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The Electrician of the Heart

Dr. Ishu RaoDirector of ElectrophysiologyFeatured in the February issue of YHC magazine. Download Article

YHC Magazine
February 2013

Electrophysiology is the discipline of cardiology that specializes in the treatment of electrical disorders of the heart. The heart can be described as a "house", with rooms (the four chambers), doors (valves), plumbing (arteries), and an electrical system (the wiring that triggers the pumping activity of the heart). Where cardiologists deal with the plumbing of the heart, an electrophysiologist is "the electrician of the heart" - the specialist who treats abnormal fast and slow heart rhythms.

Heart rhythm abnormalities can manifest in a number of ways. Slow or fast heart rates may make patients feel fatigued or dizzy, or even cause them to pass out. More serious conditions—fast fatal arrhythmias called Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF)—result in Sudden Cardiac Arrest (SCA), the number one cause of death in this country, accounting for over 300,000 deaths annually.

Electrophysiologists offer treatments, often curing the underlying problem, in many ways. However, the procedures can typically be divided into two categories: device implantation or ablation therapy.

Patients whose hearts beat abnormally slowly may experience dizziness, fatigue, or a lack of energy. Pacemaker implantation alleviates the symptoms for these patients with a procedure that takes less than an hour with minimal risk and recuperation.

The implantable cardioverter-defibrillator (ICD) implantation procedure bears striking similarities to pacemaker implantation but with one major difference. While pacemakers can keep the patient's heart rate from going too slowly, ICDs also offer the patient the potentially life-saving benefit of shocking the heart from the fatal VT or VF arrhythmias back to a normal rhythm.

These devices, which also can be implanted in an hour or less, are responsible for reducing Sudden Cardiac Arrest in patients at risk, over and above the benefits accorded by medical therapy alone. A non-invasive test, the echocardiogram (an ultrasound of the heart), is the most efficient method of identifying such patients, as it can show decreased heart function which serves as a marker of high risk for SCA.

Many arrhythmias, or heart rhythm abnormalities, can be successfully treated and cured with a procedure known as an ablation. While ablation technology has been used for two decades, recent technological advances have rendered it first-line therapy for arrhythmias such as SVT, Atrial Flutter, and even Atrial Fibrillation, an arrhythmia that affects 3 million Americans.

Unlike VT and VF, these arrhythmias pose no risk of Sudden Cardiac Arrest. They, however, can cause significant symptoms to patients and interfere with normal activities. Frequently, patients complain of palpitations, or rapid heart rates, as well as fatigue or dizziness.

Treatment with an ablation requires the patient to undergo a minimally invasive procedure in the hospital where, under gentle anesthesia, thin catheters with electrical recording capabilities are threaded through blood vessels in the groin into the heart. These catheters are used to record electrical activity in the heart, and using a computerized 3-dimensional mapping system, abnormal impulses are tracked. Once the site of origin of the abnormal rhythm is identified, a specialized ablation catheter delivers radiofrequency energy to cauterize the offending focus.

Ablation procedures require only an overnight stay in the hospital, and the patients require no stitches or incisions, resuming their usual activities within several days. Success rates for SVT and Atrial Flutter ablations hover at 90 percent, and success rates for Atrial Fibrillation ablation range from 70 to 85 percent.

Until recently, many Ventura County residents with rapid, abnormal heart rhythms who needed the advanced technology and expertise of potentially curative ablation procedures were forced to travel outside the region for their care, seeing physicians with whom they had no familiarity, and receiving treatment in hospitals far removed from their families.

In response to this, Community Memorial Hospital (CMH) in Ventura developed an electrophysiology program to meet the needs of our community, so that county residents could avail themselves of expert care close to home. Working with the administrative team at CMH, I had the opportunity as the Director of the Electrophysiology program, to build this program from the ground up. It began with the investment of funds to develop the necessary medical environment for this program, including the acquisition of the most contemporary 3-dimensional mapping and ablation systems available. Recently, we installed the region's only Stereotaxis Odyssey monitor system which also gives us the ability to transmit live cases via the internet for educational purposes.

The rapidity with which the program developed exceeded even the most optimistic expectations, and its sustained growth continues to serve Ventura residents. The program now boasts a complete line of services—including complex ablation, device implantation, and lead extraction capabilities. While several years ago, patients requiring these procedures would have had to travel to outside the area, no such need now exists.

CMH pioneered the region's first center to offer complex ablation therapy for treatment of Atrial Fibrillation and Ventricular Tachycardia, and has now established itself as the leading EP Center for the Central Coast. Our expertise has attracted the attention of General Electric who intends to establish our program as a technology show site, and EP Lab Digest which has featured the program twice within its national publication.

Today, the program continues to explore all of the new frontiers in arrhythmia management therapy. We also actively participate in research trials and I speak regularly at educational forums, both for the public and fellow physicians. Most importantly, heart rhythm patients here in Ventura County can rest assured that the best care that they can get resides in their own backyard.

 

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