VCU news

By Joe Kuttenkuler

The Virginia Commonwealth University Pauley Heart Center is the first in the United States to use a new type of intracardiac ultrasound machine that produces enhanced imaging of the heart, allowing cardiac electrophysiologists to better diagnose and treat atrial fibrillation.

Atrial fibrillation, or a-fib, is caused by abnormal electrical impulses that begin at the top of the heart and travel down the upper chambers, or atria, causing erratic contractions. The irregular rhythm, which affects more than 2 million Americans, interferes with the heart’s ability to efficiently pump blood. As a result, blood can pool in the atria, which can lead to the formation of clots and the possibility of a stroke.

Intracardiac ultrasound (ICU) is a technique that allows doctors to better visualize structures in the heart using a special catheter that is laced through a blood vessel in the leg and advanced into the heart. Traditionally, ultrasound imaging of the heart is done outside the chest with a probe and requires a large, heavy machine that cannot be moved easily.

“Using the ICU catheter allows us to better visualize important structures in the heart, it allows us to better move our catheters around more safely inside the heart and finally, it allows us to move catheters to certain areas in the heart where we feel we need to deliver radio frequency energy so we can ablate the right tissues,” said Kenneth Ellenbogen, M.D., professor of cardiology and director of the cardiac electrophysiology lab at the VCU Medical Center, who performed the imaging technique using the new technology.

GE Healthcare developed the small and compact, Vivid i system that delivers imaging performance equal to that of today’s leading high-end console ultrasound systems without crowding the lab. The Vivid i ultrasound system displays high quality images of the anatomical structures of the heart and delicate valvular structures, helping to improve efficacy of the catheter ablation and patient safety.

“We’re going from a machine that is quite big and takes up a lot of space to one the size of a laptop computer that is positioned at the bedside. It gives us spectacular images of the heart, our catheters in the heart and the structures in the heart and helps us do an even better job of ablating atrial fibrillation more safely and more effectively,” Ellenbogen said.

Using ICU, cardiac electrophysiologists can to some extent avoid or decrease the use of X-ray or radiation to image the heart because the catheter uses sound waves to help detect what’s going on in the heart.

About 10 years ago, VCU cardiac electrophysiologists, together with experts from several other centers, pioneered the use of this catheter to treat a-fib.

Catheter ablation is used to burn sites inside the atria and ventricles – the heart’s lower pumping chambers – that cause arrhythmias. In the procedure, one or more catheters is placed inside the heart to locate the origin of the electrical short circuits. Once the area is located, the surgeon delivers heat energy to destroy the abnormal electrical circuit.

“Through catheter ablation of a-fib, our main goal is not just to improve efficacy but to make it safer for patients. The way we do that is to make it so we’re better able to visualize what we’re doing inside the heart, by avoiding delicate structures that we don’t want to treat and using our imaging tools and technology to get the best and safest results,” Ellenbogen said.