It was a case no one else was ready to take on – a heart condition so rare that even the Mayo Clinic has recorded just 30 cases in the past 20 years – and a patient with a history of going into cardiac arrest during surgical procedures. But for Dr Khaled Awad, Electrophysiologist and Interventional Cardiologist at Clemenceau Medical Center Hospital (CMC Hospital), it was a chance to give a woman her life back.
Everybody was telling her, ‘we can’t do it’, but she was really suffering. For years, even with high dosages of anti-arrhythmia drugs, she would have a heart rate going up to 180 for many hours, every couple of days.
For people with her condition, this was potentially life-threatening, he says, because it could trigger sudden cardiac death.
Born with dextro-transposition – a rare congenital heart defect where the position of the pulmonary artery and aorta are swapped – and the survivor of open-heart surgery as an infant, this 36-year-old woman from Saudi Arabia is a medical rarity for the simple reason that most born with this condition don’t live long, passing away due to heart failure. It took the doctors at CMC Hospital three weeks of preparation, reading the sparse medical literature and doing imaging scans before taking on this “once-in-a-lifetime case”, doing a tricky three-hour procedure involving multiple ablations – introducing a catheter into her blood vessel, and using heat or cold energy to create burns on the heart to stop the electrical signals causing the tachycardia.
“One week later, she is off medications, doing well and happy to live,” says Dr Awad. “She will be able to watch her daughter go off to university, where she plans to study to become a doctor, perhaps even a cardiologist!”
This and other cutting-edge procedures are the mainstay of the Electrophysiology and Pacemaker Clinic in Dubai at CMC Hospital – one of the few such specialised clinics in the city for the treatment of all disorders of heart rhythms. These include the implantation of sophisticated Cardiac Resynchronization Therapy (CRT) devices to prevent heart failure, and the latest therapies such as Conduction System Pacing (CSP), a revolutionary treatment where the pacemaker closely mimics the natural physiological pacing of the heart, considerably reducing adverse outcomes – done two months ago at CMC.
“To the best of my knowledge, this is the first time it has been done at a private hospital in the entire MENA region,” says Dr Awad, one of only eight specialised electrophysiologists in the UAE.
Growing word of mouth means that the clinic has patients coming to them from different countries such as Pakistan and Lebanon for treatment. The reason is that electrophysiology – the study of the electrical impulses governing heart rhythms – as a specialised discipline is relatively new. Often, it is interventional cardiologists who deal with these devices and procedures, and they might lack the expertise to do so.
Who needs to see an Electrophysiologist?
If the patient has low heart-rate (bradycardia), a fast heart-rate (tachycardia) or arrhythmias (heart rhythm disorders), he or she needs to see an electrophysiologist to find the underlying cause. Also sometimes, patients who have a syncope (fainting or dizziness) may need to see an electrophysiologist for a proper workup.
Treatments and procedures
Implantation of a pacemaker or defibrillator - small battery-powered devices that send weak electrical impulses to trigger the heart muscle to contract (pacemaker) or that detects and stops irregular heartbeats (defibrillator).
Ablation for the correction of heart rhythm disturbances. During the procedure, thin and flexible wires are inserted into a vein in the groin, and threaded up through the vein into the heart. Heat or cold energy is then delivered through an electrode at the tip of the wires.
“There are a lot of young people who have a pacemaker put in, even when the indication was not correct. It hurts me when I see them,” Dr Awad says, adding that it could mean multiple procedures to maintain or replace the device during their lifetime. “An electrophysiologist has special training and perspective, and we might not see the indication for a pacemaker or an intervention at all.”
Access to specialists of this sort is especially crucial because these procedures are so very sophisticated and delicate. “Everything in electrophysiology is about millimetres; if you’re millimetres away during an ablation, you could damage or perforate the heart,” he says.