The problem: One of the best treatments for many types of irregular heartbeats, which can be deadly, is something called ablation. In that procedure, a doctor, watching on an X-ray, guides a wire to bad spots on the heart and uses radio waves to scar the problem area so that the irregular beats, which often cause the heart to quiver, can be corrected and the heart returns to its normal 60 or 70 beats a minute.
To find these bad spots, doctors use an electrocardiograph, or EKG. The machine’s electrodes are placed on the outside of the chest to determine where the irregular electrical currents are coming from. Because those electrodes are not directly on the heart, the EKG only estimates where the irregularity is. That means, 30 percent to 40 percent of the time, doctors don’t have an exact idea of which area to scar.
They can obtain more accurate information by putting the patient under anesthesia, inserting a catheter into a blood vessel and guiding it up to the heart for a better view. But that process can take hours and requires anti-clotting drugs and lengthy exposure to radiation from the X-rays. It also increases the chance of stroke and other complications. And it doesn’t always work. As a result, some patients have to undergo a second or third ablation, increasing their risk of complications and driving up health-care costs. The biggest problem, though, is that many people who have irregular heartbeats might not have them or have them infrequently during the diagnostic process so doctors can’t gather the information they need to know where to scar.
The solution: The ECVUE, a vest with 252 electrodes, using technology invented by former Case Western Reserve University professor Yoram Rudy and two of his former biomedical engineering students, Charu Ramanathan and Ping Jia. Patients with irregular heartbeats wear the vest while undergoing a CAT scan. The scan shows doctors the patient’s heart while electrodes on the vest send electrical information to a computer that uses a mathematical formula to tell doctors precisely where to scar. Even better, the vest needs only one irregular beat to provide the information. That’s important in cases where the heart goes out of rhythm only occasionally.
The ECVUE vest is made by the Cleveland company CardioInsight, formed by Ramanathan and Jia, and is being tested at four hospitals across the country, including the Cleveland Clinic and University Hospitals Case Medical Center. Early use shows that it identifies the proper ablation points with 90-percent accuracy.
The vest has received clearance in Europe and is being used in England, France and Germany. CardioInsight hopes to have FDA clearance next year to begin selling it in the United States. The next step for CardioInsight is to expand use of ECVUE to help some types of heart failure currently treated by special pacemakers. And Rudy, now director of the Cardiac Bioelectricity and Arrhythmia Center at Washington University in St. Louis, is using the technology to study and develop new ways to treat many other heart conditions.