Electrophysiology at Ascot Cardiology Group

Author: Dr Warwick Jaffe

Click here for Patient information on the Electrophysiology Study (EPS) offered at Ascot Cardiology Group.

Transcript:

Dr Patricia Ding:

Morning everyone, I'm Patricia Ding, Cardiologist. I'm here with Dr. Warwick Jaffe, Interventional Cardiologists from Ascot Cardiology. So Warwick, I hear that we've got some new electrophysiology services available at Ascot angiography. Can you tell us about that? That sounds really exciting.

Dr Warwick Jaffe:

Yes, it's a great breakthrough for us. We have a new electrophysiology laboratory that's ready to go and has done several cases here at Ascot angiography. Using this principal user, is Dr. Andrew Gavin. He is a cardiac electrophysiologist based at North Shore Hospital, but also working widely throughout Auckland.

Dr Patricia Ding:

What are the procedures we are performing there from electrophysiology point of view?

Dr Warwick Jaffe:

Well, we're doing ablation procedures, pacemakers, et cetera. I'd like to really talk about what sort of patients we want to be doing these procedures on and generally the indications for them.

Dr Patricia Ding:

Clinically they all have palpitations.

Dr Warwick Jaffe:

Yes.

Dr Patricia Ding:

Do we need to see all the patients with palpitations?

Dr Warwick Jaffe:

No. A lot of patients with palpitations can of course, be managed in general practice, usually those with the ectopic beats and more minor forms of arrhythmia. Most of those that end up at the cardiologist are those that are the more symptomatic or have very frequent palpitations.

Dr Patricia Ding:

There's the supraventricular tachycardia patients and the atrial arrhythmia ones that we are interested in.

Dr Warwick Jaffe:

Mostly, yes. Most of you will remember supraventricular tachycardia that's now, terms not used so much. We usually precisely define the mechanism of it because it allows us to work out how to fix it. But these patients generally with narrow complex arrhythmia, most of the time they are either managed with simple reassurance of Valsalva maneuver to try and get rid of it. Or if it's intrusive, these days they have an ablation procedure. That's because taking drugs for a younger person lifelong, to prevent these atrial arrhythmias is not very attractive. One from a lot of side effects and the ablation procedures for SPT and et cetera, are relatively safe and very effective.

Dr Patricia Ding:

What are the success rates of these procedures?

Dr Warwick Jaffe:

Very high, mostly about 90, 95%. Those people would do get a recurrence. They can often be treated with a second procedure. Now that's not true of course, for the more complex forms of arrhythmia that we're going to talk about in a second.

Dr Patricia Ding:

What about the more complex patients with atrial fibrillation or atrial flutter?

Dr Warwick Jaffe:

Okay, well you bring up an important point there. A lot of you are GP's think atrial flutter and fibrillation are the same thing, but they're actually two quite different arrhythmias. Flutter is a much more organized, regular arrhythmia. The majority of patients with flutter arises from the right atrium. That is something that is very suitable for an ablation procedure of simple antiarrhythmic drugs fail. The success rates high and the relative risk of doing it is pretty low.

Dr Patricia Ding:

Got it. That's for atrial flutter. What about atrial fibrillation? That's a lot more common than atrial flutter. How do we manage that?

Dr Warwick Jaffe:

Most patients with atrial fibrillation can be managed with preventative drug therapy and those that can't, that's where we consider the ablation procedures. Now for people who've got atrial fibrillation permanently, the ablation procedures are really not very useful for that. Mostly they don't work very well. We're generally talking about people who've got atrial fibrillation coming and going or people who've had it for a relatively short period of time.

Dr Patricia Ding:

What about those patients who are not very suitable for AAF ablation? What do we do with those patients?

Dr Warwick Jaffe:

Well, those patients even have to have rate control with drugs and then some people it's very difficult to control the rate or the drugs that they take is too toxic. Those sorts of patients couldn't be considered for electrophysiological procedure. What we do there is destroyed the bundle of HEDIS, so the electricity can't get from the 18th to the ventricle, put it and have them dependent on a permanent pacemaker. You've got to put the pacemaker in first and you do the bundle of his ablation a short time later. That procedure is now available at Ascot angiography.

Dr Patricia Ding:

Okay. Tell us, how is the procedure performed and what's the complication rate?

Dr Warwick Jaffe:

Well, I'm not a cardiac electrophysiologist. Basically you put some tubes into the veins in the right groin that you have to access the left atrium. That's the area where the atrial fibrillation comes from. The pulmonary veins are all isolated because that's where the triggers for atrial fibrillation come from. An injury is inflicted on the mouth of each of the pulmonary veins and can easily be done by heating them up with radio frequency or by calling them with liquid nitrogen at minus 70 degrees. That creates an injury and hopefully stops patients giving for ablation. Works about 70 or 80% of the time and highly selective patients. Some of those people, you've got to do it a second time to get an enduring result. The whole problem with the procedure of course, is that there's a risk involved. Their heart can be perforated. There are various other real risk, similar risks of low they're pretty bad or serious. We're never going to do one of these ablation procedures in someone and they seem pretty badly effective.

Dr Patricia Ding:

That sounds very exciting work. Thank you very much. It's been a pleasure.

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Remuera, Auckland 1051
PO Box 17 187,
Greenlane, Auckland 1546

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