News

News ( Posted on Sun, Aug. 08, 2004)
New heart treatments are fixing the beat
By Jan Jarvis (Star-Telegram Staff Writer)
One procedure freezes heart cells to treat an irregular heartbeat.
The other, minimally invasive treatment heats tissue to stop a heart that beats too fast from fluttering.

Both techniques were recently performed for the first time in the Metroplex, giving cardiac patients an alternative to open-heart
surgery, pacemakers and medications.

At Baylor All Saints Medical Center at Fort Worth, doctors used the tip of a catheter filled with liquid nitrous oxide to freeze and kill cells that cause an irregular heartbeat. Although the device has been used on children, Baylor All Saints is the first hospital in North Texas to perform the procedure on adults, according to a Baylor spokes-woman. The technique was used on a common rhythm disturbance called supraventricular tachycardia, in which a rapid heart rate originated above the lower chambers of the heart. The technique takes a safe and effective procedure and makes it much safer and reversible, said Dr. Vijay Jajachandran, who performed the procedure. In the past, damage could occur in nearby cells, causing 1 percent to 3 percent of patients to require a pacemaker.

"That may not sound like a significant number, but if you're 20 years old it's very significant," he said. "This reduces the chances to zero, and you don't have to commit to drug therapy or a pacemaker."

The U.S. Food and Drug Administration approved the probe used for cryoablation in 2003. At Medical City Dallas Hospital, doctors used radio frequency waves to treat atrial fibrillation, an irregular heartbeat that can cause strokes and congestive heart failure. The procedure is the first to be performed in Texas, said Dr. James Edgerton, a thoracic surgeon with Medical City.

"This is our first attempt to do it without even opening the chest, which is a real step forward for the patient," he said.

During the procedure, radio frequency waves heat the tissue, creating a mazelike pathway that disrupts the chaotic electrical impulses, or fluttering. The precise, thin line of scar tissue that develops stops the irregular electrical impulses from reaching the rest of the heart.

In conventional surgery for this disorder, scar tissue is also created, but the chest is opened and the heart stopped, Edgerton said. The new procedure means that patients have a faster recovery with fewer complications, he said.

The American Heart Association estimates that about 2.2 million people in the United States have the condition, which causes the sensation of the heart skipping a beat. Patients often have less energy, shortness of breath and an impending sense of doom because the heart rate gets very fast, Edgerton said.

Both procedures give patients more options in how to treat heart conditions. Cryoablation, the freezing procedure, does not take away from radio frequency ablation, Jajachandran said.

"It's an accent," he said. "It gives us some nice flexibility."

An arrhythmia occurs when:
The heart's natural pacemaker develops an abnormal rate or rhythm. The normal conduction pathway is interrupted.

Another part of the heart takes over as pacemaker. Symptoms can range from mild palpitation to a fluttering sensation in the chest. When arrhythmias last long enough to affect how well the heart works, symptoms include fatigue, dizziness and fainting. Death occurs if the heart rate is so slow that the heart and brain stop working.

SOURCE: American Heart Association
Jan Jarvis, (817) 548-5423
jjarvis@star-telegram.com

Innovative Treatment Offers Relief for Irregular Heartbeat
Dallas, Texas- July 22, 2004 - Dr. James Edgerton, a thoracic surgeon with Medical City, will perform Texas' first closed chest surgery to treat atrial fibrillation on Friday, July 23. Edgerton will utilize an endoscopic biopolar radiofrequency technique, known as EndoCure, to treat the dangerous irregular heartbeat known to cause strokes and congestive heart failure. The minimally invasive procedure avoids opening a patient's chest.

"We continue to employ less invasive techniques to help our patients recover more quickly; reduce complications; and achieve a more permanent solution to their medical condition," says Edgerton, Director of Robotic Surgery for Medical City, Dallas, Texas. "Most individuals experience dramatic improvement following the procedure and are able to go back to normal activities and daily living which they have not been able to do prior to the operation."

According to the American Heart Association, an estimated 2.2 million Americans suffer from atrial fibrillation. The condition is caused when the normally regular contractions of the heart are replaced by rapid and random twitching, resulting in irregular and usually faster than normal heartbeats. Those suffering from atrial fibrillation often report a feeling that their heart is fluttering or skipping a beat. Doctors traditionally treat atrial fibrillation with medication, pacemakers, open heart surgery and electrical shock therapy to restore a normal heart rhythm. Most treatments offer temporary relief and the side effects are often bothersome.

The EndoCure procedure is a minimally invasive surgery that uses bipolar radiofrequency to heat the tissue and make several scars in the heart, creating a maze-like pathway to disrupt the chaotic electrical impulses, or fluttering. The surgeon places the ablation device through a small incision in the chest. Through another small incision, the surgeon places the endoscope, or small camera, to guide the instruments. The radiofrequency energy creates several lesions to electrically isolate the pulmonary veins from the rest of the left atrium. The newly created barriers stop the irregular electrical impulses from reaching the rest of the heart. Erratic electrical signals from the pulmonary veins are believed to be the major cause of atrial fibrillation.

The benefits of the procedure include no longer having to take medication or undergo monthly blood tests. Patients generally are able to go home the day after the surgery. Researchers, including Edgerton, are hopeful the new radiofrequency ablation operation will soon be an outpatient procedure.

Dr. Randy Wolf, a pioneer in the development of the EndoCure procedure, will assist Edgerton during the procedure. Edgerton is a cardiothoracic surgeon with COR Specialty Associates of North Texas, P.A. (CSANT) physician group. CSANT is Texas' largest practice specializing in the prevention and treatment of cardiovascular disease.

Medical City is a 598-bed tertiary medical center that includes the North Texas Hospital for Children at Medical City. Some 1,250 physicians are on the medical staff, along with over 2,600 hospital employees. Many of Medical City's programs have received national and international recognition, including cardiovascular, craniofacial, oncology, and transplant services.