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.

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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