Leading-edge Treatment a Hallmark of WellSpan’s Heart Care Program

Monday, June 13, 2016
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WellSpan is committed to making it as easy as possible for the residents of York, Adams, Lebanon and Eastern Lancaster counties to access advanced specialty heart care.

These patients rely upon WellSpan specialists to work with their primary care physicians to accurately diagnose and treat their heart conditions.

“We want to provide our patients the best outcomes possible,” says Julie Miksit, Vice President, WellSpan Heart & Vascular. “We have highly skilled physicians and clinical staff, so we want to make sure they have the resources and technology available to offer patients the most appropriate treatment options in every situation. This means providing leading-edge treatments and participation in clinical trials.”

Expanding Cardiology

While WellSpan has long been the provider of choice for heart care among patients and physicians alike across York and Adams counties, the health system now offers many of these same high-quality services in Lancaster County through expansion at WellSpan Ephrata Community Hospital and in Lebanon through the affiliation with WellSpan Good Samaritan Hospital and WellSpan Cardiology (formerly Lebanon Cardiology Associates, PC), where a strong program was already in place.

The cardiac catheterization laboratories at WellSpan York Hospital, WellSpan Gettysburg Hospital, WellSpan Ephrata Community Hospital and WellSpan Good Samaritan Hospital are all equipped with state-of-the-art imaging equipment that uses low-radiation, high-resolution digital equipment, and monitoring systems, maximizing both patient safety and image quality.

Expanding the WellSpan Cardiology practice and enhancing the system’s technology makes it possible for physicians to perform more complex procedures, which means patients have additional treatment options right in their own community. Included in these procedures are chronic total occlusion-percutaneous coronary intervention (CTO-PCI), leadless pacemakers and a variety of other procedures. Patients also have access to advanced procedures through participation in clinical research trials.

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CTO-PCI

As recently as three years ago, interventional cardiologists were very limited in what they could do for patients who had chronic total occlusions.

Bill Nicholson, MD, FACC, Director of Interventional Cardiology, WellSpan Health, knew of a procedure called CTO-PCI that originated in Japan and was being used with great success in the Unites States by William Lombardi, MD. Wanting to be able to offer his patients more options, Dr. Nicholson decided to train with a few colleagues in this new procedure.

“All we hoped to learn from Dr. Lombardi was how to handle these complex cases safely,” Dr. Nicholson says. “I don’t think any of us had an appreciation for the sheer number of patients who would benefit from what he taught us, or the high demand that would exist for this skill set.”

Today, Dr. Nicholson and the team at WellSpan are considered among the best in the country when it comes to clearing CTOs — blood vessels that have been completely or almost completely blocked for 30 or more days.

“We are all asked to speak at conferences and assist on cases at locations around the nation,” Dr. Nicholson explains. “A lot of people are interested in what we’re doing and want to learn from us so that they can offer this treatment to their own patients. It’s been really great.”

The main challenge with CTOs is that they are usually quite calcified and hard by the time they’re discovered. This makes the blockages difficult to treat using traditional interventional techniques. Until recently, most of these patients would have received medical therapy and frequently lived with chronic, unrelieved symptoms.

As with any compromised blood vessel, CTOs are associated with chest or jaw pain, nausea, indigestion, dizziness, irregular heartbeat and unusual fatigue. Current estimates indicate that as many as 31 percent of people referred for coronary angiography have a CTO.

Dr. Nicholson explains that the preparation and recovery are very similar to those for other percutaneous procedures and that a patient typically notices an immediate improvement in his or her quality of life.

“Patients are sedated and two catheters are inserted — either through the wrist or groin,” he says. “One is for visualization and the other for removal. In most cases, patients spend only one night in the hospital and walk out the next day relieved of their symptoms. They really feel completely different.”

Even though CTO-PCI is relatively new in the U.S., advances in technology are already making it easier for doctors to perform these procedures.

Dr. Nicholson adds that WellSpan York Hospital was involved in the testing of one new device and that the hospital is also participating in upcoming trials testing new types of catheters.

“We have referrals from all along the East Coast for CTO-PCI and are consequently one of the highest enrollers in these clinical trials,” he says. “This means we can consistently offer our patients access to the latest treatment options.”

Electrophysiology

WellSpan’s commitment to advanced specialty heart care is also shared by WellSpan’s electrophysiologists.

Electrophysiologist Brian Schuler, MD, and his colleagues at WellSpan Cardiology leverage their combined experience and skills to ensure that patients in the region who have heart rhythm problems receive the best treatment available.

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One treatment that Dr. Schuler is particularly excited about is the Nanostim single-chamber, leadless pacemaker produced by St. Jude Medical Inc.

“We’re involved in St. Jude’s LEADLESS II trial, which is evaluating the efficacy of the Nanostim pacemaker for people with bradycardia, or slow heart rhythm,” Dr. Schuler says. “This battery-size device is implanted transvenously — usually through the femoral artery — in the heart muscle.”

According to the most recent study results from St. Jude Medical, the Nanostim is demonstrating appropriate pacing and sensing, and study participants have not reported any adverse effects among patients receiving this device. The Nanostim is also proving easy to retrieve when medically necessary, and estimates place its lifespan at 9.8 years, with a battery life that could be as high as 21 years depending on pacing needs. All of this makes it a very promising treatment for patients.

Another way WellSpan’s electrophysiology team is employing new technology is through its work with atrial fibrillation ablation. The team provides advanced treatments for all forms of atrial flutter and offers the full range of treatment options, including the second-generation cryoballoon and contact force-guided radiofrequency ablation.

“While these approaches are comparable in their efficacy — ablating the atrial fibrillation 75 percent of the time — our preference is to use the cryoballoon because it’s faster,” Dr. Schuler says. “Typically, we can complete one of these cases in under 90 minutes.”

To help improve the success of its ablations, the EP team is using a newer technology that allows Dr. Schuler and his colleagues to perform high-density mapping of the heart ventricles to identify the source of a premature ventricular contraction or tachycardia for ablation.

“I am really happy with the way we’ve been able to incorporate it into our procedures,” Dr. Schuler adds.

Sometimes, a tachycardia can’t be mapped. In these cases, the EP team relies on mechanical support such as a ventricular assist device to treat the patient.

Dr. Schuler says the team is on the cusp of trialing two new technologies for managing atrial fibrillation.

“This technology could be beneficial for those patients whose atrial fibrillation is persistent despite multiple ablations,” he says. “Thankfully, due to the extra steps we take to minimize the chance of a recurrence, the number of patients who experience this problem is very small.”

Advanced Heart Care

The commitment to helping patients reach their health goals in life is one that WellSpan’s physicians and clinicians take seriously. That’s because they know the investment they, along with the organization, make in building and sustaining a strong cardiac program is about more than a reputation. It is about relationships with primary care providers and the health and well-being of the Adams, Lancaster, Lebanon and York communities, as well as the lives of friends, neighbors and family members — today and for decades to come.


To refer a patient to WellSpan Cardiology, call 717-851-2441 in Adams and York counties, 717-738-0167 in Lancaster County, and 717-270-7951 in Lebanon County. To find out more about the procedures our interventional cardiologists and electrophysiologists perform, visit www.WellSpan.org/HV