Atrial fibrillation: one patient’s story

Every year, atrial fibrillation (AF) affects millions of people around the world, but many remain unaware of this condition and the importance of receiving timely and appropriate medical attention. A 53-year-old Vietnamese patient shares the harrowing journey of his quest for treatment – a quest that found closure in the form of meeting Dr Reginald Liew, a cardiology specialist at Mount Elizabeth Novena Hospital in Singapore.

Initial signs of heart trouble

When the patient experienced constant fatigue and difficulties in breathing in 2013, a health screening revealed that he had AF, a condition where the sinus node – a group of cells that cause the heart to contract – is no longer able to control the heart rate thus resulting in a chaotic irregular rhythm. This decreased heart efficiency often leads to other health complications, such as stroke and health failure for the patient.

After being prescribed medication, he thought that his health would improve. However, his condition only worsened. In 2015, he consulted his cardiologist, who inserted a pacemaker into his body – a device that would regulate his heart contractions by stimulating his heart.

Unfortunately his health failed to improve, so he contacted the representative office in Ho Chi Minh that arranged for him to consult with Dr Reginald Liew.

After examining the patient, Dr Liew concluded that the installed pacemaker would have been appropriate treatment for a patient with a slow heart rate. Unfortunately, the Vietnamese patient was suffering from an increased heart rate, thus the pacemaker was not able to alleviate his condition at all.

Dr Liew's investigations also revealed a stroke the patient had suffered earlier that year and that had also been caused by AF – something that had not been previously detected.

Treating atrial fibrillation with a 3D-mapping system

In order to treat the patient's condition, Dr Liew had to first perform a series of pre-procedure tests, including a computerised tomography (CT) scan and a transesophageal echocardiogram (TEE) to check the blood clots in his heart. This was followed by a minimally invasive surgery called catheter ablation, a procedure that involves passing thin flexible wires called electrophysiology (EP) catheters through blood vessels from the leg to the heart to remove the clot.

"Any AF case that requires this procedure is considered complex," says Dr Liew.

He shares that this 3-4 hour surgery is performed using specialised equipment called a 3D-mapping system, which allows the surgeon to combine electrical information from inside the patient's heart with the heart's anatomy to create an “electro-anatomical map”. 3D-mapping systems allow the electro-anatomical map to be rotated in three dimensions for accurate delivery of the lesions. According to Dr Liew, 3D mapping has been much refined over the past decade and now has an "80 to 90 percent success rate for AF cases."

A comprehensive service for complex arrhythmias with 3D mapping requires experienced doctors with extensive hands-on training who are able to handle the most complex cases using the 3D system. Having been invited to both Hanoi and Ho Chi Minh City on several occasions to help proctor cases and train Vietnamese cardiologists in handling complex EP cases that require a 3D-mapping system, Dr Liew has seen for himself how useful this procedure can be in helping patients with this challenging arrhythmia, as well as the significant benefits it offers.

Post-surgery outcomes

Following the procedure, the patient was discharged after a two-day stay and given blood medication together with a reminder not to exercise for a week after the surgery. Dr Liew shares that the patient is recovering well and should be enjoying improved health very soon as long as he does not over-exert himself.

The patient feels that travelling to Singapore to seek treatment with Dr Liew was the best choice he could have made for himself. "Before surgery, my communication skills are not good. I used to lisp and stammer very often due to my condition,” he says. “Sometimes I could not remember what I said. But after the surgery, I am able to talk normally.”

"I am very satisfied with the quality of services and treatment at Mount Elizabeth Novena Hospital,” he shares. “I was guided and supported very enthusiastically by the doctor and the clinic’s staff. During my treatment, they always make me feel comfortable – like I'm at home."

Dr Reginald Liew is a cardiology specialist at Mount Elizabeth Novena Hospital in Singapore. He is widely recognized both regionally and internationally in the field of heart rhythm problems and was involved in some of the early pioneering clinical studies in the UK validating the use of 3D-mapping systems to treat complex heart rhythm problems. Dr Liew performs the whole spectrum of electrophysiology procedures including catheter ablation using conventional and 3D- mapping systems as well as cardiac device implantation such as cardiac pacemakers, implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) devices.

Mount Elizabeth Novena Hospital  
38 Irrawaddy Road, Singapore 329563
Tel: (+65) 6735 5000
www.mountelizabeth.com.sg

The Harley Street Heart and Cancer Centre
38 Irrawaddy Road #07-41
Mount Elizabeth Novena Specialist Centre
Singapore 329563
Tel: (+65) 6694 0050