Dr. Gianluigi Bisleri and Dr. Benedict Glover: Collaborating on a cardiac first for Canada
Only a few health centres in the United States and Europe are collaborating on the treatment of arrhythmia among their cardiology and cardiac surgery units. But in a Canadian first, cardiology and cardiac surgery have now merged into a “heart team” at Kingston Health Sciences Centre (KHSC) to provide new strategies and treatment options to patients.
On June 29, a hybrid cardiac ablation procedure was successfully performed by this team, marking the first revolutionary treatment of its kind in Canada. This new procedure may be considered as an option for patients who suffer from atrial fibrillation, which is the most common kind of irregular heart rhythm.
In this hybrid procedure, surgeon Dr. Gianluigi Bisleri performs an ablation on the outside of the heart using a specialized device. The ablation involves creating scars in certain areas of the heart to block an irregular heart rhythm. While this is taking place, cardiologist Dr. Benedict Glover uses electrophysiology technologies and a catheter to map and monitor the ablation in real time.
“Previously, we didn’t have mapping systems and tools that were allowing us to monitor and understand if the ablation was effective,” said Dr. Gianluigi Bisleri, a cardiac surgeon at KHSC and associate professor of surgery at Queen’s University. “We were doing sort of a ‘blind’ ablation session.”
Using a complex mapping system called Ensite Precision produced by Abbott technologies, thousands of electrical points are collected from within the heart. A catheter is positioned in the chamber of interest, and the electrical information is processed by a complex computer. This then displays regions of block to ensure that the surgical team has created an ablation line.
“This technology is extremely accurate, and if any gaps in conduction are noted these can be completed by delivering precise applications from within the heart,” said Dr. Benedict Glover, a cardiologist at KHSC and assistant professor of cardiology at Queen’s University. “Some other centres perform this as a separate procedure but we wanted to do it all in one, which is more difficult to coordinate, but minimizes the number of procedures the patient requires.”
The new hybrid procedure requires only three keyhole incisions to navigate to the heart, avoiding more invasive surgical procedures such as opening a patient’s chest, stopping the heart and/or creating surgical incisions directly on the heart itself. With the hybrid approach, patients also benefit from a shorter hospital stay, lower chance of re-admission and less reliance on medication.
Roughly 350,000 people in Canada currently experience atrial fibrillation, most notably those between 60 and 65 years of age. However, Dr. Bisleri notes that the hybrid ablation was not designed to treat all of these patients. “This is a large pool of patients, and out of these patients, we have some who respond very well with medication,” he said. “But we also know that many patients are not responding to drugs and medication.”
As for the future, the next cardiac hybrid ablation procedure is scheduled for this month, but Dr. Glover, a native of Ireland who arrived in Kingston two years ago, is thinking long term. “We will continue to perform at least two procedures every month,” he said. “As we continue to perform these, we will modify the exact technique, and we have plans for further research and development in this field.”
But this isn’t their first accomplishment in the area. Dr. Bisleri, a native of Italy, started working on the hybrid concept for ablation in 2009, and published the first literature on the topic in 2004. From Europe, he arrived in Kingston last October, with plans to develop advanced procedures in arrhythmia.
“I had the opportunity to come into contact with the surgeons and team of cardiologists here in Kingston, and they were excited about developing and expanding the collaboration between cardiology and cardiac surgery,” he said.
Both doctors acknowledge their training abroad and the warm welcome received in Canada to help further advance this procedure.
“We have both been impressed by the leadership within both Queen’s and KHSC, who are actively recruiting new, ambitious individuals in order to develop state of the art care,” said Dr. Glover.
This article originally appeared in our monthly e-newsletter, Spotlight on Health.
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