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Stereotaxis:  A Safer Way To Perform Cardiac Ablation

Leibold Raking Leaves
Dick Leibold, whose heart now beats at a normal rate, has plenty of energy to oversee his maintenance-and-repair service and his enthusiastic and much-loved “employees.”

Richard Leibold, age 63, has a 20-year history of heart problems, including heart valve leakage and arrhythmias (abnormal heart rhythms). Over the years, his cardiologist treated his symptoms with non-invasive procedures, including medication and cardioversion (electric shock).

As time went by, Dick experienced more worrisome symptoms, including increased fatigue and heart rates as high as 130 beats per minute (normal is between 60 and 100). He also knew that his type of arrhythmia, atrial fibrillation, increased his risk for developing blood clots and a subsequent stroke.

While the causes of atrial fibrillation remain unknown, certain factors are associated with the condition, including thyroid dysfunction, high blood pressure, impaired heart pumping function and prior heart surgery. Recent research also suggests, in rare instances, a genetic predisposition. The condition is more common among people age 60 and older.

Finally in June 2010, Dick underwent open heart surgery to repair his leaky mitral valve. At the same time, his cardiothoracic surgeon performed a cardiac ablation in hopes of correcting his arrhythmia. Within months, however, his abnormal heart rhythms returned. A subsequent cardiac ablation, performed by Mark Krebs, MD, director of cardiac electrophysiology at Miami Valley Hospital, did not produce long-term results.

Fortunately for Dick, MVH’s new Heart and Vascular Center, which opened in December 2010, was equipped with an advanced piece of equipment called Stereotaxis. In recent years, cardiologists worldwide have been using this technology to perform coronary interventions, including cardiac ablation, with excellent results.

In July 2011, Dick was the first patient to undergo a Stereotaxis-aided cardiac ablation in the electrophysiology (EP) lab at MVH. Dr. Krebs, who is fellowship trained in cardiac electrophysiology, performed the three-hour procedure. Dick stayed overnight at the hospital and recuperated at home for a few days before returning to work.

Although Dick is still on heart medication, it’s far less than before. And he is off all anti-arrhythmic medications. Today, Dick’s heart rate is 70 beats a minute, and he has energy to spare.

Retired from the city of Dayton after a 34-year career as an operations manager, Dick says he’s still on call “24 hours a day.” He owns a maintenance-and-repair business and oversees 40 apartment units as well as other properties. When he’s not working, his life revolves around his seven grandchildren and their many activities, including soccer and bowling.

It appears Dick’s third cardiac ablation was the proverbial “third-time charm.”   

What Is Cardiac Ablation?

Stereotaxis
The Odyssey interface (the large monitor shown at right in the foreground) allows the presiding physician to see and control every aspect of a Stereotaxis-aided cardiac ablation. In the background, a draped and sedated patient sleeps through the minimally invasive procedure.

Cardiac ablation is a procedure used to remove heart tissue where faulty electrical pathways are causing abnormal heart rhythms. Such arrhythmias can interfere with the proper flow of blood to and from the heart.

During a cardiac ablation, thin, flexible wires (catheters) are inserted into a vein in the patient’s groin and threaded through to the heart. The cardiologist monitors the procedure via imaging equipment. When defective tissue is found, the physician activates electrodes at the tip of the wires to remove the tissue with heat-generating radio waves. [Another option, cryablation, uses freezing cold to eliminate the tissue.]

Cardiac ablation is not surgery. It is a minimally invasive procedure, which does not involve large incisions. Dr. Krebs describes the procedure as “all done through needle sticks” while the patient is sedated. [In some cases, however, ablation is combined with other surgical procedures such as bypass surgery or valve repair. This was the case when Dick underwent open heart surgery in 2010.]

To explain his sub-specialty as a cardiac electrophysiologist, Dr. Krebs says he’s “an electrician in a world of plumbers.” That is to say, he studies, diagnoses and treats the electrical activities of the heart, whereas other heart specialists focus on blockages and arteries i.e., the heart’s vascular system.

How Is Stereotaxis Different?

Stereotaxis technology is a computer-aided robotic system that allows physicians to steer catheters into heart tissue with greater accuracy than is available with conventional (manual-guided) cardiac ablation. The omni-directional catheters provide expert maneuverability within the heart, with precision measured in millimeters.

Stereotaxis technology also has softer, more flexible catheters when compared to the relatively stiff catheters used in manual-guided procedures. Such a “gentle touch” may reduce the chances of damaging the heart wall, which can result in extended hospital care.

By combining the benefits of precise, computer-aided robotic guidance with gentle catheter contact, Stereotaxis technology can provide safer cardiac ablations, with better outcomes and shorter patient recovery time.

According to the manufacturer, Stereotaxis has developed an excellent record of safety, including “44 percent less radiation exposure to the patient” compared to conventional x-ray imaging and a “reported rate of major cardiac adverse events of less than 0.1 percent.”

Krebs HS
Mark Krebs, MD

Physicians are able to sit down while performing a Stereotaxis-aided procedure – a welcome benefit with some procedures lasting six hours or more.

The Stereotaxis Odyssey Cinema interface allows the electrophysiologist to obtain real-time three-dimensional images of the patient’s heart and the moving catheter. The physician also has real-time access to vital data such as the patient’s EKG or intracardiac ultrasound and, with proper communication software, is able to collaborate remotely with other physicians.

As Devin Bailey, RN, who assists Dr. Krebs in the EP lab, explains, “The Odyssey interface offers a ‘cockpit environment’ so the physician can see and control the entire procedure. Without the Odyssey interface, the physician must rely on nurses or technicians, stationed at separate monitors, to relay information.”

MVH has the only Odyssey-equipped Stereotaxis in the Dayton area.  Since 2003, physicians worldwide have used the technology in more than 40,000 cases. [The technology is used in other types of cardiac interventions, but MVH currently employs it only for cardiac ablation.]

At last count, there are 158 Stereotaxis machines in use worldwide, 85 in the U.S., seven in Ohio and two in Dayton, Ohio. As Dr. Krebs observes, “Those are pretty amazing stats that attest to the level of cardiac care available locally.”

Leibold with Family
There is plenty of room in Dick Leibold's newly repaired heart for his seven grandchildren. Pictured, left to right, are Tom, Ella and Kevin Leibold and, in front, Annie Leibold. Not pictured are Claire Leibold and Sean and Justine Naas.

Aside from offering cardiac patients improved care, such advanced technology also enables MVH to attract and retain top-notch medical staff. A Dayton-area native, Dr. Krebs knew he wanted to return to the area to practice. But he also wanted to have the tools required to practice well. Stereotaxis is one such tool now at his disposal.

Keeping Busy

The EP lab at MVH has been busy since Dick Leibold was the first to undergo Stereotaxis-aided cardiac ablation there in July.

Dick has also been busy. In late summer, he took five of his grandchildren on a 10-day vacation to Disney World. “That’s something I would never have been able to do before,” he says of his new lease on life.

Signs of Arrhythmia

  • A fluttering feeling in the chest
  • Racing heartbeat
  • Slow heartbeat
  • Chest pain
  • Shortness of breath
  • Lightheadedness
  • Dizziness
  • Fainting or near fainting
  • Fatigue

For more information, visit us online or call MVH Cardiology Services at (937) 208-7855.