Issue link: https://viewer.e-digitaledition.com/i/155901
has specific algorithms and interventions that might make it more appropriate to particular patients. For instance, some brands may focus on younger or more athletic patients. Others may focus more on a patient with advanced heart failure. Some manufacturers provide built-in, wireless and cellular remote communication, while others have brought into the market devices allowing performance of a limited MRI. We have the versatility to match the correct device to the patient, as well as to provide ongoing service for every device." Strategic Approach to Optimize Care The Heart Group takes a similar approach in its partnerships with area hospitals to avail patients of the best possible care and technology. All local hospitals have unique technological capabilities, Dr. Anghel explains. Those capabilities, combined with the physicians' expertise, enable The Heart Group to provide precisely tailored care. "One reason we like to practice in every hospital is that we can use the most advanced equipment the area has to offer," Dr. Anghel notes. "We match each patient with the hospital that serves him or her best for particular procedures." At Upstate University Hospital, for instance, Dr. Ahmed and Dr. Anghel use the Stereotaxis remote magnetic navigation system for advanced procedures. "We provide a full range of electrophysiology services," says Amy Tetrault, RN, BSN, Associate Director of the Heart and Vascular Jamal J. Ahmed, MD, performs an atrial fibrillation ablation in the electrophysiology lab at university Hospital. Center at Upstate University Hospital. "We have a collaborative relationship with The Heart Group. Their use of our technology allows them to perform electrophysiology studies to determine the type of arrhythmia a patient might suffer from, as well as advanced ablation procedures in all of the heart's chambers, and heart device implantation." Ablation, which involves the use of radiofrequency to eliminate an arrhythmia, can be performed using 3-D mapping technology for great precision and to diminish the patient's exposure to radiation significantly. "We use General Electric's CardioLab to monitor high-resolution electrocardiograms (EKGs) and assist the physicians from The Heart Group as they are stimulating the heart muscle," Tetrault says. "Physicians can see how the rhythm is changing in each area of the heart and use either of the two 3-D navigation systems available, CARTO or NavX, to map and find out where an arrhythmia is originating. Our Stereotaxis system uses large magnets to guide, with high precision and reproducible stability, the catheters the physicians use to perform the ablation." As a further example of The Heart Group's focus on matching a patient's required procedure with the hospital whose capabilities are especially wellsuited to handle that procedure, Dr. Anghel points to Crouse Hospital's advanced mapping technologies. Those technologies include real-time, direct integration of ICE imaging acquired with Biosense Webster's CARTO 3 System 3-D mapping, he notes. "ICE and 3-D mapping help Heart Group physicians perform ablations and device implants," says Colleen Wolford, RN, certified electrophysiology specialist in Crouse Hospital's electrophysiology laboratory. "Three-dimensional mapping helps us discern the source of an arrhythmia," Wolford says. "We use different imaging components to construct a portrait of the heart. We simultaneously review data from EKGs, X-rays, CT scans and ICE, and a powerful computer integrates the data, under our control, and offers it to the physician." Traian M. Anghel, MD, (second from left) with the upstate team (from left): Jennifer LaGoy, RN; Maureen Getman, Clinical Account Specialist; and Heather DeBrita, RN The Heart Group doctors then use that data in real time to deliver care. Pinpoint Treatment Physicians with The Heart Group perform ablations in all four chambers of the heart. Wherever the procedure may be necessary, the process of locating and treating an arrhythmia follows a similar pattern. "We achieve minimally invasive access through the femoral arteries or veins, depending of whether we have to access the left or the right heart," Dr. Anghel says. "Then we use 3-D mapping, CT scans, cardiac MRI, X-rays and ultrasound imaging to help us place and guide the catheters in the heart. After that, the procedure is, to a significant degree, analogous to establishing the basic properties of an electrical circuit board and looking for shorts. When we find the origin of the arrhythmia — often with hints from the patient's presenting symptoms — we deliver a pinpointed radiofrequency current to create a small scar so that the respective area is no longer able to discharge energy. "The mapping technology is similar to a GPS, with 'satellites' attached to the patient's skin and a locator chip at the tip of the catheter within. Using a computer workstation and a 'map' provided by a highresolution CT scan, MRI or ICE, we guide the catheter based on real-time feedback." An Atmosphere of Respect, Cooperation Dr. Anghel lauds the collaboration and professionalism that guide the care provided at the hospitals where The Heart Group practices. MDNEwS.COM ■ MD News Central New York | 11