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Getting the Heart Back on Beat: When Doctors Treat Cardiac Arrhythmia, It Helps to Have Choices

SBMC Getting the Heart Back on Beat

The key to fixing an irregular heartbeat, or arrhythmia, is finding the exact spot in the heart that causes it. Because of a trio of high-tech tools now in use by heart specialists at Saint Barnabas Medical Center, the hunt just got easier.

For patients, that means more and better options for successful treatment. With these technologies, physicians can choose the most appropriate tool based on the specific problem with the patient’s heart rhythm and his or her underlying heart condition.

“Heart specialists across the nation use a procedure called cardiac ablation to locate and treat abnormal electrical circuits in the heart that cause arrhythmia,” says Marc Roelke, M.D., director of Electrophysiology at Saint Barnabas Medical Center, who specializes in the electric activity of the heart. “But at the medical center, we have an advantage. We have not one, but three advanced tools to map the heart in real time during cardiac ablation. Together, this range of features gives us the flexibility to find the right method for each patient. It really sets us apart.”

Heart arrhythmias can make the heart flutter, or beat too fast, too slow or irregularly. This causes it to pump blood less effectively, which can affect the entire body. Symptoms include feeling weak or short of breath, or having a pounding heart. Some people have chest pain or feel lightheaded, dizzy or faint.

Until the heart beats normally again, these symptoms can affect lifestyle and overall health.

Often, medicines can control the symptoms of arrhythmia. But not everyone can take those medicines, in some cases because of side effects such as blurred vision or slowed heartbeat. For other people, medicines do not work.

Cardiac, or catheter, ablation is a cure offered by experienced electrophysiologists, a special type of heart doctor. During the procedure, physicians thread a catheter through a blood vessel from the groin to the heart. Once it is in position, they use tiny tools to destroy the abnormal tissue that is causing the problem. The heart then beats normally.

What is catheter ablation?

“A procedure that uses radio-frequency energy (similar to microwave heat) to destroy a small area of heart tissue that is causing rapid and irregular heartbeats. Destroying this tissue helps restore your heart’s regular rhythm. The procedure is also called radio-frequency ablation.”

—American Heart Association

Without catheter techniques, open heart surgery might be the only other option. But in using catheters, physicians at the medical center rely on a different set of advanced tools and techniques in order to “see” into the heart. This is where the variety of equipment options at Saint Barnabas Medical Center becomes important.

During catheter ablation, physicians use tiny, high-recorders that project the images on monitors in the procedure room. The challenge is to pinpoint the errant cells in a heart that is beating, and track electrical impulses that are also in motion. Of course, the patient’s chest is also moving with each breath.

“Our equipment helps solve these challenges,” Dr. Roelke says. With the three advanced cardiac ablation tools at the medical center, physicians can choose the most appropriate one based on the specific problem with the patient’s heart rhythm and his or her underlying heart condition.

“Using GPS-like navigation, we receive real-time, three dimensional images of the chambers of the heart, the location of the catheters and the area of arrhythmia,” the doctor explains. “The images even adjust when the patient moves, which is important in avoiding healthy tissue nearby.”

Features of the three cardiac ablation tools at the medical center improve accuracy of treatment as well as patient safety. For example, one of the newest technologies uses 64 electrodes to track the path of electrical impulses, compared with just four in other tools. It’s the information from these electrodes that computer software uses to create the 3-D displays. “The images are so detailed that we can sometimes see the scar tissue and abnormal electrical circuits that are causing the arrhythmia,” he says.

One type of advanced image the tools provide is “intracardiac echocardiogram” (ICE). ICE uses sound waves (echo), like sonar, to map the inside of the heart and valves, and it has several advantages. It provides clearer images of the soft tissues of the heart, and it does so without the need for X-rays, which use radiation.

“The equipment we use incorporates the information we get from ICE into the 3-D map of the heart,” Dr. Roelke says. “Altogether, this detail helps produce the real-time images we need for the ablations.”

Another new feature improves patient safety in another way. “The technology gives feedback about the force of the catheter against the heart wall,” Dr. Roelke says. “This helps us to navigate the catheter through the heart in the safest manner.”

These tools, plus an experienced team that runs one of the highest-volume ablation centers in the state, mean heart patients with arrhythmia receive exceptional, cutting-edge treatment at Saint Barnabas Medical Center. “It’s dedicated people and technologies like these that help us give our patients some of the most advanced care available in the state,” says the doctor.

For more information about cardiac services at Saint Barnabas Medical Center, call 973.322.9440 or visit www.rwjbh.org/heart.