Ontario cardiac team celebrates north american first

Newmarket, Ontario-based Southlake Regional Health Centre is the first centre in North America to use a revolutionary technology that makes it easier to connect with human tissue when guiding catheters into the heart to treat problem areas, reducing patient risk while improving outcomes.

Approved by Health Canada, the technology is ground-breaking because it gives physicians a more precise way to measure the amount of pressure they are applying when performing cardiac ablations – or tissue burning – a common treatment for severe arrhythmia (irregular heartbeat) conditions that can be life threatening.

The exclusive technology uses propriety software to take precise electrical measurements at the tip of a cardiac catheter, providing cardiac specialists with both numbers and a visual display so they know when good tip-to-tissue contact is made. The novel approach is more accurate than current ablation methods that rely solely on haptic technology, which works on sense of touch.

“There are a lot of points where you encounter resistance on the catheter due to build up of deposits in the arteries and it can be difficult to gauge how hard to push,” explains Dr. Atul Verma, Electrophysiologist at Southlake, who, along with Electrophysiologist Dr. Yaariv Khaykin, is one of the first physicians to use the technology. “We typically enter from a vein in the leg of a patient meaning the catheter tip is roughly two to three feet away from the end of the heart and although we think we can tell how much pressure we’re placing on the catheter, the reality is that it can be very difficult to estimate,” he says.

When performing cardiac ablations, electrophysiologists guide catheters through veins and arteries into the heart to reach the tissue they intend to burn. Once there, they push the tip of the catheter against the problem tissue and deliver energy through the system to burn it, similar to cauterizing a mole on the skin’s surface. With the new technology, they now have a much more effective and objective way of knowing whether or not the catheter is in the right position.

“The addition of this technology makes cardiac ablation a safer and more effective procedure,” says Dr. Verma. “Not only does more precise measurement provide a more consistent and therefore more effective ‘burn’ for a better therapeutic outcome, but it also reduces the potential risk for major complications such as perforation of the vessels.”

Dr. Khaykin adds that the system gives physicians an extra level of certainty that they are delivering the best possible results. “The difference is that we’re getting an electronic readout that tells us the degree of contact between the tip of the catheter and the tissue, whereas before we would rely on what we could feel in the tips of our fingers.”

Although rare – the risk factor associated with cardiac ablations is about one per cent – complications do occur. According to Dr. Verma, the new system will most likely show the biggest improvement in the treatment of complex arrhythmias like atrial fibrillation and ventricular trachycardia where the success rate drops to 75 to 80 per cent compared to 95 per cent for more routine ablations.

The measurements provided by the technology – developed by St. Jude Medical of St. Paul, Minnesota – are graphically displayed on a computer monitor, the same monitor that provides the three-dimensional (3D) images of the heart used to help guide the catheter. In addition to numbers, cardiac specialists are also supplied with visual aids in the form of electrical pulses that indicate when good contact is made.

With the first procedures performed in May, Southlake Regional Health Centre – which conducts nearly 700 ablations annually – will now serve as the Canadian training centre for other cardiac specialists who wish to use the technology. The move demonstrates the ongoing efforts of the Southlake Heart Rhythm program and its commitment to bring cutting-edge research and technology to the centre so that others can benefit, the hospital’s cardiac specialists say.

Representatives from the Montreal Heart Institute and Royal Jubilee Hospital in Victoria, B.C. will be the first to train at the centre, with other hospitals from across Canada and the U.S. expected to follow.

The revolutionary contact system was first used at the University of Leipzig in Germany, and is also in use at a handful of other European health centres. According to preliminary studies from the university, use of the technology results in shorter procedure times – because physicians spend less time determining catheter placement – as well as better patient outcomes.