In less than a decade, the Heart Group of Syracuse has built a reputation as a premier provider of established as well as innovative treatments for heart rhythm disorders, and it continues to burnish that status in Central New York.
Jamal Ahmed, MD, FACC, and Traian Anghel, MD, FACC, Heart Group of Syracuse Partners
Founded in 2011 by board-certified cardiologists, cardiac electrophysiologists and internal medicine physicians Traian M. Anghel, MD, FACC, and Jamal J. Ahmed, MD, FACC, the Heart Group is a full-service cardiology practice that focuses on the diagnosis and treatment of arrhythmias. In the seven-plus years since they established the practice, Drs. Ahmed and Anghel have performed thousands of procedures in all the Syracuse hospitals, and the group has grown to encompass satellite locations in Fulton and Watertown, in addition to its main office in East Syracuse.
A hallmark of the Heart Group since its inception has been its thorough evaluation of new treatment technologies that emerge to offer better results to patients with fewer sequelae, such as the subcutaneous implantable cardioverter defibrillator (S-ICD) System for patients at risk of sudden cardiac arrest. In 2014, the Heart Group became the first practice to perform a S-ICD System implantation in Central New York.
“Cardiac electrophysiology is an up-and-coming field in cardiology and one in which a lot of progress is being made,” Dr. Ahmed says. “Seemingly, every other year, a new, potentially groundbreaking treatment emerges to benefit patients in considerable new ways, and it’s important to provide these advances in care to patients in our area.”
One such innovative procedure that is new to Central New York is convergent ablation for atrial fibrillation, which Drs. Ahmed and Anghel began offering in early 2018. This minimally invasive procedure combines the expertise of a cardiac surgeon and an electrophysiologist and is appropriate for certain individuals who have not experienced a successful outcome following conventional treatments. The procedure also benefits those who have chronic atrial fibrillation or, in some cases, structural heart disease, according to Dr. Ahmed. It is important to not abandon patients with heart failure due to atrial fibrillation, for their lifespan and quality of life are affected.
Dr. Anghel and Dr. Ahmed discuss the Watchman device.
Jamal Ahmed, MD, FACC
“Convergent ablation takes place in two phases,” he says. “First, with the patient under general anesthesia, the surgeon makes a small incision in the upper abdomen and ablates the area in question outside and behind the heart, which takes about 90 minutes. Then, the electrophysiologist uses catheters inserted through the groin to access the heart and ablates from within to complement the ablation lines made by the surgeon on the outside. That takes another 45 to 60 minutes.”
After one to three days in the hospital, patients return home and may resume all regular activities in two weeks. Drs. Anghel and Ahmed have performed more than 15 convergent ablations at Upstate University Hospital since they began offering the treatment, and they plan to introduce it to St. Joseph’s Hospital soon. Their convergent ablation patients enjoy a success rate of approximately 70 percent.
“Convergent ablation is quite promising,” Dr. Ahmed says. “Candidates may present with fatigue, shortness of breath, racing heartbeat and palpitations, and this procedure offers relief. We place a heart monitor under the skin to document complete resolution of the arrhythmia and track recurrences in the most objective manner.”
Micra Transcatheter Pacing System
Carli Kilmer, LPN, performs Cardiac Device Interrogation
A miniature, vitamin-capsule-sized pacemaker that is 93 percent smaller than conventional pacemakers, the Micra Transcatheter Pacing System offers a wireless, minimally invasive alternative for patients who need basic pacing for very slow heart rates. The Heart Group began offering Micra soon after its approval by the FDA.
“Micra is an extremely exciting device because it’s miniaturized for deployment completely inside the heart, with no wires protruding out of the organ into the skin,” Dr. Ahmed says. “Micra is an ideal choice for patients who might not be candidates for a conventional pacemaker because of preceding vascular complications, difficulty accessing the heart because they’re receiving dialysis or a history of recurrent infections that would make implanting a standard device a high-risk option.”
Electrophysiologists deploy Micra to the right bottom chamber of the heart via a catheter inserted in a vein at the upper thigh. Patients who receive Micra experience fewer post-implantation infections than individuals who receive conventional pacemakers, according to Dr. Ahmed. They also face none of the post-procedure restrictions on driving or range of motion limitations to which patients must adhere following the implantation of a standard device.
Watchman Device for Left Atrial Appendage Occlusion
Lori Horning, LPN, assists with a Cardiac Treadmill Stress Test
Traditionally, blood-thinning medications such as warfarin have been the therapy of choice for individuals with an elevated risk of stroke due to atrial fibrillation, but blood thinners can be problematic for certain groups of patients.
“Blood thinners can place older adults, those who may be predisposed to falling and individuals with ulcers or other issues of the gastrointestinal tract, at risk for excessive bleeding,” Dr. Anghel says. “Patients with cancer may also be at risk if the disease or their treatment increases the likelihood of bleeding if they take blood thinners.”
Now, those patients have a long-term solution to both their risk of stroke that comes from atrial fibrillation and their risk of bleeding that is brought upon by blood thinners: Watchman is a device that closes the left atrial appendage (LAA). Early referral for evaluation of a patient’s candidacy for Watchman is crucial to success since risk otherwise accumulates with time.
“Ideally, we want to evaluate patients before they have a major bleeding problem,” Dr. Ahmed says. “Patients who receive the Watchman typically have to take blood thinners for six weeks after implantation, so we want to implant the device before bleeding issues arise. Once these high risk patients do bleed, it is often too late for the procedure.”
Drs. Ahmed and Anghel assess patients’ eligibility for Watchman based on well-published, peer reviewed calculations of their risk of stroke and bleeding, as well as the results of a transesophageal echocardiogram (TEE). Patients receive general anesthesia for the implantation procedure, which takes an average of 75 minutes. The Heart Group performs Watchman procedures at Upstate University Hospital and will soon begin doing so at St. Joseph’s Hospital.
Traian Anghel, MD, FACC
“To place the Watchman, we gain access to the veins that converge en route to the right side of the heart via a small incision in the upper leg,” Dr. Anghel says. “We then puncture a small hole in the wall between the atria and pass the Watchman device to the LAA where it’s deployed. Patients return home after one night in the hospital. Six weeks later, they come back for another TEE to assess how well the canopy of the device has covered and occluded the relevant area.”
After the six-week TEE, the vast majority of patients stop taking blood thinners and begin anti-platelet drugs for six months. After 12 months, they have a third TEE to assess the final outcome of Watchman placement. Drs. Anghel and Ahmed have implanted more than 75 Watchman devices since early 2018, with an impressive success rate: Nearly every patient has been able to abandon blood thinners at a duration procedure risk and rate of success all better than the national averages.
“At the Heart Group of Syracuse, we have accumulated vast experience in cardiac and AP procedures. The literature shows high-volume implanters have considerably lower risk of procedural complications than average volume implanters. Just as we track our procedural volume, we also track our outcomes. Our risk of complications is well below the national average and all established standards.”
— Traian M. Anghel, MD, FACC, cardiologist, cardiac electrophysiologist and Founding Partner of the Heart Group
His Bundle Pacing
A potential complication of implanting a conventional pacemaker is that placing leads in the right ventricle of the heart can prompt contractions that are out of sync with those of the left ventricle. Over time, the resulting dyssynchrony can cause serious complications, including heart failure. To avoid dyssynchrony, electrophysiologists can implant pacemaker leads in a part of the heart’s electrical conduction system called the bundle of His.
“Dr. Ahmed and I have been performing His bundle pacing for quite a while,” Dr. Anghel says. “The procedure was described a couple of decades ago, but it tends to be technically challenging for most implanters, so it’s not commonly performed. His bundle pacing makes use of the heart’s native electrical wiring to achieve resynchronization. Instead of placing the right ventricle lead at the tip of the right ventricle, we purposefully aim a specialized lead at the very electrical wires one is born with that run between the walls of the right and left ventricles.”
Once in place, that lone lead can accomplish what a cardiac resynchronization pacemaker can do with two, Dr. Anghel explains.
Remedē System for Central Sleep Apnea
Individuals with sleep apnea are four times more likely to develop atrial fibrillation, and approximately 50 percent of people with atrial fibrillation have sleep apnea, according to the Heart Rhythm Society. Untreated sleep apnea is associated with risk factors for atrial fibrillation, including hypertension and associated forms of heart failure. Treating sleep apnea is key to the long-term success of atrial fibrillation therapy, according to Dr. Ahmed.
Dr. Ahmed and Evan Jones, LPN
“We see a large subset of individuals who have sleep apnea and present to us for congestive heart failure, hypertension or atrial fibrillation,” he says. “For these patients, it’s important to diagnose and treat sleep apnea because if we don’t, there’s a significant chance the treatment we prescribe for their heart condition wouldn’t be as effective. Sleep apnea treatment in patients with atrial fibrillation almost doubles the success rate of ablation, as published studies show.”
In 2017, the FDA approved the remedē System, a nerve stimulator that treats moderate to severe central sleep apnea in adults. The Heart Group recently became one of a small number of centers in the United States to offer the remedē System. Consisting of a small generator placed beneath the skin atop the right pectoral muscle with two leads, the remedē System stimulates the phrenic nerve to regulate the breathing function of the diaphragm.
“Essentially, by regulating the activity of the diaphragm, the remedē System mimics what a pacemaker does to the heart muscle,” Dr. Anghel says. “The device takes control of the diaphragm in such a way as to significantly improve breathing at night when sleep apnea hits.”
Dr. Anghel views the addition of the remedē System to the Heart Group’s suite of treatment options as another example of the practice’s willingness to embrace innovation — as well as drive it.
“We’re continuously assessing available procedures and the way they would best fit in the global care of a cardiac patient to minimize procedural impacts in one’s life and trying to improve the way we perform them,” Dr. Anghel says. “Working with the excellent cardiac administrators and staff members at hospitals in Syracuse has allowed us to find new ways to improve safety and reduce procedure times. We like to think of ourselves as innovators of system processes.”
For more information about the Heart Group, visit epcuse.com or call 315-277-2707.