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VOL. 129 | NO. 99 | Wednesday, May 21, 2014

In Rhythm

Stern Cardiovascular doctors using new catheter technology

By Don Wade

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It started with ice cream 25 years ago, probably vanilla with chocolate sauce, because that’s his favorite. Or maybe it was pure coincidence, except that over the years Tim Lyles noticed a pattern.

Dr. Chris Ingelmo demonstrates the ThermoCool SmartTouch heart catheter. The device recently was approved by the U.S. Food and Drug Administration. 

(Daily News/Andrew J. Breig)

“Something cold would set it off,” Lyles said.

So would alcohol – even a $200-$300 bottle of red wine. Ice cream and alcohol seemed to be culprits, Lyles discovered, often precipitating one of his bouts of atrial fibrillation (afib).

“It’s like running a marathon, but you’re going from 0 to 10 miles in the blink of an eye,” Lyles, 52, said.

Worse, it could last about as long as three marathons – 12 hours or longer. For years, Lyles would take a drug called propafenone to treat his arrhythmia, or irregular heartbeat. It would, over time, slowly bring him back within normal range. Usually.

“Sometimes the propafenone would work and sometimes it wouldn’t,” he said.

The last year, his incidents became more frequent. Maybe it was job stress. He works in marketing for Valero Energy Corp. out of his East Memphis home and can be at his desk and on his phone for as long as 12 hours a day.

In any case, in late February at about 1 a.m., he started sweating. He wasn’t just in atrial fibrillation this time; he was in RVR – rapid ventricular response. He considered dialing 911, but instead slipped on his shoes and sweatpants and drove to the hospital.

Less than two months later, he was having an atrial fibrillation ablation performed by Dr. Chris Ingelmo, a cardiologist with Stern Cardiovascular Foundation, part of Baptist Medical Group. It was one of 25 such procedures that have been done at Baptist Memorial Hospital-Memphis, the only hospital in the area currently using the ThermoCool SmartTouch Catheter, which was recently approved by the U.S. Food and Drug Administration.

“It’s been approved in Europe for a while,” Ingelmo said. “We always have to confirm the technology in the United States through our governmental process. It’s just the way it is.”

The timing was perfect for Lyles, who reports no complications or further incidents since having the surgery on April 8.

The new device, made by Biosense Webster Inc., is the first therapeutic catheter approved in the U.S. that enables direct, real-time measurement of contact force during catheter ablation procedures.

“It makes us more comfortable doing procedures on older patients.”

–Dr. Chris Ingelmo

“Before, you really didn’t know the exact amount of pressure (being placed on the heart),” Ingelmo said. “Now we have live, real-time data because this updates continuously.”

According to Biosense, during catheter ablation, the therapeutic catheter is inserted through a small incision in the groin. The catheter is then weaved up to the heart through a blood vessel. Once it reaches the left upper chamber of the heart, radiofrequency energy is delivered to the heart wall to create lesions that block faulty electrical impulses that can cause heart rhythm problems.

Another advantage of the new procedure, Ingelmo said, is it allows them to use less radiation. But the biggest advantage is eliminating the approximations in the procedure.

“Previously, we only had indirect measurements,” Ingelmo said. “It’s going to provide a lot of patient benefits. It makes us more comfortable doing procedures on older patients, where there is always the (risk) of more complications.”

Lyles, at 52, does not fit into that “older patient” category. But atrial fibrillation is the most common heart rhythm disorder and a leading cause of stroke among people 65 and older. So with a new improved procedure available, it didn’t make sense to continue down the same path.

Now he’s on a new arrhythmia drug, flecainide, to help prevent further episodes and considers his last incident, which started while he was doing the prep work for a colonoscopy (drinking a cold colon-cleansing solution), to be a “blessing.”

“I didn’t know what to expect,” Lyles said of the ablation procedure with the new catheter. “I’d never had any type of surgery. I mean, I’d had a mole taken off.”

He hasn’t yet played a round of golf, but he has returned to the driving range, so it won’t be long. Meantime, no ice cream or alcohol.

“I’m a Kentucky boy originally, so I liked my bourbon,” Lyles said. “So none of that.”

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