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PRIME HOSPITALS -- First ever Electronic balloon based ablation forCardiac arrhythmias
A 26-year-old male resident of Tolichowki, Hyderabad has been suffering from irregular heart beat for about 2 years prior to presentation at Prime Hospitals, Hyderabad.
Efficacy of drugs for this condition is limited and has a potential to develop side effects. The latest therapy for such an entity is by doing a 3 D mapping of the heart and localizing the focus from where the abnormal heart beat is originating. Once the focus has been identified this can be burnt utilizing controlled radio-frequency energy. But the experience with this new modality of therapy is limited due to non-availability of skilled physicians and expensive equipment needed.
On the 2 July 2012, an electrophysiology study was performed utilizing 3 D mapping technology. Under fluoroscopic guidance, a wire was passed into the pulmonary artery and using this for support, the EnsiteArray balloon (from St Jude USA) was passed over it and positioned in the area of interest which was the outflow portion of the right ventricle from where the PVCs were arising as per the ECG evidence. A 7Fr 4mm ablation catheter was also introduced into the RVOT near the balloon and a 3D map was created. On table patient did not have runs of tachycardia but had PVCs. Using only one beat, the entire circuit of the PVC was reconstructed and the burn was directed to the appropriate site as shown by the Array map. The PVCs disappeared within seconds of ablation and after 48 hours, the patient is fine and is not on any drugs. The successful treatment of this patient using the latest technological innovations establishes Prime Hospitals as one of the leading hospitals in the treatment of heart rhythm problems.
DrJayakeerthiRao led the team of Cardiac specialists at Prime Hospitals in performing this complex procedure. The entire procedure took four hours and was performed under local anesthesia. DrJayakeerthiRao has undergone specialized training for performing complex procedures using Ensite Array balloon under Professor Pedro Brugada at Belgium. In fact, the two together have published a seminal article on the same topic in Journal of Cardiac electrophysiology early this year. Mentored by professor Brugada he has gained enormous experience in 3-D mapping techniques and ablation of complex arrhythmias such as atrial fibrillation and ventricular tachycardias.
Almost 50% of us would have PVCs during 24 hour monitoring but less than 2% have more than 50 PVCs per 24 hours. The incidence increases with age and the presence of heart disease. Upto 80% of PVCs arise from the right side of heart. They may present with uncomfortable awareness of heart beat, chest pain, giddy spells, loss of consciousness, or heart failure. Drugs useful for the treatment are called anti-arrhythmic. These drugs cannot be used for a long time because they are toxic. The expense involved and the inability to offer a cure make medical management impractical in symptomatic frequent PVCs from the right side of the heart.
Electrophysiological study and radio frequency ablation has the potential for single shot cure. With improved mapping techniques the risk is significantly less and the procedural success is higher. Even in asymptomatic patients with frequent PVCs, there will be structural changes in the heart which could lead on to heart failure and can be prevented by timely ablation and in some with heart failure the problem can be reversed. During the electrophysiological study the heart is mapped for identifying the focus of the origin of abnormal heart rhythm. Conventional mapping may be misleading and may miss the critical areas. In such cases 3D mapping helps us by homing in on the right spot to burn; reduces the fluoroscopy time; helps in exactly pin pointing the origin of the abnormal beats; it has helped in successful ablation of ectopic beats when conventional ablation has failed, less ablation points as the area needed to be ablated is well defined.Thus extensive manual mapping may be avoided.
What is the specialty of EnsiteArray balloon? – This is a special Electronic balloon which is a revolutionary technique utilizing cutting edge technology. This technology allows rapid and accurate location of the origin of the heart rhythm disturbance in a 3-dimensional geometry of the heart chambers and guides successful treatment with the use of catheter ablation.This balloon has a highly sophisticated mesh of 64 electrodes mounted over a balloon, which simultaneously records the cardiac signals from the adjacent tissue and collects about 3000 points to build what is called the activation map. This combination of balloon loaded with electrodes makes it unique. As we do not touch each of these areas mapped, this system is called the non-contact mapping system and is increasingly being used in Europe and North America. In situations where the VT or the ectopic beats are very infrequent or poorly tolerated even one abnormal beat is enough to reconstruct the exact path of the abnormal beat and guide us in successfully ablating the site. The major advantages of this electronic balloon are less radiation, less number of burns means less pain, reduces the procedure time so discomfort and complications are less, success rates are higher.
The procedure was performed under the Arogyasri scheme and was hugely subsidized by Prime Hospitals. The cost of therapy under normal circumstances would be Rs. Two lakhs fifty thousand.