One of the exciting things about working in medicine is the way the science keeps breaking new ground. Techniques and technologies that were a surgical pipedream 30 years ago are now a regular part of patient care.
That’s especially true in heart rhythm cardiology, where so many of our treatments have been transformed by monitoring devices like pacemakers or procedures such as cardiac ablation (where surgeons apply a controlled dose of intense energy to heart tissue to correct an abnormal rhythm).
This month, the medical journal Hospital Professional News Ireland asked Dr Lyne to highlight recent advances in two key areas: pacing (using an implanted device to regulate heart rhythm) and electrophysiology (studying the heart’s electrical system to treat rhythm problems). Although the journal and articles are for medical professionals, the theme may be of interest to many patients. Here are 10 of the biggest technological advances.
Heart rhythm devices are becoming more sophisticated by the year. The latest pacemakers and defibrillators transmit data directly to doctors, allowing us to check the device is working well and quickly identify rhythm problems like atrial fibrillation (AF).
Earlier devices needed an external transmitter based in the patient’s home in order to send out data about their heart. Now many of them connect to apps that patients can download to their phones, which means they can provide near-continuous remote monitoring.
Longer battery life
Batteries have been getting simultaneously smaller and more powerful. This is important for cardiac devices, because it means a reduced footprint inside the body, and longer gaps between replacement procedures.
New techniques using guided ultrasound and “balloon dilation” have made it easier and safer to introduce electrical leads into the heart. This is particularly helpful when a patient has narrowed veins that can potentially block the entry of the leads.
Surgeons have recently developed a new “hybrid” technique that enables us to gently remove old leads at the same time as new ones are introduced; this is helping to make replacement procedures safer, with better outcomes.
3D “maps” of the heart have been with us since the mid-1990s, but the software is becoming far more powerful. We can now visualise catheters in real-time with up to 1mm precision, allowing for more targeted ablations, and less need for alternative procedures that involve high volumes of x-ray.
New catheters (the tiny tubes used to run wires into the heart) include “force-sensing” technology as the wires make contact with heart muscle, helping surgeons to be even more targeted with ablations.
Modern catheter tips can precisely detect the temperature at the surface of the heart tissue, which prevents the device from overheating and improves the overall safety of the operation.
Ultra-low temperature treatment
“Cryoablation” uses pinpoint freezing technology to correct arrhythmias. A recently-released system allows us to cool tissue to -190C (compared to -70C or -80C); research is ongoing but we hope it will enable us to treat a wider range of patients with AF.
“Electroporation” is another very encouraging development within ablation technology. Originally designed for cancer care, it has been repurposed to provide the first non-thermal ablation technique for cardiac arrhythmias. Doctors hope it will lead to shorter operation times.
Interested in finding out more about how these devices and procedures work? You can read more about both on the Heart Rhythm Cardiologist website, in our pacemakers and electrophysiology studies sections.