Webcast lets doctors share methods across globe

Thousands of cardiologists from as far away as China had a front-row seat Monday evening as doctors in Salt Lake City repaired an electrical defect in Eva Lindsay's heart.

Via webcast, doctors at LDS Hospital performed the 90-minute procedure known as atrial fibrillation ablation, while doctors from around the globe got an up-close look and were able to ask questions via e-mail in real time. The hospital has performed close to 1,000 of the ablations since 2004, when the procedure replaced open heart surgery as the method of choice for treating the arrythmia, said cardiac electrophysiologist Dr. John Day.

Because ablation requires no surgery, patients like Lindsay can leave the hospital the next day, with no stitches and just two small bandages.

As people live longer, atrial fibrillation is becoming a global epidemic and is responsible for one in four strokes, Day said at a press briefing Monday morning. The condition is characterized by an irregular, rapid pulse that causes extreme fatigue and shortness of breath. The 77-year-old Lindsay, who has worked as a telephone operator at the hospital for 19 years, says she is often too tired to walk.

As is often the case, her condition was episodic at first but over the years became nonstop, leaving her with a resting pulse Monday morning of between 100 and 120. The misfiring and resulting chaos in the heart's upper chambers can cause blood clots to form, leading to strokes.

The ablation is performed using magnetic resonance imaging (MRI) and a 3-D electro-anatomic mapping system that allows doctors to see inside the heart as they move catheters around to cauterize off segments, thus preventing the misfiring electrical impulses from spreading to the rest of the heart. Day described the cauterization as creating a "firewall."

Drugs are often used as a first response to atrial fibrillation but often stop working after a couple of years, Day said. Atrial fibrillation is often genetic but risk factors also include age, high blood pressure, obesity, sleep apnea, valve problems and heart attacks.

The ablation is relatively new and is a "very complex procedure, requiring years and years and years of training," Day said. Monday's webcast training won't make ablation experts out of the doctors sitting in front of their computers but will help doctors refine their techniques.

"There is not a standard way of offering this procedure yet," Day explained.

Some 5,000 to 7,000 cardiac electrophysiologists around the world currently do the procedure at about 500 institutions, according to Amy Guberman, vice president for education at the Heart Rhythm Society in Washington, D.C., who was on hand for the press briefing and procedure. In the Salt Lake Valley, ablations are performed at University Hospital and Salt Lake Regional Medical Center in addition to LDS Hospital.

Patient Lindsay says she is looking forward to having enough energy to "go out on the town" and to play with her grandchildren.

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E-mail: jarvik@desnews.com

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