Ull it S as Sinai Experts Diagnose and Treat Heart's Electrical Malfunctions I t took the sudden, tragic death of Boston Celtic Reggie Lewis to draw the country's attention to a prob- lem that kills 350,000 Americans a year. Heart rhythm distur- bances, or arrhythmias, can cause everything from palpitations, irregular heartbeats, lightheaded- ness, dizziness and passing out to cardiac arrest and sudden death. The good news is that, if properly diagnosed, the disorder is treatable and the treatment can be far less risky and debilitating than in the past. A recent international symposium in Boston reported that implantable devices that shock the heart back to normal are, increasingly, the solution. The heart is a pumping machine that is fueled by its own anatomic pace- maker. Each heartbeat results from electrical waves that emanate from it. If the circuitry fails to maintain regularity and potency, the heart's pumping action becomes insufficient to support the body with oxygenated blood. The first organ to suffer is usually the brain — thus the symptoms of lightheadedness, dizziness or fainting. When the episode is prolonged and severe, sudden death can result, even in a young, ac- tive and apparently healthy person. To address these problems in the Detroit community, Sinai Hospi- tal has established a world class service, known as the Electrophysiology (E-P) Program and the Sinai Ar- rythmia Center — one of only two with its level of capabilities in Michigan. The Center benefits from the co-directorship of two leading researchers and associate professors of medicine at Wayne State University School of Medicine; together Dr. Michael Lehmann and Dr. Russell Steinman have collaborated on 70 scien- tific publications. The Center's services are also strengthened by the expertise of electrophysi- ologist Dr. John J. Baga. Because Sinai offers the entire triad of scientific services in its E-P pro- gram – patient care, edu- cation and research — patients benefit from state-of-the-art develop- ments, Dr. Steinman points out. "Our extensive research team at Sinai is on the leading edge of developing, testing and applying new E-P techniques," he says. 'We do things here that are not available at other hospi- tals, attracting fellowship applications from cardiol- ogists all over the world." "We've always been pretty good at slow heart- beats," explains Dr. Baga. These are often treated with the installation of a cardiac pacemaker. But fast, irregular heartbeats can be much more complex and are some- times life threatening. They require pinpoint diagnosis so that the appropriate treatment is prescribed and a tragedy is averted. Many disabled patients who may be passing out from a fast heartbeat can be "cured in one day," Dr. Baga says, with what is known as radiofrequency ablation. A catheter is introduced into the heart via a vessel and, using the gentle, precise energy of radiofrequency, its tip is heated to destroy the errant or excess tissue causing the problem. Dr. Lehmann, who served on the American Heart Association's Sud- den Death Committee, has a special interest in the prevention of sudden death from cardiac arrest. Cardiac arrest can result from a heart attack — blockage of an artery serv- ing the heart that subsequently shuts down its electrical system — or Russell Steinman, M.D., co directs Sinai's Electrophysiology Program and Arrhythmia Center. - from electrical impulse disturbances caused by a variety of other factors. To discover methods of determining who is at risk of sudden death, Sinai's E-P division is a principal investigator in a National Institutes of Medicine multi-center trial. This is one of ten ongoing research projects for Sinai's prestigious E-P team. Its participation in a na- tionwide automatic im- plantable cardiac de- fibrillator (AICD) trial means that patients with life-threatening speedy heartbeats can count on advanced technology being available to them at Sinai. The AICD is a shocking and pacing device that no longer requires open-chest surgery for implantation. "They're unbelievable!" says Dr. Baga of the device. "It's like having your own paramedic unit implanted in your body. The patient is home in two days and is able to live an essentially normal lifestyle." Of course, Sinai's E-P team also addresses less threatening heart rhythm problems. A battery of tests are available. These sinai may include the electro- cardiogram (EKG); a 24-hour monitor worn for days or longer and capable of transmitting the readings over the phone; and, the head-up tilt test where the secured patient is tilted in an attempt to provoke faint- ing for the study of the un- derlying mechanism. One of the most sophisticated tests is known as an E-P study. Patients with apparent life-threatening cardiac irregularities may have the electrical activity in their hearts' chambers diagnosed by catheters that have been inserted to trigger the misfirings. These tests are so informative that far more appropriate treatments can be prescribed, ranging from drug therapy to surgery. "I came to Sinai," Dr. Lehmann says, "because of the optimal marriage of clinical medicine and academic research. The cardiology division at Sinai is a continually developing and evolving resource and it is a challenge to us to contin- ue that tradition." IP