Tip:
Highlight text to annotate it
X
>> Hi.
I'm Dr. Richard Hongo
and I'm a Cardiac Electrophysiologist.
Today we're here at California Pacifica Medical Center
which is in San Francisco.
This is one of our dedicated electrophysiology labs where
we're very fortunate to have cutting edge technology that
allows us to perform complex catheter ablation procedures,
such as ventricular tachycardia ablation.
Ventricular tachycardia ablation is all about finding the spot or
the short circuit that is causing the rhythm disturbance
and using catheter based technology
we find and eliminate the cause.
Here at California Pacifica Medical Center we have our
anesthesiologist sedate our patients very comfortably at
the onset of the procedure.
And, through a small incision that I make at the groin site
I place sheaths into the veins, and you can see me putting in
catheters here.
Then we push soft insulated wires, or catheters,
through the large central veins and you can see the catheters
now floating up through the inferior vena cava.
And, we can also utilize the Steriotaxis remote navigation
system to move catheters inside of the heart.
There are several advantages of using this newer system.
One of them is that the catheters are very soft.
You can see me pushing the catheter now up against my hand
and it buckles very easily.
This virtually eliminates the risk of catheters
causing any unwanted injury to the heart wall.
Also, in additional to this using these large earth magnets
that are housed in these retractable towers,
and in this image you can see the towers being pulled in on
either side of the patients, the magnets then move the magnetized
catheter with millimeter precision to really all corners
of the heart just through computerized controls.
And you can see us now dragging the arrow icon on the screen and
moving the catheter this way.
In a very controlled environment we start up and stop
the ventricular tachycardia using pacing and intravenous
medications and we start visualizing where
the tachycardia is actually coming from.
Here is a reconstructed 3D virtual image of the inside of
the right ventricle in a patient with ventricular tachycardia.
The earliest electrical activation is seen here on
this map and shown by red.
So let me explain catheter ablation in
a little more detail.
If this here, my hand, is the wall of the heart,
the ablation itself is caused when the tissue underneath the
tip of the platinum catheter electrode is heated to somewhere
between 50 to 60 degrees Celsius.
Now this in and of itself is not very hot but when kept on one
spot long enough, somewhere between 30 to 60 seconds at a
time, that's enough to cause some denaturing right below
the tip of the catheter itself.
And this denatured tissue stops all electrical conduction and
over a few months time this denatured tissue then heals
itself into some permanent scare and this is what keeps
ventricular tachycardia from reoccurring.
So in summary, catheter ablation for the treatment of ventricular
tachycardia is a procedure that really relies on us being able
to precisely localize where they sight of the tachycardia is
actually coming from.
It is through real advances in technology that we've been able
to now perform this procedure not only effectively but safely
such as the use of 3D imaging where we're able to visualize
where that spot is actually coming from.
Or the use of magnetic remote navigation where we're able to
move catheters safely as well as precisely within the ventricle.
Catheter ablation is an emerging tool in the treatment of
ventricular tachycardia and along side other therapies such
as medications or implantable cardio inverter defibrillators,
it should be a treatment that is considered anytime
you're dealing with ventricular tachycardia.