There’s good news for persons who have the condition called atrial fibrillation and are on lifelong anti-coagulants. A Goan cardiac surgeon based at Easton Hospital, Easton Pennsylvania, has pioneered a new treatment that does not involve drugs.
Dr Neville Mascarenhas, also known as Dr Daniel Mascarenhas, took a ‘daring’ step forward and began using insertable cardiac monitors in patients with atrial fibrillation and has achieved good results.
Dr Mascarenhas may be familiar to many people. The cardiac surgeon from Navelim who studied at Bombay and then went on to the United States flies down to Goa twice a year and consults at the Goa America Heart Foundation at the CMM Hospital in Panjim that he helped set up. And this pioneering work of his involved not just treating people with cardiac problems but bringing in a human touch in the treatment.
Atrial fibrillation or irregular heartbeat, affects millions of people across the world. All are immediately put on anti-coagulant drugs which thins the blood, preventing blood clots in the heart that can with time travel to the brain and cause a stroke. While the anti-coagulants take care of this one area, they have other side effects that include stomach pain, joint swelling and excessive bleeding. That is something the Dr Mascarenhas wanted to stop.
“Now, we have fine drugs and only this much of the population pie, so these people have been pushing the drugs so with more sales they make up the research money they have put in. I don’t have anything against big pharma, don’t get me wrong, I am very happy with the drugs. But like anything in life, every drug is a poison and it is a double-edged sword,” Dr Mascarenhas said, speaking to Herald.
So he looked elsewhere and the answer came when a representative of a company that had manufactured insertable cardiac monitors visited his office. The monitor existed since the 1990s and had approval from the US Food and Drug Administration, he makes it quite clear that he didn’t invent it, he stresses that he only pioneered its use.
“Everybody who has atrial fibrillations should be on anti-coagulants. We have a scoring system and if in the scoring system you are judged at a certain level you are on anti-coagulants for life. If a person has had atrial fibrillations for a brief period of time due to some underlying reason he has to be on anti-coagulants for a lifetime, this is meaningless… we are physicians, we are not machines so we don’t require scoring to look at the underlying issue of why it has happened,” said Dr Mascarenhas.
Dr Mascarenhas began by implanting the tiny cardiac monitor in the chest of his patients. The monitor, which was connected to a system in his clinic, told him whether the patient’s heartbeat was persistently irregular. Only in cases where the monitor showed that the heartbeat was indeed persistently irregular, he continued the patient on anticoagulants. If the patient’s irregular heartbeat was not persistent, then he took the patient off anticoagulants. The patient was put back on anticoagulants only if the monitor, that remained implanted in the patient’s chest and connected to his clinic, showed that the condition needed drugs.
In November 2015, Dr Mascarenhas published his findings in the medical journal Europace of the European Heart Rhythm Association of the European Society of Cardiology. He was the lead author of the paper along with Mohammad U Farooq, Paul D Ziegler and Bharat K Kantharia. The paper presented the findings of 70 patients, but since then the number of patients who have opted for the implant has risen to 140.
“We succeeded and I must say that 90 percent of the patients have been taken of anticoagulants. What we did was put them on anti-arrythmic drugs,” said Dr Mascarenhas. This drug helps maintain a consistent heartbeat.
The paper concluded that, “The results of the study, which represents a first step in a personalized medicine approach to anticoagulation management, justify and warrant larger, proactive, randomized trials of transient oral anticoagulant management guided by insertable cardiac monitor surveillance to help define practice guidelines for the complex issue of anticoagulation in atrial fibrillation patients.”
Though there are costs of the surgery to implant the monitor, Dr Mascarenhas maintains that there are savings from the anticoagulants that the people would be taking their entire life.
