I read Dr.Wes’ blog to get better insight into the professional lives and needs of clinical cardiologists and EPs. This week, Dr.Wes posted an excerpt from and commented on this interesting account of ablation in a baby. I’ll repeat the excerpt because it’s worth showing:

All of the planned means of tackling Stellan’s SVT today during his ablation failed initially. Heart block was induced each and every time from each and every angle they tried to ablate. Dr. A and his team were left with little choice but to ablate Stellan’s AV node in order to get rid of his accessory pathway. But before they did, one of Dr. A’s colleagues threw out a wild idea.

“Let’s try to go through his aorta.”

Not in the plan. Not even in the possible or hypothetical plans. Not considered safe or feasible or wise on a 10 kilo baby. But with few options left before destroying Stellan’s node, they decided to risk it.

To be honest, I’m glad I didn’t know about it at the time.

So from his groin, they threaded the catheter up into his aorta, down into his atrium and through his valve toward his ventricle. From that angle, even though Dr. A said they were in the exact same spot as they’d tried ablating earlier, there was a money shot. He tried cryoablation. It started to zap his SVT with no heart block. So he tried a little more cryo. Again, no heart block.

So Dr. A pulled out the big dog. The radio frequency ablation catheter. His ultimate goal was to get 2 to 3 seconds of ablating done, even if it destroyed his node.

1 second. 2 seconds. 3, 4, 5.

From that angle, through the aorta, Stellan’s AV node remained untouched.

Unbelievably, Dr. A was able to crank up the wattage and ablate Stellan’s extra pathway for one solid minute before declaring his pathway dead on arrival.

And his AV node is as happy as the day is long.

Dr.Wes aptly notes that this sort of thing does not meet with the idealized always-follow-the-guidelines-or-else strategy being espoused by Washington of late. On the one hand, I’m all for evidence-based medicine and adhering to known best practices. On the other, this is a clear example of the variability that occurs from patient to patient, and the importance of experience and skill on the part of physicians enabling them to know when to bend or break the guidelines. Bravo.

We had a family emergency last week, so this post is delayed. I hope you all had a great weekend.

This is from a post by Dr.Wes. A friend of one of the device nurses got the tattoo to go with her ICD. “No jumpstart needed” per the shirts that inspired the design.

If you’ve been following my Twitter or Facebook accounts, you’ll already know that I successfully defended my doctoral dissertation this past Wednesday. I now (essentially, absent the completion of some clerical things) have my PhD from Johns Hopkins University.

One thing that is asked a lot of people graduating from anything is what they plan to do next. I have been waiting for some time to be able to answer that question, and now I can.

The lab of which I have been a member since late fall of 2002, the Trayanova lab is one of (if not the) the leading groups in the world when it comes to cardiac electrophysiology and mechanics research. I would guess that the lab as a whole has probably run an order of magnitude more simulations, at a minimum, than the next closest group. A lot of my time and effort as a graduate student went into improvement of the tools used for generating and running models, and I have nearly seven years of experience setting up, running, and analyzing simulations.

The lab does very interesting things, and cutting-edge research. Almost every new study is accompanied by tool and methodological development. However, there are a lot of practical applications that are never explored by the lab, because they don’t necessarily constitute scientific discovery of the kind valued in academia.

It takes a long time to train people to use simulation software developed in an academic research environment. It is extremely powerful, and has far more options available than any one user will ever use. This is acceptable for graduate students that will be spending years in the lab, and will often be digging in the guts of the code and adding their own features. It’s not acceptable for, say, industrial or academic wet-lab researchers that just want to run some simulations and figure something out.

That’s where CardioSolv comes in. CardioSolv, LLC, is a new cardiac simulation and services company. Its aim is to commercialize cardiac simulation, and make it easy for new users to rapidly produce scientifically valid and useful results. To that end, we are building a web interface that will by default handle most of the difficult choices for users, while still allowing them to specify detailed parameters if necessary.

My role in this company is Vice President of Operations. I’ll be managing the day-to-day operations of the company, interacting with customers, and guiding product development. My hope is that we can bring our technology and our discoveries out of academia, and into the drug and device development markets, with the ultimate goal of improving patients’ safety and quality of life.

Dr.Wes has a very cool post up about Belgian soccer player Anthony Van Loo being saved by his ICD, with a video of him collapsing on the field, getting zapped, and then getting up, and another video of him describing the experience.

Very interesting stuff from Dr.Wes as usual!

Check this out:

An 81-year-old woman with a mercury-zinc powered permanent pacemaker experienced the sudden pain on her pacemaker pocket followed by an explosion. We are aware of no other report of the spontaneous and symptomatic bursting of a generator battery with fracture of the pulse generator capsule.

Emphasis mine. It’s an old paper (1987) and you can get the full text for free at the journal’s site, here.

Crazy, huh?