Mario Pascual, MD, electrophysiologist at the Miami Cardiac and Vascular Institute at Baptist Hospital, talks about using old cancer procedures to treat the heart.
Explain this case and why this case is the first of its kind.
PASCUAL: So, this is a 77-year-old gentleman who had a really a severe cardiomyopathy. And he had multiple interventions for an arrhythmia called ventricular tachycardia. Despite these interventions, he continued to have that arrhythmia, which is similar to an episode of sudden cardiac death. We felt he was too sick and therefore we had to look at new treatment options in order to treat this arrhythmia, and that’s where we came up with the idea to attempt our first stereotactic radio ablation. Stereotactic radio ablation is using an old procedure which is used to treat patients with cancers such as lung tumors and instead applying that therapy to the heart. So, what we did is we targeted the area of the heart which was causing this arrhythmia using stereotactic radio ablation instead of a traditional catheter-based approach, which is essentially our standard of care within electrophysiology.
Why hasn’t this been used in the past?
PASCUAL: It has at Washington University, the trials are just getting started. So, they probably have the most experience with it. And, you know, I think it takes a lot of collaboration. So, if you look at this approach to the patient care, it’s a really a multidisciplinary approach. Electrophysiologist is involved, a general cardiologist, a cardiac imaging specialist, an advanced heart failure specialist and then you have to collaborate with a radiation oncologist on top of that. So, I think it just takes a lot of moving parts in order to have a successful treatment plan and a successful outcome.
Why was this the best-case scenario for this man?
PASCUAL: This gentleman had a couple of issues where we didn’t feel he would be a great candidate for the standard ablation technique. We felt he was too sick to undergo any type of invasive intervention. We also felt that the areas we needed to target would not be amenable to ablation from our traditional approach. So, if we look within the heart, there certain areas that we have a tough time targeting with our catheters, radio ablation can really target anywhere within the heart and can do it safely and effectively.
How is this going to change things going forward?
PASCUAL: This has been a huge success and we couldn’t be happier with the overall outcomes. I think we need to look at the overall long-term safety and efficacy of the procedure as it’s still a very new procedure. If we look at our standard ablation techniques, most patients will require prolonged hospital stay and optimization after surgery because most of those patients require general anesthesia or at least modified anesthesia care. This gentleman arrived, we put in an IV, he underwent treatment, we watched him for 20 minutes later and he went to home to have dinner with his family that night. So, it was just an incredible outcome for the patient and his family and really a success story for our institution.
How does this make you feel as a physician?
PASCUAL: Extremely proud. This is a patient who we had really been being taking care of over the last at least 20 years in our group, and so we have a very long relationship with him from his general cardiologist all the way down to the radiation oncologist. We had just seen him really deteriorate over the last 12 months and any time you have a longtime patient like that you take that home with you and it means a lot to you. So, to be able to offer him this treatment and see the outcome and the success has really brought a lot of happiness to our group.
How does it feel to pioneer something?
PASCUAL: It’s been a very thrilling adventure, that’s for sure. We relied heavily on all our specialists. So, we relied on our advanced heart failure specialists to get her to the procedure in a very stable condition. We relied on our radiation oncologist colleagues in order to be able to target the appropriate, and we were there to support them throughout the entire way. Now, you know it’s a lot of hard work. I kid with the radiation oncologists that, for probably two to three weeks prior to the procedure, I had dinner with him more often than I had dinner with my family, but now to see the success of the procedure, it’s certainly well worth it and we’re thrilled.
Describe the procedure.
PASCUAL: Essentially, the radio ablation is targeting areas in the heart that are causing abnormal arrhythmias. So, electricity should flow in the heart in a very efficient and very smooth pattern. When you have areas of scarring, either because of previous heart attacks or because of an underlying cardiomyopathy or a weak heart, you can develop arrhythmias in the heart that can cause abnormal heart rhythms such as ventricular tachycardia. So, what the radio ablation is doing is we’re identifying those areas that are contributing to the abnormal heart rhythm and treating them with radiation in order to not allow that area to conduct electricity. So, it’s using a radiation therapy to prevent abnormal electrical conduction in the heart.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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