2016 Sentara Heart Annual Report

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Sentara Heart Arrhythmia Center

Program Leads
Jonathan Philpott, MD, Cardiothoracic Surgeon
Philip Gentlesk, MD, Cardiac Electrophysiologist

The Sentara Heart Arrhythmia Center (SHAC) is one of the few centers in the country with the expertise and technology to perform all of the most revolutionary ablation procedures available for the treatment of heart arrhythmias.

The center is also a national leader in performing the Open Cox Maze IV and minimally invasive Cox Maze procedures, as well as hybrid surgical ablation.

Doctors at the SHAC are committed to employing the latest methods and tools to treat Afib, which is a growing national health concern. Sentara Heart is experiencing an increase in the number of patients seeking treatment for Afib. The risk of developing this heart rhythm disorder, which affects nearly 5.1 million Americans, increases with age. As the Baby Boomer generation gets older, the number of people with Afib could triple to 15.9 million by 2050.

Individuals seeking arrhythmia care comprise a very diverse group, some of whom require complex therapies.The SHAC provides a resource for managing unique patients across the region with seamless access to advanced diagnosis and medical and interventional treatments—all within one setting. We are the only center in Southeastern Virginia to bring together highly talented cardiothoracic surgeons and cardiac electrophysiologists in a highly collaborative approach to cardiac care. We consider this centralized treatment process to be an important step forward for patient care and satisfaction.

Sentara Heart Arrhythmia Center Offers:

  • A hybrid team approach toward patient care—both a cardiothoracic surgeon and cardiac electrophysiologist review every option with patients to determine the best treatment plan
  • Comprehensive Afib treatment program that includes an advanced heart mapping system, advanced diagnostic testing and leading-edge procedures not available anywhere else in the region
  • The only advanced hybrid EP cardiovascular operating room in Southeastern Virginia
  • Services tailored to referring doctors, ranging from one-time recommendations for medical management to invasive interventions
  • A dedicated program navigator who provides a single point of contact to referring doctors and patients through the entire care cycle process
  • Access to advanced Afib research studies that are among the top enrollers in the nation, including:
    • ARCA Biopharma Genetic-AF trial
    • AtriCure Hybrid DEEP Pivotal AF trial
    • AtriCure ABLATE study for open maze procedures

Areas of Growth

The SHAC is continuing its development of integrated services and use of the Hybrid Cardiac Operating Suite. Cardiothoracic surgeons, cardiac electrophysiologists and cardiothoracic anesthesiologists work closely together to handle complex treatments and surgeries for patients requiring more in-depth procedures.The increasing efficacy and success of these complex procedures is a testament to the benefits of a highly collaborative and hybrid approach to care.

The SHAC also dramatically increased its community outreach efforts and coverage for patients who require arrhythmia management, providing ablation procedures and standard of care therapy for flutter and fibrillation to under-served and under-resourced areas of the Hampton Roads community. In 2015, the SHAC worked with Sentara Heart cardiologists at Sentara Heart Hospital to develop an arrhythmia program that allowed expansion of an arrhythmia clinic and service offerings throughout the Hampton Roads region. This will allow the SHAC to better meet the growing demand for arrhythmia care and electrophysiology procedures.

Cardiac lead removal continues to be an area of growth for the SHAC. There is a growing need for doctors at the SHAC to perform cardiac lead removal procedures as part of the normal course of management of implantable devices such as cardiac resynchronization therapy defibrillators (CRT-Ds), implantable cardioverter defibrillators (ICDs), and pacemakers.

Five-box Thoracoscopic Maze Procedure

With the addition of the five-box thoracoscopic maze procedure, the SHAC is poised to become one of the nation’s foremost sites for Afib treatments.

Cardiothoracic surgeon John Sirak, MD, who pioneered the five-box procedure, performed 14 of the surgeries during his first year at Sentara Heart in 2015; the first was on a patient from Australia. Dr. Sirak is training other cardiothoracic surgeons here and nationwide in the technique which is expected to be in high demand in 2016 and beyond.

Unlike earlier maze surgeries that require opening the chest, the five-box maze is a minimally invasive, closed chest procedure. Surgeons access the heart via four small incisions made on each side of the chest. A thoracoscope provides clear, magnified visualization of all key anatomic structures without the need for computer-enhanced imaging. This technology enhances both the safety and precision of every maneuver.

Surgeons use an ablation energy source to create lesion patterns that encompass five discrete, but adjoining, compartments or “boxes” on the heart: the two pulmonary antra, the posterior left atrium, an enclosed triangle on the

dome of the left atrium, and the superior vena cava. A novel verification technique using a pacing probe allows surgeons to confirm in real time whether all electrical signals entering and exiting each of the five “boxes” are blocked. This provides for immediate identification of areas requiring additional treatment.

The success rate for the five-box procedure is 96 percent, meaning the majority of patients no longer have Afib symptoms and can stop taking antiarrhythmic medications. Because the five-box procedure is minimally invasive, patients experience less pain and recover more quickly than with traditional maze surgeries like the Open Cox Maze IV.

The Open Cox Maze IV is an open heart procedure performed on either a stopped or beating heart. Earlier maze procedures used a process involving cutting and suturing areas of the heart. The resulting scars would block the transmission of irregular electrical impulses that cause arrhythmia. With the Open Cox Maze IV, surgeons use an ablation energy source to create the scars. Sentara Heart surgeons performed 20 Open Cox Maze IV procedures in 2015.