• are at increased risk for stroke and systemic embolism based on CHADS2 or CHADS2-VASc scores and are recommended for anticoagulation therapy , and
• have an appropriate rationale to seek a nonpharmacologic alternative to oral anticoagulation , taking into account the safety and effectiveness of the device compared to warfarin .
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Baylor Scott & White Heart and Vascular Hospital - Dallas | ELECTROPHYSIOLOGY
Catheter ablation of ventricular tachycardia
In the past fiscal year , catheter ablation volumes have grown as a treatment option for patients with ventricular tachycardia ( VT ), the abnormal rapid heart rhythm originating from the lower pumping chambers of the heart — the ventricles . Most commonly seen in patients with a weakened heart muscle from cardiomyopathy or from scar tissue as a result of a prior heart attack , VT left untreated can evolve into potentially fatal ventricular fibrillation . To perform the procedure , a long , thin wire is placed into the heart chambers femorally ( through veins in the leg ). Once the areas of the arrhythmia are identified , a localized burst of radiofrequency energy is applied , cauterizing the abnormal electric circuit of the VT .
Left atrial appendage occlusion
Another early adoption for the department was the use of left atrial appendage occluder ( LAAO ) devices to treat patients at risk of developing blood clots , specifically patients with atrial fibrillation due to the compromised heart pumping ability increasing the potential for clots to form . The LAAO device is designed to prevent blood clots that frequently form in the left atrial appendage from traveling in the blood stream to the brain , lungs and other parts of the body .
Electrophysiologists on the medical staff in Dallas were successful with bringing left atrial appendage occluder devices through clinical trials and post-FDA approval . Approved by the FDA in 2016 , the device is now a more commonly offered viable option for many patients who have difficulty with blood thinners or not able to tolerate blood thinners .
After receiving this device , patients are typically released from the hospital after 24 hours . Medical follow-up continues over the course of time as patients decrease their blood thinner medication under the supervision of a cardiologist . Generally , with the device in place , patients no longer have a need for blood thinners .
LAAO device is suitable for patients with nonvalvular atrial fibrillation who :
• are at increased risk for stroke and systemic embolism based on CHADS2 or CHADS2-VASc scores and are recommended for anticoagulation therapy , and
• have an appropriate rationale to seek a nonpharmacologic alternative to oral anticoagulation , taking into account the safety and effectiveness of the device compared to warfarin .
Leadless pacers
For nearly a decade , electrophysiologists on the medical staff at Baylor Scott & White Heart and Vascular Hospital – Dallas have been involved in safely bringing to market and to patients the world ’ s smallest leadless pacemaker .
The size of a nickel or paperclip , the pacemaker represents the first entry in what is a new class of slender , minimally invasive pacemakers that rest entirely inside the heart , specifically the right ventricle .
Tiny bits of metal on the end of the pacemaker hook or screw into the heart tissue . This avoids the need for traditional pacemaker insulated wires ( leads ) to deliver the pacemaker ’ s electric pulses . Leads have long been called the “ Achilles ’ heel ” of pacemakers because they can wear out and create infection risk .
Aveir™ VR Leadless Pacemaker Courtesy of Abbott
Device lead extraction
Patients who are referred to the Dallas campus with complex conditions may need removal of leads because of electrical malfunctions , blocked blood vessels or infection . In most cases , the leads can be removed using a catheter-based approach .
LAAOs performed ( FY23 )
140