A team of cardiologists and cardiac surgeons have performed a new open chest procedure to treat a patient’s serious heart rhythm disorder – the first of its kind in the city’s hospitals and in the East Midlands.
The team from Nottingham’s Trent Cardiac Centre catheter lab based at Nottingham City Hospital, used Cardiac magnetic resonance imaging (MRI) to locate the cardiac scar causing the patient’s dangerous heart rhythm abnormality called ventricular tachycardia (VT). This information was used to plan the procedure before the operation and live electrical data from the patient’s heart was used to guide the procedure.
This, combined with the strength and expertise of the different teams’ specialist skills, led to a positive outcome for the 49-year-old male patient from Lincolnshire who has remained free from VT for 32 months following the procedure.
Consultant Cardiologist Dr Shahnaz Jamil-Copley and her cardiology, and cardiac surgical colleagues performed this hybrid ablation procedure – also known as catheter ablation – to treat scarring in the patient’s heart, which causes abnormal heart rhythms (arrhythmia). The procedure works by correcting certain types of arrhythmias by modifying the electrical pathways or channels which can cause dangerous cardiac arrhythmias.
The five-hour “hybrid” procedure, which was conducted in the Cardiac Catheter Laboratory within the Trent Cardiac Centre at Nottingham’s City Hospital rather than in a conventional cardiac operating theatre, has now been published as a case report in a leading cardiac medical journal, the European Heart Journal.
Dr Jamil-Copley led the team that performed the demanding operation, which involved a multidisciplinary team including two cardiac surgeons, two cardiologists, a cardiac anaesthetist, cardiac technical and nursing teams.
Dr Jamil-Copley commented: “This was a highly innovative procedure to treat a challenging medical condition replacing the traditional percutaneous (passing through the skin) access to the heart, which had previously been tried but had failed with this patient.
“Recurrent ventricular tachycardia and ICD shocks were having a significantly negative impact on this patient, leading to them needing regular hospital admissions. The most important outcome here is that our patient has remained free of VT and we have been able to stop the poorly tolerated drugs being used to treat his condition. This has meant a major benefit to the patient’s quality of life.”
The European Heart Journal report written by the Nottingham team, is the first case study to describe the practicalities, safety and feasibility of this hybrid procedure which performed in a cardiac catheter laboratory solely to treat ventricular tachycardia.
The procedure has been performed in other hospitals in the UK and United States on heart transplant patients who were having their chests opened for other medical reasons. However, the Nottingham procedure was a “first” because it was for the sole treatment of VT and used live electrical data with surgical tools and techniques to give it the best chance of success.
The patient was initially admitted to the Trent Cardiac Centre after recurrent VT required frequent defibrillator shocks from their implantable cardiac device (ICD), despite being on the maximum permitted dose of multiple cardiac drugs.
Standard cardiac catheter ablation for VT is performed using tubes placed through the veins in the groin or through the front chest wall with catheters, X-rays and 3-D mapping systems used to locate the scar and burn the abnormal areas causing trouble.
When this procedure was tried but proved unsuccessful for this patient, they chose the more radical method of reaching the heart by opening the patient’s sternum, which provided direct access and greater visibility of the area of scar.
The Nottingham City cardiac MRI team have worked hard to establish an advanced imaging “protocol” which improves visualisation of scar tissue in the heart compared to historic protocols. Before this patient underwent his hybrid surgical ablation procedure, the team performed an MRI scan, which located the patient’s cardiac scar and helped guide the surgical team in planning the procedure.
One of the major benefits of performing the procedure in the Cardiac catheter laboratory was the ability to capture and use the live electrical data from the patient’s beating heart to map and guide cryoablation (freezing) therapy of scar tissue. Direct visualisation of the area allowed the team to stay safe by avoiding structures around the heart like the coronary arteries during this precision treatment approach.
- The European Heart Journal case report is available at:
https://doi.org/10.1093/ehjcr/ytad223
