Under The Knife Of Innovation

My Experience With Cardiac Ablation Surgery

was born with a heart condition called Wolff-Parkinson-White syndrome. I recently underwent a procedure to correct my heart condition, and during the surgery I was surrounded by amazing looking machinery which allowed the doctors, and myself, to see my heart in real-time on the big screen. For this blog, I’d like to share my experience being under the knife, and investigate the technology that made this procedure possible. So strap in, we’re going behind the scenes in the operating room, and straight into the innovative technology that is involved in cardiac ablation.

What Is Wolff-Parkinson-White syndrome?

As far back as I can remember, I can think of a few infrequent times when I’d have minor episodes of an uncomfortably fast heartbeat, called an arrhythmia or tachycardia. However in more recent memory, these episodes became more frequent and developed into a major concern to my moderately active lifestyle because they often hindered me from prolonged periods of regular exercise.

Diagram illustrating one of the possible locations for an accessory pathway causing WPW.

WPW is caused when an extra electrical pathway, found between the heart’s upper chambers (atria) and the heart’s lower chambers (ventricles), causes a rapid heartbeat (tachycardia)… For people with WPW, the extra electrical pathway is present at birth and is considered fairly rare. WPW is reportedly detected in about 4 out of every 100,000 people [1].

As result of my increasingly frequent episodes of tachycardia, I sought out the opinion of various cardiologists. After a few consultation sessions, I opted for a surgical procedure that would permanently correct the problem; the other option would have been to take medication for the rest of my life… no thanks.

The Surgical Procedure

The procedure I opted for is called cardiac ablation. This is a procedure that is used to scar small areas in the heart that may be a part of an extra pathway that is involved in heart rhythm problems. Scarring these areas can prevent the abnormal electrical signals or rhythms from moving through the heart.

In short, during the procedure, small wires called catheters were fed up towards my heart through the veins starting near my groin, and were placed inside my heart to measure the electrical activity. When the source of the problem was found, the tissue of the extra pathways causing the problem was destroyed using electrodes on the catheter.

The Technology Involved

X-Ray Radiography C-Arm System

When I was brought into the operating room, the first piece of hardware I noticed was the large overhead machinery mounted to various arms. This device was a component of the X-Ray Radiography C-Arm system which would provide the surgeon real-time imaging of my heart.

X-Ray Radiography system hardware, providing real-time x ray images on the monitor.

Radiography is an imaging technique that uses electromagnetic radiation other than visible light, especially X-rays, to view the internal structure of a non-transparent object of varying density and composition such as the human body. To create the image, a beam of X-rays is produced by an X-ray generator and is projected toward the object. A certain amount of X-ray is absorbed by the object, which is dependent on the particular density and composition of that object. The X-rays that pass through the object are captured behind the object by a detector. The detector can then provide a superimposed 2D representation of all the object’s internal structures [2].

Remote Magnetic Navigation: Stereotaxis Niobe System

As I lay on the operating table awaiting the procedure to begin, I took note of the two large units on either side of the table (as can be seen in the image above). Although this technology was not used in my particular procedure, it was fascinating to think that a doctor doesn’t even need to be directly working on a person to control the movements of an object in their body.

The Remote Magnetic Navigation system utilizes two permanent magnets mounted on pivoting arms that are enclosed within a stationary housing, with one magnet on either side of the patient table. These magnets can generate a magnetic field allowing control of a catheter tip within 1mm accuracy.Advantages of the system include more precise control of diagnostic and therapeutic devices, reduction in x-ray exposure to physicians, staff and patients, soft and consistent tissue contact along with efficient and successful procedures due to computer control and digital automations [3].

Electroanatomic Mapping

A large part of the procedure involved mapping my heart to locate the specific region of the accessory pathway. This part of the procedure required me to be mostly awake, because had I been fully under, my heart would have been beating too slow for any extra electrical signals to be detected. I remember a portion of the procedure where they crossed through the septum of my heart, and I could feel the catheter puncturing and moving inside my heart; I got a good dose of pain that day. After the drugs wore off, I saw the map of my heart on the screen. I saw all the points where the doctors tested, and ultimately the cluster of points where they destroyed the tissue of the accessory pathway causing my condition.

The on screen image of a heart mapping, the red points indicate regions of scarring.

Electroanatomic mapping systems provide colorful 3D images that show variations in a patient’s anatomy. These systems may assist doctors in assuring that lesions are contiguous (no gaps), and in reducing complications, such as perforation of the heart… Electrophysiologists create a real time 3D view of the heart by positioning a mapping catheter in the heart. When the doctor moves the catheter in a sweeping motion, the systems track the catheter’s location. Electroanatomic mapping systems also provide real time data on electrical activity within the heart, which means that electrophysiologists can see whether conduction block has been achieved. The systems also provide other real time information, such as atrial pressure and volume, so doctors can easily monitor the patient during the procedure [4].

Ablation Catheter

One of the key components of the procedure is the ablation catheter, the actual device which is used to correct the affected regions. The device was fed up through a vein in my groin to my heart using the previously mentioned guidance systems. Once the accessory pathway was isolated, the ablation catheter was activated to burn and scar the region to make it no longer effective for conducting electrical currents. I remember at the end of the procedure the medical team were going over the prices of the equipment being used. They had said that this particular device cost $3000; I think they were trying to make me nervous, and it worked, because I felt like there were some sort of hidden fees that I had to pay. Thank goodness for the Canadian healthcare system!

Radiofrequency ablation (RFA) catheters.

Radiofrequency energy is used to destroy abnormal electrical pathways that are contributing to a cardiac arrhythmia. The energy-emitting probe (electrode) is at the tip of a catheter which is placed into the heart, usually through a vein [5].

The End Results

That just about sums up my experience with cardiac ablation surgery. I am now three weeks into life after the procedure, and so far recovery has been without any issue — knock on wood. My doctor said that there is a less than 2% chance that the condition would return, and so far I have yet to feel any sign of palpitations. I think I’m fixed! I hope this exploration into the technology that made this procedure possible was enjoyable, and I definitely feel lucky to have learned so much from this experience.

-J

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