• 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 anticoagulants .
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Pulsed field ablation
In fiscal year 2024 , pulsed field ablation was added as a treatment option . The technology is a significant advancement in the field of electrophysiology using electroporation to induce cell death and durable lesions . Collateral damage to the lungs and esophagus has been shown to be significantly minimized , as ablation is cardiac tissue-selective . In addition , operators have found that efficiency of performing the procedures is improved without compromising effectiveness .
VT ablation
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 , nonischemic cardiomyopathy or scar tissue as a result of a prior heart attack , VT left untreated can be potentially lethal .
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 .
Convergent for persistent Afib
The convergent procedure for persistent Afib is available on the Dallas campus . This procedure involves both epicardial and endocardial ablation and combines the expertise of both a cardiothoracic surgeon and an electrophysiologist . Generally , the full treatment is performed in two stages , two to six weeks apart .
An endocardial ablation approach with pulsed field ablation is usually performed first , with a surgical epicardial procedure combined with left atrial appendage clipping to minimize stroke risk performed for patients with recurrent atrial fibrillation episodes . Electrophysiologist on the medical staff , Alan Donsky , MD , FACC , has spearheaded this technology with the CT surgery division .
The Heart Rhythm Center at Baylor Scott & White Heart and Vascular Hospital – Dallas offers referring providers and their patients multidisciplinary assistance in navigating the journey of seeking treatment options for heart rhythm disorders . For more information about the Heart Rhythm Center , see additional information in the Advanced Cardiovascular Centers section of this book or call the nurse navigator at 214.820.5306 .
LAAO devices becoming standard of care
An early adoption in the history of the department was the use of left atrial appendage occluder ( LAAO ) devices to treat patients with atrial fibrillation who cannot tolerate blood thinners to minimize the chance of strokes . The LAAO device is designed to prevent blood clots that form in the left atrial appendage from dislodging and traveling in the bloodstream to the brain , lungs and other parts of the body .
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LAAOs performed ( FY24 )
Electrophysiologists on the medical staff in Dallas were successful with bringing left atrial appendage occluder devices through clinical trials and post-FDA approval in 2016 .
The use of a 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 anticoagulants .
Baylor Scott & White Heart and Vascular Hospital — Dallas | Electrophysiology
Medical follow-up continues 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 .