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SIUH Electrophysiologist is on the Beat

silive.com

Back to a normal beat: A new procedure freezes the source of intermittent and irregular heart rhythms

Published: Monday, March 07, 2011, 9:54 AM     Updated: Monday, March 07, 2011, 10:04 AM
Andrea Boyarsky
marcinkowalski.jpg
Staten Island Advance/Irving Silverstein
Clinical electropsysiologist Dr. Marcin Kowalski, right, and Dr. George Abourjalli use the Arctic Front Cardiac CryoAblation Catheter.
STATEN ISLAND — Louise Quinn never expected anything to be wrong with her heart. But in October, during a routine physical, an electrocardiogram discovered an abnormal rhythm.

She was diagnosed with atrial fibrillation, an arrhythmia that affects more than 2 million Americans and can lead to stroke. Ms. Quinn began seeing Dr. Marcin Kowalski, a clinical electrophysiologist at Staten Island University Hospital, who put her on medications to treat the condition.

When those failed, the 59-year-old Huguenot woman, opted for a new procedure instead of trying different antiarrhythmic drugs.

“I didn’t want to be on all that medicine,” said Ms. Quinn, who already uses inhalers for chronic obstructive pulmonary disease. “You do what you have to do.”

The treatment uses a balloon catheter to freeze malfunctioning heart tissue to stop electrical signals causing the arrhythmia.

Dr. Kowalski was the first physician in the city to commercially use the Arctic Front Cardiac CryoAblation Catheter system after it was approved by the Food and Drug Administration in December.

During Ms. Quinn’s three-hour procedure, Dr. Kowalski inserted several catheters through her groin to reach her heart. Using machines such as ultrasounds and X-rays to guide him, he punctured the membrane separating the right and left sides of her heart to get to the four pulmonary veins in the left atrium.

The Arctic Front catheter was positioned against the entrance to one vein, where the balloon was inflated and filled with coolant to freeze the vein’s circumference.

In four minutes, the catheter created a scar around the pulmonary vein, which was a source of erratic electrical signals causing Ms. Quinn’s irregular heartbeat. The procedure was then repeated on the other three pulmonary veins.

“The goal of the procedure is to stop the rapid beating of the upper heart chambers by ablating, or blocking the conduction of atrial fibrillation by isolating the pulmonary vein,” explained Wendy Dougherty, a spokeswoman for Medtronic, which developed the technology.

The success rate for the procedure has been around 80 percent, explained Dr. Kowalski, who was involved with clinical trials of the Arctic Front while at the Medical College of Virginia.

Candidates for the procedure include those with periodic atrial fibrillation that do not respond well to drug therapy.

Cardiac ablation has been used for years to treat arrhythmias. The most common method uses heat to block the unwanted electrical signals.

“Freezing has a less chance of collateral damage to the structures around the heart and we’re able to pinpoint better where we want the scar to be,” said Dr. Kowalski. “The procedure is performed much quicker using the balloon than the conventional burning because you can freeze the entire circumference of the vein at the same time.”

A week after Ms. Quinn’s procedure, she was doing well. For her, heart problems are especially scary, having lost both parents and her husband to heart attacks.

“It’s been emotional,” she said. “I lost too many people because of heart problems.”

Gary Owen, 44, of Westerleigh, was Dr. Kowalski’s first Arctic Front patient. The musician was in the middle of a gig in March 2009, aptly playing the song “It’s All Over Now” by the Rolling Stones, when he suddenly felt faint.

After being taken to SIUH, Owen learned he had atrial fibrillation. He realized he may have been going in and out of the arrhythmia for some time.

“I had heart palpitations throughout the years, but I thought it was anxiety or lack of sleep — the life of a musician,” said Owen, who is a rhythm guitarist with local group The Blue Meanies.

After his initial hospital visit, Owen thought the arrhythmia had run its course. But when he visited his cardiologist this past August, he learned he was going in and out of atrial fibrillation for more than a year.

Dr. Kowalski delivered an electrical shock to his heart that put him back into normal rhythm, and put him on anti-arrhythmia medication. When drug therapy failed to normalize Owen’s heartbeat, he opted for ablation.

“I feel 10 times better now,” Owen said. “So far, so good. I’ve been staying pretty much in rhythm.”


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