MDNews - Central New York

"Cardiac electrophysiology is an up- and-coming field in cardiology and one in which a lot of progress is being made," Dr. Ahmed says. "Seemingly, every other year, a new, potentially groundbreaking treatment emerges to benefit patients in considerable new ways, and it's impor- tant to provide these advances in care to patients in our area." CONVERGENT ABLATION One such innovative procedure that is new to Central New York is convergent ablation for atria l f ibrillation, which Drs. Ahmed and Anghel began offering in early 2018. This minimally invasive procedure combines the expertise of a car- diac surgeon and an electrophysiologist and is appropriate for certain individuals who have not experienced a successful outcome following conventional treat- ments. The procedure also benefits those who have chronic atrial fibrillation or, in some cases, structural heart disease, according to Dr. Ahmed. It is important to not abandon patients with heart failure due to atrial fibrillation, for their lifespan and quality of life are affected. "Convergent ablation takes place in two phases," he says. "First, with the patient under genera l anesthesia, the surgeon makes a small incision in the upper abdomen and ablates the area in question outside and behind the heart, which ta kes about 90 minutes. Then, the electrophysiologist uses catheters inser ted through the groin to access the hea r t a nd ablates from within to complement the ablation lines made by the surgeon on the outside. That takes another 45 to 60 minutes." After one to three days in the hospital, patients return home and may resume a l l reg u la r activ ities i n t wo week s. Drs. Anghel and Ahmed have performed more t ha n 15 convergent ablat ion s at Upstate University Hospita l since they began offering the treatment, and they plan to introduce it to St. Joseph's Hospital soon. Their convergent ablation patients enjoy a success rate of approxi- mately 70 percent. "Convergent ablation is quite promis- ing," Dr. Ahmed says. "Candidates may present with fatigue, shortness of breath, racing heartbeat and palpitations, and this procedure offers relief. We place a heart monitor under the skin to document complete resolution of the arrhythmia and track recurrences in the most objec- tive manner." MICRA TRANSCATHETER PACING SYSTEM A miniature, v ita min-capsu le-sized pacemaker that is 93 percent sma ller than conventional pacemakers, the Micra Transcatheter Pacing System offers a wireless, minimally invasive alternative for patients who need basic pacing for very slow heart rates. The Heart Group began offering Micra soon after its approval by the FDA. "Micra is an extremely exciting device because it's miniaturized for deployment completely inside the heart, with no wires protruding out of the organ into the skin," Dr. Ahmed says. "Micra is an ideal choice for patients who might not be candidates for a conventional pacemaker because of preceding vascular complications, dif- ficulty accessing the heart because they're receiving dialysis or a history of recurrent infections that would make implanting a standard device a high-risk option." Electrophysiologists deploy Micra to the right bottom chamber of the heart via a catheter inserted in a vein at the upper thigh. Patients who receive Micra ex perience fewer post-impla ntation infections than individuals who receive conventional pacemakers, according to Dr. Ahmed. They also face none of the post-procedure restrictions on driving or range of motion limitations to which patient s must ad here fol low i ng t he implantation of a standard device. WATCHMAN DEVICE FOR LEFT ATRIAL APPENDAGE OCCLUSION Traditionally, blood-thinning medications such as warfarin have been the therapy of choice for individuals with an elevated risk of stroke due to atrial fibrillation, but blood thinners can be problematic for certain groups of patients. "Blood thinners can place older adults, those who may be predisposed to falling a nd individua ls with ulcers or other issues of the gastrointestinal tract, at risk for excessive bleeding," Dr. Anghel says. "Patients with cancer may also be at risk if the disease or their treatment increases the likelihood of bleeding if they take blood thinners." Now, those patients have a long-term solution to both their risk of stroke that comes from atrial fibrillation and their risk of bleeding that is brought upon by blood thinners: Watchman is a device that closes the left atrial appendage (LA A). Early referral for evaluation of a patient's candidacy for Watchman is crucial to Carli Kilmer, LPN, performs Cardiac Device Interrogation Lori Horning, LPN, assists with a Cardiac Treadmill Stress Test 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 7

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