Listening to the patient as well as their heart

Doctor’s philosophy helps him discover correct diagnoses for patients with arrhythmias
April 26th, 2016

Atrial fibrillation is a condition that affects more than 2.5 million Americans. It can lead to serious consequences like blood clots, strokes and heart failure, and often requires management with lifelong medications or invasive procedures. But for UCHealth cardiologist Dr. Ethan Ellis, a specialist in electrophysiology and abnormal cardiac rhythms, managing A-fib requires not just treating someone else’s heart, but using his own.

“My first priority is to really listen to my patients and identify with what they’re dealing with,” Ellis said. “There’s not one right answer for a lot of these problems.”

Just ask Patrick Fleming and Dennis Klinker.

Fleming images
This is a posterior view of Patrick Fleming’s left atrium (top left chamber of the heart) with its four pulmonary veins. In atrial fibrillation, abnormal electrical signals within the pulmonary veins are a common cause for initiation of atrial fibrillation. The image is created by tracing the inside of the heart with a catheter during the procedure. Electrical signals can then be recorded and marked on the map — everywhere it is touched with a catheter. In this left atrial map, purple represents large electrical signals and gray represents no electrical signals. In an ablation for atrial fibrillation, the goal is to remove all electrical signals in and around the pulmonary veins. The left image depicts the heart before and shows large electrical signals in and around the pulmonary veins. The right image shows the his left atrium after ablation and the electrical signals in and around the pulmonary veins have been eradicated.

For more than five years, numerous cardiologists told Fleming, 55, that he had chronic pericarditis, or inflammation of the tissue surrounding his heart. The same doctors had also presumed that the pericarditis was causing Fleming’s A-fib.

Yet despite an aggressive treatment regimen, Fleming’s symptoms persisted. And the chief investment officer for the Wyoming State Treasury Office, a self-described “numbers guy,” wasn’t satisfied.

“I could be functioning fine (at rest) but my normal active lifestyle wasn’t the same,” Fleming said. “I’d feel the irregular heart beat coming on, and it would make me very lethargic. I used to be a (10K and half) marathon runner, and I love to be outdoors, and every time I exercised I was worried my A-fib would kick in.”

In June 2015, Fleming saw Ellis at his UCHealth Heart Center office in Fort Collins. After reviewing his patient’s prior test results, Ellis, too, was unconvinced.

“The diagnosis of chronic pericarditis was unusual, and based on the history he gave me, and the studies he had already had done, I wasn’t convinced the diagnosis was correct,” Ellis said. “Because of his A-fib, his heart muscle had started to weaken. We needed to suppress his arrhythmia (abnormal heart rhythm) to allow his heart to recover.”

A-fib occurs when disorganized electrical signals originating in the upper chambers of the heart (the atria) cause the heart muscle to contract fast and irregularly.

Ellis also was concerned that the aggressive anti-inflammatory medications Fleming was taking for “chronic pericarditis” were irritating his preexisting gastrointestinal problems and increasing the risk of serious side effects.

So in August 2015, Ellis took Fleming off all his medications and performed an ablation, a highly specialized procedure where catheters are inserted through the veins in the groin and extended up to the heart. Electrodes on the end of the catheters are then used to record the heart’s electrical signals and identify the regions where abnormal heart rhythms originate. Other catheters are then used to freeze and cauterize the problem areas in the hopes of eliminating arrhythmia.

Since the procedure, Fleming’s A-fib is gone and he no longer takes any medications.

“It’s been a life changer,” Fleming said. “I have the ability to exercise and not think twice about it. I’m much healthier now.”

Dennis Klinker feels similarly.

The 68-year-old had been dealing with a chronic arrhythmia for years. When a kidney stone landed him in the emergency room, he was diagnosed with atrial tachycardia, an arrhythmia similar to A-fib, and his heart rate was more than 200 beats per minute, double the normal rate. Even after a long hospital stay, his pulse remained dangerously high and an echocardiogram, which measures the heart’s working capacity, showed that his heart was pumping at 20 to 25 percent of its normal function.

“Mr. Klinker was extremely sick when he first came to us,” Ellis said. “He was in decompensated heart failure and I was concerned that his incessant atrial tachycardia was causing his heart to fail.”

Ellis initially prescribed a strong drug to try to suppress the arrhythmia. But he was concerned about the medicine’s potential toxicities. “It’s not something I wanted to keep him on long term,” he said.

Like he had done with Fleming, Ellis decided an ablation was the best course of action.  And it worked. Again.

He was able to identify a small area of abnormal heart muscle where the atrial tachycardia originated and after cauterizing this small region, Mr. Klinker’s arrhythmia was gone.

“After his arrhythmia was gone, Dennis went from being a really sick man with decompensated heart failure back to normal healthy guy,” Ellis said.

At his three-month follow up with Ellis at UCHealth Heart Center, Klinker’s heart function was back to normal. So the cardiologist discontinued a few of Klinker’s medications and adjusted some others.

posterior view of Dennis Klinker’s left atrium
This is a posterior view of Dennis Klinker’s left atrium (top left chamber of the heart) with its four pulmonary veins. The image is created by tracing the inside of the heart with a catheter during the procedure. Electrical signals can then be recorded and marked on the map — everywhere that it is touched with a catheter. In this left atrial map, the colors represent electrical activation during the patient’s arrhythmia. Red represents the earliest electrical signals and purple represents the latest electrical signals. There is a small area of red within the right superior pulmonary vein (top right-hand corner) and this is where Klinker’s arrhythmia originated. The ablation catheter is over this site just before cauterization was performed. Following cauterization, the arrhythmia terminated and did not recur.

Klinker said he’s back working “as hard as ever” and has been thrilled with Ellis’ work.

“Dr. Ellis is very caring, and he focuses on the person. He did a great job of explaining everything, including showing us the photographs after the procedure,” Klinker said. “He has changed my life.”

Fleming also was impressed that his care involved more than just expensive tests and fancy equipment.

“Dr. Ellis is a unique and special doctor,” Fleming said. “You can honestly tell that he cares. He’s willing to do things that I’ve never had another doctor do. It’s apparent that he looks at his job in a very different way.”

Ellis attributes much of his skill to a well-rounded training program and lots of practical experience. But in addition to a steady hand and diagnostic aplomb, he clearly takes just as much pride in approaching patient care straight from, well, the heart.

“In order to help a patient figure out what treatment strategy is right for them, you really need to understand who that patient is and where they’re coming from,” Ellis said. “I try not to make decisions for people. I help people make their own decisions. That’s what I’d expect for a family member of mine, and that’s how I try to approach the care of my patients.”

About the author

Andrew Kensley has worked as a freelance writer in northern Colorado since 2009. In addition to his work for UCHealth, he is a regular contributor of essays, features and the News & Notes section of Fort Collins Magazine. He also has written numerous cover profiles, Q&As, and travel and wellness features for Mind+Body Magazine and the Fort Collins Coloradoan, the newspaper in which his parenting column, “Wee Wisdom,” ran Sundays from 2009 to 2013. His travel essays have been featured in the family travel website, Momaboard.com.  

Andrew published his first novel, “Seeking Blue,” in 2014, and his short fiction has appeared in the University of Wyoming’s literary journal, Owen Wister Review.

Andrew was born in Montreal, Canada, and has lived in Fort Collins since 2004. A 1996 graduate of McGill University, he continues to work as a physical therapist, helping people regain their mobility, confidence, and functional abilities. He speaks French, Spanish and Hebrew, and loves to travel.