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New Technology To Calm Racing Hearts

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ORLANDO, Fla. (Ivanhoe Newswire) - About three million Americans suffer from irregular heartbeats, also known as cardiac arrhythmias. For many who have them, life is brutal. Some people can be treated with medicine, but others need surgical intervention. Now doctors are using computerized magnetic navigation to calm racing hearts.

It's been nine years since Angelo Woodard has felt healthy enough to truly enjoy his life.

"I haven't smiled in years, and that ain't no kidding," ventricular tachycardia patient Angelo Woodard, told Ivanhoe.

Angelo had ventricular tachycardia, which caused severe heart palpitations.

"This is what I felt 24 hours a day for nine years. Just like that, and I felt that through my whole body," Angelo said while banging on his glass patio table.

For eight years, Angelo says he took prescription medications that didn't work.

"Kept me tired all the time, slept all day," Angelo said.

He recently underwent a new high-tech procedure using the Stereotaxis Magnetic Navigation System, which allows surgeons to more easily seek and heat-destroy the abnormal tissue causing the palpitations.

Traditionally, a doctor would push—by hand—a stiff catheter through the heart. The new catheter is soft like a noodle.

Doctors use a joystick and huge magnets to move that noodle like catheter through the heart and the computer software creates a 3-D map that highlights the trouble spots.

"So now you have a roadmap. Now you can go to the area of interest, apply heat and take care of the problem," Electrophysiologist, Doctor Usman Siddiqui from Florida Hospital told Ivanhoe.

Doctor Siddiqui said the new technology enhances precision, which leads to fewer complications, shorter procedures which reduces radiation exposure, improved outcomes and faster recoveries.

One week after surgery Angelo's pounding was gone.

"I can do anything. I go to the gym every day, spend time with my daughter, so it's great," Angelo said.

All surgical procedures come with risks, so if you suffer from cardiac arrhythmias, talk to your doctor about the safest and most effective treatment for you

RESEARCH SUMMARY

WHAT IS VENTRICULAR TACHYCARDIA? Tachycardia is a heart rate of greater than 100 beats per minute. A normal heart rate is 60 to 100 beats per minute at rest. Ventricular tachycardia is a consistently, faster-than-normal heart rate that begins in the heart's lower chambers. In most patients with ventricular tachycardia the rate is in the range of 170 beats per minute or more. (SOURCE: http://www.webmd.com/oral-health/guide/salivary-gland-stones)

WHAT CAUSES VENTRICULAR TACHYCARDIA? Ventricular tachycardia is caused by other heart problems such as coronary artery disease, high blood pressure, an enlarged heart or after heart surgery because of scar tissue that forms on the heart. (SOURCE:www.my.clevelandclinic.org/heart/disorders/electric/ventricular-tachycardia.aspx)

WHAT TREATMENTS ARE AVAILABLE? Radiofrequency catheter ablation (RCA) is a procedure performed by a cardiac electrophysiologist. In the first part of the procedure, the physician uses electrophysiology techniques to pinpoint the location in the heart where the abnormal rhythm originates. Next, the physician uses a catheter with a special tip on it that emits a high frequency form of electrical current. The energy is directed at the area in the ventricle where the abnormal current originates to destroy a tiny amount of tissue. This is called an ablation procedure. (SOURCE:www.my.clevelandclinic.org/heart/disorders/electric/ventricular-tachycardia.aspx

INTERVIEW

Usman Siddiqui, MD, Cardiac Electrophysiologist at Florida Hospital a new treatment for cardiovascular care.

I don't know if you watch the Sopranos but James died at fifty one years old with a heart attack, what did you think?

Dr.Siddiqui:  It's unfortunate but it's a very common. In fact, from recent cardiology guidelines there have been almost more than five hundred thousand deaths associated with, what is called sudden cardiac death. In most cases this sudden cardiac death is associated with blockages in arteries. If we adopt unhealthy lifestyles, don't take care our blood pressure, our blood sugar; we tend to develop these blockages in arteries, which can progress and subsequently present as either acute heart attack. Most cases patients have time to present with chest pain, jaw pain, neck pain, and non-specific shortness of breath or even passing out. However, there are times where this would present as one episode or what is called sudden cardiac death and cardiac arrest.

How does the body not give you the warning?

Dr.Siddiqui: In some cases if you have a blockage in the artery, which is in the range up around fifty percent, that blockage may not be critical to produce symptoms. If there's plaque it may suddenly rupture, which causes acute thrombosis; a shutdown of flow in that vessel. So let's take an example, it was an interior artery, there was a plaque sitting there for fifty percent. It never produced any symptoms, but it could have been diagnosed or screened if you would have routinely done cardiac checkups or done stress testing, or a CT scan of the heart. Some type of testing like that we could have routinely screened them. Or if you would have had treatment for high cholesterol, high blood pressure we would have been able to prevent the progression or maybe even regress those blockages. Now so in that particular phenomena which does happen, it happen rarely, but it does happen is that fifty percent blockage that there was all of a sudden get acutely thrombosed, now there's no blood flow. So the heart is hungry there is no blood going in so the whole electrical system gets confused and it creates an abnormal circuit, which leads to what is called ventricular tachycardia or ventricle fibrillation; this is basically a lethal arrhythmia. The blockage is so critical and involves such a big area the heart goes in to a dangerous arrhythmia because there's no blood going to the area and the whole electrical circuit gets confused. This is called ventricle tachycardia or ventricle fibrillation. And—and that leads to what is called cardiac arrest. So there are two separate entities, one is heart attack. The heart attack is a common name that we use for acute blockage in a main artery, but if this blockage is severe enough it could lead to what is called cardiac arrest, which is the heart electrical activity gets all confused. The heart is not able to pump any blood and people can die within seconds. And this is the phenomena that happened. You can label this as Sudden Cardiac Death and then we can talk about Ablation and what we can do for prevention of that. So in cases where people do end up getting a big heart attack they usually develop a scar inside the heart. After a heart attack we usually recommend implanting defibrillators prophylactically even though they didn't have a documented arrest we'll still put the defibrillators in.  A lot of the times since the disease has become so advanced and people are living longer now that they're able to open arteries up at a good time we've seen a lot of people who are getting shocks from these defibrillators which saves their life. They live longer but it affects their quality of life because you can feel those shocks. And to treat those we've developed a technology to actually go inside the heart and modify that scar that has developed. To do those one of the new technologies that we have over here at Florida Hospital is called a stereotaxis robotic navigation system. What it does is this is a spaghetti like very soft catheter has holes on the tips where you can actually profuse saline through them so that it doesn't shower out and then you have electrical holes at the tip where you can apply heat energy to that abnormal circuit to modify it. We usually get inside the heart through one of the veins in the legs and enter the heart through this vein which is called inferior vena cava, through one of these veins. Once we're inside the heart we can perform detailed mapping of these electrical chambers. So the catheter can prolapse in here and take points, electrical points, in a three dimensional space to identify where the normal voltage is which is the normal muscle and the abnormal voltage which represents the diseased or damaged tissue from the infarct. We can do this on the right side of the heart and we can also cross over from this side in to the left side of the heart and map it that way. And this is all without opening up the chest, this is all through the leg. Years and years ago, up to twenty five years ago we used to do this procedure by open heart. And whenever people would have a heart attack and they had a big scar it was a very invasive bloody procedure. There was a very high mortality, mortality means death rate, associated with that procedure. Now with these navigation techniques and mapping techniques and doing this procedure through uhpercutaneous, through the leg, we have been able to reduce the morbidity mortality of these cases to less than five percent.

You're moving that through the heart with the use of the magnet?

Dr. Siddiqui: There are two ways to do this. One is for a long time we used to use manual techniques to do this and which actually became quite cumbersome for us because these are very trabeculated structures, the ventricles. It takes a lot of time and effort to manually use your hands to map these structures. The advantage of using this specific type of catheter is that it has rotors associated with it and it has a magnet in it which is driven by two big magnets sitting on the side of the patient, which drives this catheter forward and backwards. It's called magnetic navigation or robotic navigation. So what we do is we actually sit in the booth, use a joy stick to move the catheter back and forth, right and left, in all directions. The other advantage of this is being able to use this magnetic catheter this is much softer than what a manual catheter is. So the risk of damaging any adjacent structures is very low with this. And obviously you can create a much detailed map using this technology as compared to manual technology.

So the benefits are less risk?

Dr. Siddiqui: Definite, that's the top less risk because the catheter tip is much softer as compared to a catheter tip of a manual. So the chances of damaging adjacent structure or making a hole while ablation in the heart is very low. The second advantage is these procedures can be long and cumbersome so if an operator is standing manually by the patient he may be get more fatigue; a phenomena of doctor fatigue while doing this procedure as compared to using this irrigated catheter, where you can actually sit down and focus on the arrhythmia rather than having to deal with a fatigue associated with it.

For you personally was that a big deal?

Dr. Siddiqui: Yes, it has changed the way I treat ventricular tachycardia now, I mean I'm switched hundred percent. I trained under manual for a long time, but with this technology and the success rates we have seen we have switched hundred percent of ablation, ventricle tachycardia ablation to stereotaxis robotic. The patients are happy we're getting patients from all over the state, which who have had failed ablations before come to us and we're able to address it. And partially because we have a nice team set up and support set up at this hospital.

And you're not worried being in the other room with the joy stick, you don't need to be like right on top of the patient?

Dr. Siddiqui: That's a good question. We usually do all our cases with anesthesiology, there's an anesthesiology person watching it. We have monitors which portray everything that is on the bedside in to that booth so we're able to use that.

FOR MORE INFORMATION, PLEASE CONTACT:

Chris Ramkissoon
Florida Hospital
cramkissoon@flcard.com

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