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cardiac care

Harvey Atkin was one of the first patients to benefit from heart surgery using the robotic navigation system.

Computer-guided automation is becoming  the most trusted assistant in the operating room

You may have heard him on the radio or TV as the voice for Leon's furniture. Or you may have seen him in movies such as Barney's Version or Meatballs. But you may not know Harvey Atkin, actor, comedian, in his most serious role – heart patient at Sunnybrook's Schulich Heart Centre.

He is also one of the first to benefit from the hospital's new, state-of-the-art robotic surgery navigation system to repair his heart.

Harvey, 72, suffers from atrial fibrillation (AF), a condition in which the upper chambers of the heart race (up to 175 beats per minute) and thump erratically and out of sync with the lower chambers.

Experiencing an AF episode is very frightening, says Harvey, because it can happen for no discernible reason, day or night. "It's like having someone standing in front of you and pounding hard on your chest," he says.

When the heart fails to pump efficiently, symptoms include dizziness, palpitations, shortness of breath and weakness. At worst, blood can pool and form clots, which can then block flow to other parts of the body, most dangerously to the heart and brain, causing a heart attack or stroke.

Many patients with AF can be successfully treated with medication and cardioversion, in which paddles to the chest shock the heart to restore normal rhythm. However, chronic cases may require surgery to eradicate the cluster of cells in the heart that are shooting out random electrical pulses that cause the arrhythmia.

During the procedure, known as catheter ablation, the surgeon stands by the patient and manually inserts a catheter into the groin, guiding it up to the heart. The catheter then delivers radio-frequency energy at temperatures reaching as high as 50 C to ablate or "burn" the area that is triggering the episodes.

Harvey has had four such operations, but each time the arrhythmia returned. However, in July 2014, as a patient of Dr. Eugene Crystal, director of Sunnybrook's Schulich Heart Centre's Arrhythmia Services, Harvey underwent an operation known as a pulmonary vein isolation. This procedure is made possible with Sunnybrook's recent installation of a device known as a Vdrive™, the latest addition to the Stereotaxis computerized, magnet-guided technology. Sunnybrook is the
first hospital to install the robotic navigation system in Canada.

Instead of standing by the operating table and manually guiding the catheter, Dr. Crystal performs the procedure robotically from a control booth. "The Vdrive™ enhances access, reaching the more challenging areas of the heart chambers with greater accuracy during ablation and reduced risks of complications," Dr. Crystal says.

Recovery times are also reduced. Most patients can go home the same or following day.

Ever since his Vdrive™ operation more than a year ago, Harvey has been symptom-free. "It feels great," he says. Before the procedure, he could only manage to walk up one flight of stairs. "Now I get a little winded three-quarters of the way up the CN Tower," he says, joking.

Harvey can't say enough about the treatment he received at Sunnybrook. "Dr. Crystal and the team is the best I've ever known. They are all very caring and conscientious." While he is hopeful his AF is under control, he says that there's always a possibility it could come back. "If it does, I know where to go to get it fixed."


Photo: Doug Nicholson

Dr. Eugene Crystal, director of Sunnybrook's Schulich Heart Centre's Arrhythmia Services, sits in front of a 42-inch screen, a keyboard, a mouse and a joystick-like control console known as "the puck."

But he's not playing a video game. He's fixing unhealthy hearts.

With these tools, which are part of the newly installed Vdrive™ Stereotaxis robotic heart navigation system, Dr. Crystal is able to perform a procedure that eliminates the erratic heartbeats of his patients who suffer from atrial fibrillation. "Using robotic technology is better than using human hands to perform this surgery. There's greater catheter stability," says Dr. Crystal.

By manipulating two one-tonne magnets in giant pods that wheel into place on either side of his patient on the operating table, he moves a magnet-tipped, flexible, spaghetti noodle-thin catheter – or as many as three – using the magnetic field to the deepest, innermost parts of the heart to administer an ablation using radio-frequency energy at temperatures as high as 50 C. "Magnets are a lot gentler and use less force."

The Vdrive™ offers a variety of improvements over the older mechanical "pull-wire" system:

• The Stereotaxis catheter is thin and flexible.

•  The catheter's tip contains three miniscule magnets that respond to a magnetic field created by two pods containing powerful iron-ore magnets on each side of the operating table.

• The flexibility and the robotic nature of the catheter make it much less likely to damage heart tissue.

• The electrophysiologist can move up to three catheters into place from the safety of a control booth, instead of standing by the patient's bedside and being exposed to radiation.

• The amount of radiation required is reduced by more than half.

• Patients can usually go home the same or following day. •

This content was produced by The Globe and Mail's advertising department, in consultation with Sunnybrook. The Globe's editorial department was not involved in its creation.

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