MUHC team uses an innovative and less invasive technique to treat arrhythmias
A unique collaboration between cardiologists and radiation oncologists at the McGill University Health Centre (MUHC) will allow some patients with severe arrhythmias, including ventricular tachycardia, to benefit from a radiotherapy treatment consisting of accurately irradiating the abnormal parts of the heart that cause the arrhythmias.
“This is a whole new way to reduce or even eliminate arrhythmic episodes for patients with few treatment options,” says Dr. Martin Bernier, an MUHC cardiologist specialized in the electrical activity of the heart, who worked in collaboration with Dr. Tarek Hijal, a radiation oncologist at the MUHC.
“For us, the approach is different and similar at the same time,” says Dr. Hijal. “The approach is different because we normally locate tumours and treat them by directing the beams onto them. In this case, we use the same technology, the same techniques, but to locate and treat a section of the heart that is not working well. ”
Ventricular arrhythmias are related to the presence of scars that act as the activation centre of an electrical short circuit. “In cases of severe arrhythmia, the heart pumps so quickly that it runs in a vacuum, there is no circulation, and that results in a cardiac arrest. The goal of the treatment is to calm the game by changing the electrical properties of the tissue, so that short circuits can no longer form, ” explains Dr. Bernier.
The treatment includes several steps. First, an electrophysiological study is carried out by the cardiology team to accurately define the scar, its extent and its electrical properties. Then the radiation oncology team takes over, using cardiac mapping data and applying them to radiotherapy scans and to determine the volume and maximum irradiation dose tolerated. The treatment techniques are the same as those used for treating cancer and the duration of treatment is about thirty minutes.
According to Dr. Bernier, this avenue represents an alternative for patients whose quality of life is restricted: “Standard treatments are usually quite invasive. For some patients, it is an important medication, for others it is the insertion of a catheter into the femoral vein to the heart to abolish arrhythmia circuits and as a last resort, it is heart transplantation, a risky intervention, considering that the overall health of the patient is often weakened “.
To achieve this project, it took two ultra-specialized teams that had to learn to speak the same language. It is the result of many people working together, whether in the medical and nursing teams in cardiology or radiation oncology. Dr. Hijal did not hesitate to encourage his colleagues to leave their comfort zone to work with Dr. Bernier and his team. “To treat cancer patients, the interdisciplinary work is done with, among others, the radiation oncologist, the medical physicist and the technologist; but a collaboration of this type between radiation oncology and cardiology to treat patients with serious heart disease is rather rare and this makes the experience unique and rewarding.”
So far, only a few dozen patients worldwide have benefited from this brand-new technique, and one of the first Canadian patients was treated at the MUHC last October. A research protocol will be established by MUHC teams in the first months of 2020 to gather more data and develop expertise that will ultimately benefit more patients.
December 10 2019