El Camino Hospital has a comprehensive program to treat heart rhythm problems, featuring an electrophysiology lab that breaks new technological ground.
Bing Liem, DO, a cardiologist at El Camino Hospital, is the first in the Bay Area to implant the next generation of cardiac defibrillator. The implanted device, called a cardiac-resynchronization-therapy defibrillator (CRT-D), is just half as thick as others on the market and offers self-correcting software for patient safety, as well as new battery technology that gives it up to seven years of life instead of the typical five years or less.
Dr. Liem joined El Camino Hospital after practicing medicine at Stanford for 18 years and serving as the president of the New Mexico Heart Institute.
Studies show that resynchronization therapy, now in its third generation, improves both survival time and quality of life. Implanted systems, in use since the 1990s, continue to be refined, and because heart failure patients have lower cardiac reserves than those with healthier hearts, the devices must be meticulously fine-tuned.
In addition to the advantages offered by the device itself, recent technological strides have made it easier for physicians to monitor their patients once the defibrillators are in place. Physicians can now keep track of the device’s performance, and of important aspects of the patient’s clinical status, via remote monitoring.
The device records the data automatically and then transmits it wirelessly to physicians, using a Web-based system.
That’s just one of the electrophysiology lab’s advances, however. Our lab now encompasses all aspects of electrophysiology, including improvements in the field of catheter ablation and the implantation of pacemakers and ICDs.
Our physicians use implantable cardioverter defibrillators to treat patients that have heart rhythms that are too fast. The device is implanted in the chest to monitor for and, if necessary, correct episodes of an abnormal heart rhythm. If the heartbeat gets too fast, the ICD will stimulate the heart to restore a normal rhythm. In cases where the heartbeat is so rapid that the person may die, the ICD will also give an electric shock to "reset" the heartbeat.
Catheter ablation and cardiac mapping
Ablation is now a common therapy to treat all types of arrhythmia, including the two most difficult—atrial fibrillation and ventricular tachycardia. The procedure entails threading a catheter through a vein into the trouble spot in the patient’s heart. A pulse of electricity then burns the targeted muscle tissue and kills the nerve cells that cause the irregular heartbeat. The procedure offers good success rates, often over 80 percent, but if done improperly it can further damage the heart and worsen the patient’s condition. As a result, it’s imperative that the physician correctly place the catheter to avoid damaging the coronary arteries, and new advances in mapping have made this greater safety margin possible.
Physicians now have a significant advancement in complex mapping. At El Camino Hospital, our team uses a three-dimensional system that merges CT imaging into the electrical 3-D mapping. Studies show that this merging process, called registration, improves catheter navigation by providing important patient-specific anatomical information, thus making the procedure safer.
The maze procedure is performed on patients who have irregular heart beats (called atrial fibrillation). The name of this procedure is based on the concept of a puzzle. The heart is "divided" by incisions that create a series of barriers that block the path of unwanted abnormal electrical impulses. The incisions are created with a microwave energy source, creating barriers and several blind alleys that allow for only one major route for an electrical impulse to travel from the top to the bottom of the heart. The surgery has a success rate of 80 percent, and is currently always performed in conjunction with another open-heart procedure.