Shown from left: Bernadine Chmielowicz, one of the first RWJUH patients to undergo a procedure with the new Stereotaxis system at RWJUH, stands with her physician, Amardeep Saluja, MD Assistant Professor of Medicine, UMNDJ-Robert Wood Johnson Medical School and an electrophysiologist at RWJUH.
The first time Bernadine Chmielowicz felt her heart racing, she thought it was because of something she ate. During the next 19 months, these frightening episodes happened more often, some fleeting and some lasting hours. “It was unsettling, but I attributed it to stress,” says the 60-year-old, who had just retired from a job she loved and was planning to move to Florida with her husband. Afraid of bringing on an episode, Mrs. Chmielowicz stopped doing the things she loved, like walking and weight training, and she stopped drinking caffeine and red wine.
During a winter spent in Florida, a doctor diagnosed Mrs. Chmielowicz with stress. Upon returning to New Jersey, the episodes had gotten worse, so Mrs. Chmielowicz went to see her doctor, who had her wear an event monitor for two weeks, which records the heart's electrical activity and is used to diagnose arrhythmias. Arrhythmias are problems with the rate or rhythm of the heartbeat. The test showed that Mrs. Chmielowicz had an arrhythmia and she needed to see a cardiologist.
Mrs. Chmielowicz chose Amardeep Saluja, MD, Assistant Professor of Medicine at UMDNJ-Robert Wood Johnson Medical School (RWJMS), and an electrophysiologist (a cardiologist who specializes in abnormal heart rhythms) at Robert Wood Johnson University Hospital (RWJUH). He reviewed Mrs. Chmielowicz’s records and diagnosed her with atrial flutter, an arrhythmia where the atria (the heart’s upper chambers) beat very fast and suspected there may be a second arrhythmia. Untreated, atrial flutter can lead to stroke and, over time, decreased heart function.
Dr. Saluja recommended an ablation to return Mrs. Chmielowicz’s heart to its normal rhythm. Ablation uses radiofrequency energy, delivered through a catheter (a long flexible tube), to destroy a tiny area of heart muscle, stopping the electrical impulses causing the arrhythmia. To perform the procedure, Dr. Saluja used the state-of-the-art Stereotaxis system in which magnets helped him steer the catheter precisely from a vein in the groin to the right spot in the heart. Unlike the rigid catheters used in a regular ablation procedure, the magnetic navigation catheter is flexible and moves easily with the curves of the heart.
“Stereotaxis moves like spaghetti,” said Dr. Saluja. “It’s safer. There’s very little risk of damaging blood vessels or heart tissue.” RWJUH is the only hospital in central New Jersey and one of just three in the state offering this technology.
During the procedure, Dr. Saluja found an extra electrical connection in Mrs. Chmielowicz’s heart, which was the cause of the second arrhythmia detected on the monitor. In a complex procedure, the catheter was directed from the right side of the heart to the left side of the heart and the extra electrical connection was destroyed. In a second procedure, the catheter was withdrawn to the right side of the heart where the atrial flutter was ablated. Without Dr. Saluja’s expertise and magnetic navigation, this procedure would have been much riskier.
“I really do feel good,” said Mrs. Chmielowicz. “I’m anxious to get back to exercising and everything I did before this hit me out of the blue.”
Left: Ron Dunham.
Last fall, Ron Dunham found himself in the Emergency Department at Robert Wood Johnson University Hospital (RWJUH), where shock paddles were waiting, wondering “What am I doing here?” He was in good health, except that his heart sometimes felt like it was racing. There wasnï¿½t any pain and it would come and go, so he paid little attention.
One day in November, Mr. Dunham was working from his Long Branch home and expressed his concern to his wife Maryann, during a phone conversation. As a nurse, Mrs. Dunham insisted he see his primary care physician right away. Mr. Dunham drove himself to Thomas A. Schwartzer, MD, an internist with Central Jersey Internal Medicine Associates, PA in Somerset. Two electrocardiogram (EKG) tests followed. Results from the first test were normal, but results from the second test were cause for concern. “Dr. Schwartzer and his associate, Christina Wang-Epstein, MD said to my wife “We have to take Ron to the hospital,” Mr. Dunham recalls. An ambulance, not his wife, would transport him to RWJUH where Mr. Dunham was found to have a potentially life-threatening arrhythmia.
After a brief stay in the Intensive Care Unit (ICU), there was another EKG, a cardiac catheterization, and another echocardiogram, magnetic resonance imaging (MRI) and a stress test. No significant abnormalities were found, but the dangerous heart rhythms continued. Subhashini A. Gowda, MD, a cardiologist with the New Brunswick Cardiology Group in Somerset, determined that Mr. Dunham was experiencing ventricular tachycardia, or recurrent symptomatic abnormal heart rhythms.
Initially Mr. Dunham was treated with medication but there was no guarantee it would work, Dr. Gowda explains. Mr. Dunham remained stable, but the tachycardia was accompanied by drops in blood pressure, which were concerning.
Following a consult with Clifford D. Gladstone, MD, also with the New Brunswick Cardiology Group, they decided to take him to the Electrophysiology (EP) Lab for an electrophysiological study and 3D mapping of the heart, induction of the arrhythmia and elimination of its source through delivery of radiofrequency energy using the Stereotaxis GentleTouchï¿½.
With Stereotaxis technology, doctors can perform remotely controlled, image-guided computerized heart procedures more precisely and safely than traditional methods allowed. It is used to treat a number of irregularities including arrhythmias, heart failure, and coronary artery disease. “This technology is amazing,” Dr. Gowda says. “It allows for detailed mapping and studying almost all parts inside of the heart. The catheters soft, flexible tip can easily be manipulated without major concern about causing damage to the heart
Dr. Gowda used Stereotaxis to search for triggers that caused Mr. Dunhamï¿½s rapid heartbeat. In the bottom chamber of the heart, on the left ventricle, around the mitral valve, she found an area of early activation that was causing his arrhythmia.
Mr. Dunham underwent an ablation, which is the burning or removal of cells causing abnormal electrical impulses leading to arrhythmia, and then he went home. “I came home and was able to return to work soon after,” Mr. Dunham, now 62, said. “My heart rate has been regular since the procedure. Special thanks to Dr. Gowda and her team for a job well done!”