Issue link: https://viewer.e-digitaledition.com/i/1065149
"Dr. Ahmed and I have been perform- ing His bundle pacing for quite a while," Dr. A nghel says. "The procedure was described a couple of decades ago, but it tends to be technically challenging for most implanters, so it's not commonly performed. His bundle pacing makes use of the heart's native electrical wiring to achieve resynchronization. Instead of placing the right ventricle lead at the tip of the right ventricle, we purposefully aim a specialized lead at the very electrical wires one is born with that run between the walls of the right and left ventricles." Once i n pla ce, t hat lone lea d ca n accomplish what a cardiac resynchro- nization pacema ker can do with two, Dr. Anghel explains. REMEDĒ SYSTEM FOR CENTRAL SLEEP APNEA Individua ls with sleep apnea are four times more likely to develop atrial fibril- lation, a nd approximately 50 percent of people with atria l fibrillation have sleep apnea , according to t he Hea r t Rhythm Society. Untreated sleep apnea is associated with risk factors for atrial f ibri l lation, including hy per tension and associated forms of heart failure. Treating sleep apnea is key to the long- term success of atrial fibrillation therapy, according to Dr. Ahmed. " We see a large subset of individuals who have sleep apnea and present to us for congestive heart failure, hypertension or atrial fibrillation," he says. "For these patients, it's important to diagnose and treat sleep apnea because if we don't, there's a significant chance the treatment we prescribe for their heart condition wouldn't be as effective. Sleep apnea treatment in patients with atrial fibril- lation a lmost doubles the success rate of ablation, as published studies show." In 2017, the FDA approved the remedē System, a nerve stimulator that treats moderate to severe central sleep apnea in adults. The Heart Group recently became one of a small number of centers in the United States to offer the remedē System. Consisting of a small generator placed beneath the skin atop the right pecto- ra l muscle with two leads, the remedē System stimulates the phrenic ner ve to reg ulate the breathing function of the diaphragm. " E s s e n t i a l l y, b y r e g u l a t i n g t h e activity of the diaphragm, the remedē System mimics what a pacemaker does to the hea r t muscle," Dr. A nghel says. " The device ta kes control of the dia- phragm in such a way as to significantly improve breathing at night when sleep apnea hits." Dr. Anghel views the addition of the remedē System to the Hea r t Group's suite of treatment options as a nother example of the practice's willingness to embrace innovation — as well as drive it. "We're continuously assessing available procedures and the way they would best fit in the global care of a cardiac patient to minimize procedural impacts in one's life and trying to improve the way we perform them," Dr. Anghel says. "Working with the excellent cardiac administrators and staff members at hospitals in Syracuse has allowed us to find new ways to improve safety and reduce procedure times. We like to think of ourselves as innovators of system processes." Fo r m o re i nfo r m a t i o n a b o u t th e He a r t G r o u p , v i s i t e p c u s e . c o m o r call 315-277-2707. n Direct Collaborators M A N AGING PATIENT S W ITH arrhythmia, heart failure and other cardiac conditions requires close coordination so that physicians of varying specialties can successfully navigate the complexity of multiple serious comorbidities. That is why cardiologists, cardiac electrophysiologists and the Heart Group Founding Partners Traian M. Anghel, MD, FACC, and Jamal J. Ahmed, MD, FACC, eschew the use of an answering service in favor of speaking directly by cell phone or secure messaging with referring physicians and patients. The Heart Group does not employ physician extenders, and that allows Drs. Ahmed and Anghel to build rapport with their patients and ensure consis - tency of care. Typically, patients see the same physician at every appointment. "We strive to educate not just patients, but also their physicians about the best available treatment options, we ask for and we provide feedback regarding the ways the care team can help coordinate services," Dr. Anghel says. "We always try to be there for other physicians, not as dictators of care, but as partners on the patient's medical team. Every physician with whom we collaborate receives detailed notes about our work with their patients so we can avoid any surprises with medication interactions or side effects in the context of patients' overall medical management. That, along with the fact that every patient of ours has direct access to us via cell phone, is part of our effort to be as close to our patients and their care teams as possible." Dr. Ahmed and Evan Jones, LPN M D N E W S . C O M /// M D N E W S C E N T R A l N E W Y O R K ■ 2 019 0 9