Electrophysiologists Develop Therapies for Complex Cardiac Arrhythmias

An international resource for treating complex arrhythmias, the Cardiac Arrhythmia Service recently transitioned into a new, state-of-the-art electrophysiology suite in the Carl J. and Ruth Shapiro Cardiovascular Center at Brigham and Women’s Hospital. The Service promotes the development of new technology and innovative therapies, as well as supports research into the mechanisms of arrhythmias. Focus on Atrial Fibrillation To address the expected increase in prevalence of atrial fibrillation (AF) as the population ages, Brigham and Women’s Hospital has created the Center for Advanced Management of Atrial Fibrillation. Led by Gregory F. Michaud, MD, the Center encompasses innovative patient care, as well as pre-clinical and clinical research into the causes of AF and identification of the most appropriate therapies. Ventricular tachycardia Electrophysiologists, including William Stevenson, MD, an internationally-recognized expert in treating ventricular tachycardia, also work with referring physicians to manage challenging ventricular arrhythmias (VT). Even with implantable defibrillators (ICD), VT episodes indicate an increased risk of mortality and hospitalizations, and symptomatic episodes reduce quality-of-life. The Service is among a select few with extensive experience in epicardial mapping and ablation. Multicenter clinical trials have demonstrated that ablation therapy markedly reduces the risk of recurrent VT and is effective at reducing the frequency of VT in 70 to 75 percent of patients. When the VT circuit is deep within the myocardium and cannot be reached either from the inside or the outside surface of the heart, electrophysiologists work with interventional cardiologists to perform transcoronary alcohol ablation or with cardiac surgeons who are skilled at creating pericardial windows to access the heart and ablate the VT circuits, or can directly perform ablations via open heart arrhythmia surgery. On the Horizon Another innovative technique involves MR imaging to replace fluoroscopic guidance during ablation procedures. Real-time MR images would allow operators to see the tissue they have ablated and to more effectively characterize lesions, improving the success of ablation and reducing the incidence of second procedures. Another is the use of focused ultrasound to perform MR-guided completely non-invasive ablation. New Clinical Trials Physicians in the Center for Advanced Management of Atrial Fibrillation are offering participation in a variety of clinical trials, including: ·CABANA (Catheter Ablation Versus Anti-Arrhythmic Drug Therapy for AF) – An NIHsponsored, multicenter, randomized trial evaluating catheter ablation versus antiarrhythmic drug therapy for symptomatic AF. This trial is designed to test the hypothesis that catheter ablation is superior to rate and/or rhythm control therapy and will reduce mortality in patients whose AF is incompletely controlled by medical therapy. Cabana Trial contact: Principal Investigator William Stevenson, MD, (857) 307-1948 ·Pace-Guided Ablation Trial – Designed by Dr. Michaud, this trial – offered at only three centers worldwide – seeks to improve the one-time procedural success rate of catheter ablation for paroxysmal AF. Pace-Guided Ablation Trial contact: Principal Investigator Gregory F. Michaud, MD,(857) 307-1946 Dr. Michaud also is working on a hybrid AF protocol with cardiac surgeon Prem Shekar, MD, that will combine the benefits of catheter ablation with mini-MAZE surgery. The intent is to demonstrate that the combined procedure, approaching the heart from both the endocardium and epicardium, will allow them to create transmural lesions that will effectively ablate the arrhythmia. This approach also allows the removal of the left atrial appendage to reduce the risk of clots and stroke. Information and Referrals For more information, or to refer a patient, please contact our Referral Coordinators at (617) 732-9894 or email bwhteleservices@partners.org.

Brigham and Women's Hospital, a teaching affiliate of Harvard Medical School, is consistently ranked as one of the nation's leading hospitals. With a state-of-the-art cardiovascular center & orthopedic center of excellence, BWH is committed to excellence in patient care with expertise specialty of medicine and surgery.