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photoS CourteSy oF CLeveLaND CLiNiC deliver the radiofrequency to the openings of the pulmonary veins. ���In a large percentage of patients, those pulmonary veins send out electrical signals that can trigger atrial fibrillation,��� explains Christine Tanaka-Esposito, MD. ���They also seem to have a role in the maintenance of this rhythm once it starts. So if we can burn around those openings and create scar tissue to electrically isolate them from the rest of the atrium, we find that it���s a fairly effective way of suppressing AFib.��� Dr. Tanaka is one of the newest members of Cleveland Clinic���s EP team. A graduate of St. Louis University School of Medicine in Missouri, she completed residency training in Internal Medicine and fellowship training in Clinical Cardiovascular Medicine and Electrophysiology Research at University Hospitals Case Medical Center. In 2009, she joined Cleveland Clinic for a two-year fellowship in Cardiology Electrophysiology. Today, she���s based at Cleveland Clinic���s health center in Avon and performs procedures at Fairview Hospital. ���PVAI is a pretty complex procedure that does carry some risk of major complications like stroke, bleeding around the heart, narrowing of the pulmonary veins and risk of injury to the esophagus,��� she says. ���At Cleveland Clinic, we���ve learned to minimize those risks.��� Cleveland Clinic���s electrophysiologists have developed new techniques and technology for ablation procedures. Christine tanaka-esposito, mD Currently, they���re studying new catheter designs. One, for example, provides feedback on the amount of force contact that a catheter has with tissue, which should improve the safety and efficiency of ablation. These physicians are also involved with some of the balloon technologies for ablation of AFib. On the device side, a new subcut a neous defibrillator, which was recently FDA approved, is now offered at Cleveland Clinic for patients who don���t require pacing. Traditional defibrillators require the leads to be positioned in the heart. Sometimes those leads break or become infected and require removal, which carries the risk of bleeding from the veins and heart. Subcutaneous defibrillators��� leads are implanted just under the skin, so removal when needed is easier. ���Cleveland Clinic is a major national and international referral site for lead extractions. Our electrophysiologists perform more lead extractions than any other medical center in the world, so we have a lot of experience and our complication rate is very low,��� says Dr. Lindsay. In fact, in 2011, Cleveland Clinic���s main campus��� lead extraction complication rate was 0%. Another new device recently offered at Cleveland Clinic is the left atrial appendage occluder device. It was developed for patients who cannot take blood thinners in preparation for an ablation procedure. ���The left atrial appendage is a structure that is most prone to developing blood clots in patients who have atrial fibrillation,��� Dr. Tanaka explains. ���Part of the therapy for AFib is to thin the blood to minimize the risk of stroke. For patients who cannot take blood thinners, there are devices on the market to occlude or tie off that appendage, and in doing so, minimize the risk of stroke.��� On the horizon are small neuromodulation devices that modulate the autonomic nervous system and, in experimental models, have been shown to be beneficial in managing patients with heart failure. There is also a catheter-based ablation procedure involving the renal artery for difficult to control hypertension that is showing promise in clinical trials. ���The broad picture is that because we serve as a center for patients with very complex and difficult issues, we have a huge amount of experience in dealing with these cases,��� says Dr. Lindsay, ���and we have all of the advanced technology to help us.��� For more inf or m at ion v i s it clevelandclinic.org/heart. To refer a patient, call (216) 444-6697. ��� MarcH -april 2013 ��� MDneWS.coM ��� MD News Cleveland/Akron/Canton | 13