Electrophysiology (EP) is a vast and challenging field, a reality made evident by the intricacies of just one of the conditions involved: Ventricular Arrhythmia (VA).
It’s never too soon to refer a patient for ventricular arrhythmia, according to Francis E. Marchlinski, MD, the Director of Electrophysiology and the Richard T. and Angela Clark President's Distinguished Professor at Penn Medicine.
Ventricular Arrhythmia: Two Types of Rapid Heart Beat
Originating in the lower chambers of the heart, ventricular arrhythmia is made up of two distinct conditions: tachycardia and fibrillation. Both are life threatening, and marked by rapid heartbeat. There are clear differences in the character of their beats, however.
In ventricular tachycardia (VT) the beat is rapid, but regular. Evolving over a span of years, VT causes gradual, irreversible damage to a patient’s heart muscle.
The increased heart rate in VT prevents the ventricles from fully contracting, and less blood is circulated through the body. Patients may live with VT as a chronic, debilitating condition for years.
Ventricular fibrillation (VFib), by contrast, is the most dangerous of the rapid heartbeats. Marked by meteoric and irregular heartbeats, it can cause uncontrolled quivering of the ventricles. The abnormal heartbeat often leads to limited blood flow from the heart through the body and brain. VFib is unique, often strikes suddenly, and can kill an individual within minutes of onset.
Treatment for Ventricular Arrhythmia
Therapeutic intervention is warranted for patients with the following symptoms:
- VT faster than 100 beats per minute (BPM), lasting at least 30 seconds;
- frequent nonsustained VAs (that stops by itself <30 seconds); and
- frequent premature ventricular contractions (PVCs, or extra heartbeats originating in the ventricles).
Whatever the type or inherent challenges of VA, its treatment, diagnosis and investigation intersect at Penn Medicine at the Electrophysiology Laboratory at the Hospital of the University of Pennsylvania directed by Francis Marchlinski, MD .
Electrophysiology at Penn Medicine
Known far and wide in his field as a prominent educator, researcher and clinician, Dr. Marchlinski has consistently advanced the field of electrophysiology.
The Richard T. and Angela Clark President’s Distinguished Professor at the University of Pennsylvania, Dr. Marchlinski has been lauded for his capacity to maintain a thriving practice and world class training program while directing a laboratory well known for innovation.
“Frank has devoted every segment of his life to making the EP field better,” says colleague David Callans, MD. “Everything he’s done has been dedicated to the ideal of pushing the field forward.”
With atrial fibrillation (AFib), ventricular arrhythmia is a principal part of Dr. Marchlinski’s practice and research. And like AFib, his perspective on ventricular arrhythmia can be said to embrace a universal understanding of the condition’s pathogenesis, triggers and substrates -- and the diagnostic and therapeutic permutations for each of its variants.
One extension of Dr. Marchilinski’s commitment to both education and clinical innovation in ventricular arrhythmia is the International Symposium on Ventricular Arrhythmias: Pathophysiology and Therapy.
Now in its 14th year, the Symposium will be held October 11-12 in Philadelphia.
Early Referral: An Answer to the Ablation Referral Dilemma
While patients are the primary beneficiaries of Dr. Marchlinski’s dedication to ventricular arrhythmia therapy, many should be seen in an EP clinic sooner for intervention, he noted.
“In patients with structural heart damage manifesting as cardiomyopathy, chronic VT can be managed for years with amiodarone or implantable cardioverter-defibrillators. But both of these therapies can be a source of concern,” Dr. Marchlinski observed. “The risk of organ toxicity throughout the rest of the body, with long-term antiarrhythmic drug therapy, specifically amiodarone, is well known… as are the idiosyncrasies of ICDs.”
In addition, Dr. Marchlinski said, these treatments can bring about serious adverse events and effects over time.
“Too often, people receiving amiodarone with recurrent VT and ICD shocks simply have their drug dose doubled,” he explained. “Even if these patients escape the toxic effects of this therapy on the thyroid, liver, and lungs, other effects, including daily tremors, photosensitivity, anorexia, constipation, and neuropathic symptoms, can create a constant state of disability.”
Catheter Ablation for Ventricular Tachycardia
Increasingly, the answer for patients with VT involves catheter ablation (CA), a technique refined at Penn Electrophysiology for more than 30 years.
Catheter ablation uses radiofrequency and mapping technology to create lesions that interrupt aberrant electrical pathways in the heart muscle. This therapy offers an effective resolution for patients with chronic VT and structural heart disease.
“Studies have shown an association between early referral for ablation in patients with cardiomyopathy and improved long-term VT suppression,” Dr. Marchlinski explained. While it’s not possible to ablate every individual, he added, patients with the signs and symptoms of chronic VT or progressing cardiomyopathy who are not being carefully managed on medical or ICD treatment should be referred for evaluation.
Historically, data from Penn’s Department of Electrophysiology suggests that the majority of patients receiving catheter ablation for VT benefit from the procedure.
Treating Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
The breadth of the Penn’s Department of Electrophysiology is demonstrated in the treatment of arrhythmogenic right ventricular cardiomyopathy (ARVC), a rare form of non-ischemic cardiomyopathy that causes fibrous scar tissue and fat deposits to replace muscle tissue in the right ventricle. ARVC is a precipitant of ventricular tachycardia, ventricular fibrillation and atrial fibrillation.
Looking to improve upon the limited efficacy of medical and device-related treatment of ARVC, Dr. Marchlinski and his Lab have had promising results with endo-epicardial ablation (endo-epi) for VT.
In a recent multi-center clinical trial that included Penn’s Electrophysiology Program, 81% of patients were free of recurrent VT after endo-epi for ARVC.
The International Symposium on Ventricular Arrhythmias: Pathophysiology and Therapy
In October, physicians and researchers from around the world committed to the management of ventricular arrhythmias will gather in Philadelphia for the 14th International Symposium on Ventricular Arrhythmias: Pathophysiology and Therapy.
Specialists and researchers will be joining us from around the world -- from as far as Australia, Israel and Taiwan -- to present emerging updates on the pathophysiology and treatment of ventricular arrhythmias.
Meeting objectives include:
- Strategies to improve treatment outcome in patients with ventricular arrhythmias and structural heart disease including new techniques and technologies;
- Current status and future role for device therapy in the management of sudden cardiac death and heart failure;
- The status of ongoing multicenter VT related trials and discuss future directions and questions to be answered.
Structured for electrophysiologists, heart failure and transplant cardiologists, interventional cardiologists, pharmacologists and basic/translational investigators, The International Symposium on Ventricular Arrhythmias: Pathophysiology and Therapy is a collaborative effort of Penn Medicine and Mount Sinai Hospital. The event is co-sponsored by the Heart Rhythm Society.
14th International Symposium on Ventricular Arrhythmias: Pathophysiology & Therapy
October 11 and 12, 2019
Hyatt at the Bellevue
200 South Broad St., Philadelphia, PA
Physicians: Penn Medicine designates this live activity for a maximum of 18.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physician Assistants: AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™from organizations accredited by ACCME or a recognized state medical society. PAs may receive a maximum of 18.5 Category 1 credits for completing this activity.
Additional Ventricular Arrhythmia Resources from Penn