While ablation has been a treatment option for abnormal heart rhythms for decades, it had its limitations. Some rhythm problems can be easily treated with ablation. However, this can be a much longer process for more challenging rhythm abnormalities. For these more complex rhythm abnormalities, physicians could spend a significant period of time trying to map these rhythms in real time action to identify the origins in the heart as targets for ablation. Historically, cardiac mapping has been done invasively via catheter inserted through the vein or artery. Now, we have the capability to start the mapping process prior to catheter insertion to locate the origin of heart rhythm irregularity.
Heart ablation capabilities are expanding at Novant Health Forsyth Medical Center. For the past year, clinical cardiac electrophysiologists like Dr. Lai Chow Kok have been using the CardioInsight™ Noninvasive 3D Mapping System by Medtronic since February 2022 to improve ablations. This is the first hospital in the Piedmont Triad to introduce the high-tech tool.
What could have taken hours is now taking minutes, we can image the heart and triangulate where the abnormal rhythm is coming from. Once we have that information, we’ll bring the patient into the procedure room to confirm and validate the findings we see, and quickly and accurately complete the ablation procedure.
This allows the cardiac team to confidently offer ablation as a possible option for even more patients, including those with abnormal rhythms with origins that are more difficult to pinpoint.
“With the tool, it’s less daunting to map more challenging rhythms,” Kok said.
And with pre-procedural mapping, he and other Novant Health electrophysiologists have more information to customize their plan for ablating each individual patient, to achieve better outcomes even sooner.
The 3D cardiac mapping process
When Novant Health physicians identify a patient with a rhythm abnormality and determine that ablation is the right treatment, they want to see that rhythm abnormality in action on the day of the procedure.
“It’s like when your car makes a funny sound and you bring it to the mechanic,” Kok said. “You need the mechanic to hear that sound the day you bring it in, so they can figure out where the sound is coming from.”
Once a physician confirms the abnormal rhythm the day of the procedure, the 3D mapping tool comes in to identify the origin. The patient is equipped with a 252-electrode sensor vest to combine body surface electrical data with heart-torso anatomy so the noninvasive mapping system can collect chest ECG signals. Those signals combine with CT scan data to generate simultaneous biatrial and biventricular 3D cardiac maps.
The system has the ability to display rhythms spanning several chambers of the heart as well as rhythms that vary in cycle length, like atrial fibrillation. The system can even produce maps with data from just one heartbeat, so electrophysiologists can confidently move forward with an ablation procedure for infrequent and unstable rhythms such as ventricular tachycardia.
This approach is boosting overall accuracy for arrhythmia identification. Studies showed that CardioInsight accurately identifies an arrhythmia’s chamber of origin in 95.2% of cases, far surpassing an ECG’s accuracy of 76.2%.
The patient continues to wear the vest during the procedure to provide ongoing mapping information to guide ablation procedure.
Novant Health Forsyth Medical Center’s ablation program will continue to expand through the next year
Kok and his team are working to bring an additional electrophysiologist to the ablation program, as well as additional technology. To shorten the procedure for certain kinds of heart rhythms, they are considering a new form of energy for ablation. They are also looking into more ways to improve workflow efficiency, such as with new closure devices to help quicken patient recovery.
Kok’s overall philosophy for the Novant Health ablation program focuses on improving patient experiences and outcomes. “If we can do any procedure safely in a shorter duration of time, it’s always a plus for patients,” he said. “So why not do that?”