablation to have his best long-term outcome.”

Mr. Watson recalls his experience with having his catheter ablation last October. “Being a paramedic, we’ve treated many people who have AFib so I’m kind of familiar with what’s going on. But it wasn’t really until I entered the Electrophysiology Lab when it all hit home. The magnitude of what they do there every day and the technology they use is so impressive. Going into the procedure, I felt comfortable that I was going to be okay.”

And indeed he was: the procedure went perfectly and Mr. Watson went home from the hospital the very same day. “They wheeled me into the procedure room just after 7:30 in the morning and I was home by 5:30 or 6:00 that evening,” he recalls. “After the procedure, I was more interested in seeing exactly what they did and how they did it. Dr. Pascual sent me a copy of the mapping of the ablations they did, so that was a pretty cool little souvenir.”

Back at work after Afib

Mr. Watson says he is “feeling good” and happy that he had the catheter ablation with Dr. Pascual. “He has a really good bedside manner. When someone is going to put a catheter inside your heart to do something, it’s comforting to have trust in the person doing it. I trust Dr. Pascual’s judgment and his suggestions. I hope I don’t ever have to do it again but if I did, I’d gladly go back to him.”

Now that he’s back to full duty at work, Mr. Watson says he hasn’t had any problems and hasn’t had a single Afib episode since his ablation. “Dr. Pascual told me that I might possibly have some episodes of AFib afterwards due to the agitation and irritability of the heart from the procedure, but I haven’t had any.”

Dr. Pascual says he is equally pleased with his patient’s results. “Mr. Watson is doing fantastic and I don’t think he can be happier with his outcome right now,” says Dr. Pascual. “His AFib burden has essentially resolved. He’s back to his baseline. He is currently off all his medications that he was on before.”

Noting that younger patients are perhaps more hesitant to have procedure interventions, Dr. Pascual says Mr. Watson’s outcome highlights the importance of not delaying the inevitable. “The earlier you take care of a problem like atrial fibrillation and the earlier you do the ablation, the better the long-term outcome is going to be.”