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Catheters replacing drugs in treating heart problems

M. Dinesh Varma

`Heat-without-smoke' technique helps stop rapid heartbeat spells



Prof. Anders Kirstein Pederson, consultant cardiologist, University of Aarhus, Denmark. — Photo: handout

CHENNAI: The use of catheters that are guided into the heart with cutting edge devices is fast replacing drug-based management of arrhythmias, or heart rhythm disorders.

Advances in technology have now made it possible for interventional cardiologists to upgrade from a two-dimensional perspective of the heart to real-time three-dimensional imaging and navigate catheters to the precise spot which is triggering the rhythm disorders.

Radiofrequency ablation using 3D Carto Mapping is helping cardiologists across 1,200 tertiary cardiac care institutions worldwide and six hospitals in India treat complex arrhythmias.

"The experience is a bit like viewing cardiac anatomy with magic glasses," said Anders Kirstein Pedersen, consultant cardiologist, Aarhus University Hospital, Denmark who held a demonstration of the Carto Mapping technology for doctors at Frontier Lifeline hospital on Tuesday.

The ablation (delivering heat selectively to heart tissue) procedure involves guiding a catheter to the origin of the arrhythmia and delivering a heat beam (radio frequency energy) in the 50-60 degree range for about 30 or 40 seconds. "It is akin to wax drops falling on the skin. You momentarily feel the heat but there is no damage," said Joy Thomas, consultant cardiologist, Frontier Lifeline.

The application of this `heat-without-smoke' technique aims at stopping the spells of rapid heartbeats by destroying this abnormal area and allowing the normal heart rhythm pathways to take over. The only difference while performing on newborns and children that the size of the catheter used is less than the standard 2.5 mm, says Dr. Pedersen, who has performed on 2,000 catheter procedures over 14 years.

Permanent cure

The catheter-based treatment offers a permanent cure for most forms of arrhythmias without patients having to undergo the side effects or costs of taking drugs lifelong or the discomfort of surgery. Dr. Pedersen, however, feels that more improvements in electrophysiology technology, particularly navigation software, are required to better success rates in treating various forms of arrhythmias.

Atrial Fibrillation is one of the common and easily the most dangerous forms of arrhythmias where a pair of small chambers (atria) are in simmer mode instead of beating effectively. Success rate of treating AF across the world is about 80 per cent. One of the main reasons for failure rates is attributed to inability of physicians to reach catheters to the exact spot. "Also, the more advanced the disease the less the success rates," Dr. Pedersen said.

What is of concern is the risk of people with severe AF developing clots and strokes. The cardiologist pointed out that 30 per cent of incapacitated inmates in nursing homes in Denmark had suffered AF-triggered strokes.

Dr. Pedersen performed an ablation on a 50-year-old woman with a thrombosis (blood clot) that had blocked blood supply to an arm. The clot had been caused by AF and the one-and-a-half hour procedure restored her heart beat to Sinus (normal) rhythm. The expert did not agree that advances in treatment are taking away the focus on preventive programmes. "The real problem lies in the centring of expertise in too few institutions." Aarhus Hospital currently has a wait-list of two years in spite of performing 350 procedures per million of population every year.

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