Robotic heart ablation changes lives
Please note—this article originally appeared in the March 1, 2010 edition of the News-Sentinel. Original Web site linkProcess treating erratic electrical signals renews hope of Decatur man.
By Jennifer L. Boen
In 1960, when Christopher Meyer was born with a serious congenital heart defect called tetralogy of fallot, doctors told his parents, " 'Take him home and don't let him cry.' "
If he cried too long or too hard, his heart might give out. Surgical repair on an infant with this condition at the time was unheard of, says the Adams County cabinet maker.
His condition, which included a hole between the two lower chambers and other anomalies, causes "blue baby syndrome." The skin develops a bluish cast due to lack of oxygen in the blood. The family lived close to their church "so the nuns would come over from church to our house and take turns rocking me," Meyer said.
Nearly 50 years later, Meyer is a walking testimony to surgical and technological advancements in medicine. His original defects and scarring from surgeries caused a complex cardiac arrhythmia called atrial fibrillation. More than two million American's have been diagnosed with the condition.
In November, Meyer underwent cardiac catheterization and ablation to correct the electrical misfirings after medications failed to do so.
Ablation is a process that uses radiofrequency energy to burn away "hot spots" in the heart that cause the erratic electrical signals. Atrial fibrillation refers to chaotic rhythms in the atria, or upper heart chambers. The right atrium contains the heart's "pacemaker" cells that produce the impulse for the start of each heartbeat.
"Comparing medications to ablation, ablation is far superior," said Dr. Sree Karanam, a cardiac electrophysiologist with Lutheran Medical Group. In fact, a study comparing the patients in the catheter ablation patient group showed no further rhythm irregularities at one year, compared with only 16 percent of the group treated with medication.
What sets the robotic cardiac catheter ablation apart from the manual procedure is that the robotics enables the physician to guide the catheter into hard-to-reach places within the heart, Karanam says.
"In the area between the left pulmonary veins and the mitral valve we typically do not get good catheter contact." The radiofrequency energy provides more effective contact. The robotics also provide more accuracy.
"With manual ablation, depending on the operator, it can lead to perforation and blood leaking out of the heart into the pericardium."
But with the robotics, "no matter how much pressure you apply—you get a force feedback," he said. "It will tell you if you have too much tissue contact."
Another advantage of using robotics over manual ablation is the radiation exposure is lower.
Still, use of robotics in cardiac ablation is relatively new. Initial studies show complications can occur at about the same rate as manual ablation, but Karanam says, "What we need to look at, and that's ongoing, is to see if the (atrial fibrillation) reoccurrence rate is lower with robotics."
Lutheran Hospital paid more than $800,000 for the Sensei X Robotic Catheter System developed by Mountain View, Calif.-based Hansen Medical, which specializes in flexible robotics. This system was chosen, Karanam said, because supplies needed for operation of it are compatible with existing equipment. In addition, its portability allows the Sensei X to be moved from lab to lab as needed.
Meyer had open-heart surgery at age 8 at Riley Hospital for Children. Although it was successful, complications, including a blood clot, ensued. He was told active sports were out of the question, but is grateful that "my mom and dad let me run. It probably made me as strong as I am." He participated in wrestling and later basketball in junior high school but had several incidents of heart failure during that time.
He still remembers the day an insurance salesman came to his home. He was 16 and sat at the dining table with his father. As was the custom back then, the salesman looked at the actuarial tables to give a price quote, and Meyer recalls, "I was sitting right there when he said my life expectancy would be 28."
He had a new personal goal: "I wanted to be 30."
He turned to golf, walking the course—and "walked right into 50," he said of his upcoming 50th birthday.
Because life-threatening blood clots can occur with atrial fibrillation, he was on blood thinner and other cardiac medications for years to treat the electrical disarray. Even then, in the past couple of years, "I was huffin' and puffin' when I got to the top of the stairs," he said of his two-story home. The medications had side effects too.
Cardioversion, a procedure in which the heart is shocked back into normal rhythm, is effective for some arrhythmias. But for those people with more complex electrical problems, improvement is often short-lived. So when offered the robotic ablation procedure, Meyer gave the green light. Insurance covers robotic ablation, Karanam said. Use of robotics adds somewhat to the cost compared with manual ablation.
Ablation for atrial fibrillation can take three to five hours. Meyer stayed in the hospital overnight and experienced immediate improvement. Just a few weeks later, he told family and his doctor, " 'I feel so good it's almost scary.' "
This father of three and new grandfather who once hoped to live to see 30 has revised his goal.
"Now my goal is I want to see my grandchildren graduate," Meyer says. "I want to walk my daughters down the aisle."
