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Targeting Arrhythmias

Every physician knows that when it comes to heart arrhythmia, precise diagnosis and treatment saves lives. The Heart and Vascular Center at Washington University School of Medicine and Barnes-Jewish Hospital includes five cardiac electrophysiologists (EP) who offer the complete spectrum of clinical procedures for patients with heart arrhythmia. They’re also leading the way in developing better approaches to diagnosis and treatment.

Individualized Care Through Noninvasive 3-D Imaging

One of the most exciting advances employs a new noninvasive three-dimensional cardiac imaging technology called electrocardiographic imaging (ECGI). By imaging a single heartbeat, this technology provides a precise assessment of an arrhythmia and may lead to more individualized treatment.

ECGI, invented by Washington University biomedical engineer Yoram Rudy, PhD, takes the basic 12-lead electrocardiogram to a higher level. It gathers detailed electrical information about the heart from the surface of the body by using 256 electrodes placed on the patient’s chest and back, like a vest. A rapid CT scan combined with sophisticated software creates a virtual three-dimensional heart surface, which ECGI uses to show in great detail how the heart beats.

“We use ECGI to gain better knowledge of a patient’s specific arrhythmia, with the ultimate goal of tailoring a safer and more effective treatment strategy,” says Washington University cardiac electrophysiologist Phillip Cuculich, MD, who has been working with ECGI since 2006.

Because ECGI was developed at Washington University, Barnes-Jewish Hospital is the only hospital in the world to use it, though only currently through clinical trials. Cuculich says the ongoing work with ECGI has been very promising.

“Each patient’s heart-rhythm disorder is unique,” he says. “At Barnes- Jewish Hospital, we have the refined technology to understand these subtle but important features that make each person different. By doing so, we can offer safer and ultimately more effective treatment options for heart-rhythm disorders.”

Curing Atrial Fibrillation With Magnetic Precision

Washington University cardiac electrophysiologists were the first in the St. Louis area to perform catheter ablation to treat atrial fibrillation. With this approach, catheters placed through blood vessels stimulate the arrhythmia with high-frequency electrical impulses and then destroy the abnormal cardiac tissue that is causing it.

Mitch Faddis, MD, PhD, director of cardiac electrophysiology, and colleagues were instrumental in pioneering the use of Stereotaxis magnetic guidance systems to further refine catheter ablation of arrhythmias, including atrial fibrillation. “Stereotaxis makes it easier, faster and safer to treat atrial fibrillation,” Faddis says. “The technology allows catheter ablation in difficult-to-reach areas of the heart. We’ve been using the system here since 2002 and have the most experience of anyone in the country.”  

According to Faddis, cure rates have improved from 20 percent to 75 percent due to changes in the ablation strategy. 

Saving More Lives With ICDs 

Cardiac electrophysiologists at Barnes- Jewish Hospital have expanded the use of implantable cardioverter defibrillators (ICDs)—implanted devices that sense the heart rhythm, pace the heart, and deliver electrical shocks when the heart rhythm becomes irregular or stops.

Until about five years ago, ICDs were only used to prevent sudden death in patients who had a previous cardiac arrest. However, Washington University participated in a landmark clinical trial that showed ICDs reduced deaths in a wider patient population. Patients can now receive ICDs if they are at risk for sudden death, often identified by an ejection fraction less than 35 percent.

“These trials are also blazing the way for using ICDs for cardiac resynchronization therapy earlier in heart failure patients to reduce the disease’s progression,” says Marye Gleva, MD, a Washington University electrophysiologist.

“We have an amazing legacy here started by pioneering physicians,” says Gleva. “This has become self-perpetuating momentum that leads to innovative thinking across the hospital’s entire cardiovascular and electrophysiology program. Everything we continue to accomplish now is related to this legacy.”

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