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Summer 2007

Novel Therapy Fixes Abnormal Heart Beat

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A pioneering cardiac ablation technique offered at UCLA can help patients with potentially dangerous ventricular arrhythmias on the surface of the heart.

Approaching from outside rather than inside the heart, the procedure gives these patients a minimally invasive alternative to heart surgery.

“Previously, cardiologists could address arrhythmias with minimally invasive ablation techniques only from inside the heart,” says Kalyanam Shivkumar, M.D., Ph.D., director of the UCLA Cardiac Arrhythmia Center and electrophysiology programs. “But irregular heart rhythms can originate anywhere, even on the heart’s surface. The closer the cardiologists can get to the origin of the arrhythmia, the more effective treatment will be.”
Several million Americans suffer from ongoing fatigue or regular shortness of breath due to changes in electrical function of the heart muscle that cause rapid or abnormal rhythms. While many arrhythmias are benign, nearly 250,000 people die suddenly each year due to these rhythm disturbances.

Ventricular arrhythmias, those arising from the lower chambers of the heart, are particularly dangerous and increase risk of sudden death due to cardiac arrest. Atrial fibrillation, a common heart problem originating in the upper chambers of the heart, carries increased risk of stroke when untreated.

Endocardial ablation, which uses heat to destroy abnormal tissue inside the heart, is the standard of care for both atrial and ventricular arrhythmias. The procedure uses X-ray guidance to thread a wire, or catheter, through a blood vessel in the groin to the interior of the heart and cauterize the site with radiofrequency.
However, about 30 percent of ventricular arrhythmias originate in tissue on the outside of the heart and cannot be treated effectively with endocardial ablation. So UCLA physicians helped perfect an alternative called epicardial ablation and about five years ago became the first to use the procedure on the West Coast. UCLA is one of the most experienced centers in the world offering this innovative technique.

Epicardial ablation involves threading a wire beneath the rib cage to reach the exterior of the heart and applying energy via catheters that can destroy problem tissue with either heating or freezing. The outpatient treatment carries low risk of complications and most patients resume normal activities within a few days.

Dr. Shivkumar, and his cardiology colleagues Noel G. Boyle, M.D., David Cesario, M.D., and Osamu Fujimura, M.D., are investigating innovative techniques for managing cardiac arrhythmias without medication.

See a patient's story at streaming.uclahealth.org/ablation

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