BIO:

After graduating from the University of Toronto in internal medicine and cardiology, Dr. Verma attended the world-renowned Cleveland Clinic to study to become an electrophysiologist. An electrophysiologist is a cardiologist specializing in the diagnosis and treatment of abnormal heart rhythms, essentially the electrical workings of the heart. He was born and raised in Winnipeg and, fittingly, his father is an electrical engineer and his mother a physician.

Dr. Verma very quickly became a star in his field—an innovator bound and determined to find better methods of treatment. In 2005, at the encouragement of Dr. Zaev Wulffhart, Dr. Verma came to Southlake to continue the groundbreaking work he had begun in Cleveland.

Much of Dr. Verma’s work centres around cardiac arrhythmia (irregular heart beat) and specifically atrial fibrillation (AF). Affecting millions of people worldwide, AF is a condition in which the upper chambers of the heart beat rapidly and erratically, affecting the heart’s ability to adequately pump blood to its lower chambers and the rest of the body. The condition is responsible for 15 to 20 per cent of all strokes and is a leading cause of hospitalizations. The most common treatment for AF is ablation or burning inside the heart. The resulting scar tissue helps return the heart to a regular rhythm.

Dr. Verma has authored or co-authored more than 70 articles and abstracts on electrophysiology issues, ablation and arrhythmia, including a study recently published in the New England Journal of Medicine. He has also received many honours and awards, including the first ever Southlake Research Award of Excellence in 2012.

( Dr. Atul Verma, Electrophysiologist, Newmarket, ON ) is in good standing with the College of Physicians and Surgeons.

Let’s talk a little bit about the risks and benefits of the ablation procedure. Let’s start with the risks. Fortunately all of the risks are very low, but there are some that you should be aware of. During the ablation procedure, for example, we could cause a blood clot in the heart, and this could result in a stroke.

That’s why we ask you to take blood thinners up until the ablation procedure, and we also give you extra blood thinners during the ablation procedure. So this risk is 0.2% or less. There’s also a risk that while we’re performing the burning in your heart that we could burn a hole in the heart, and cause bleeding, which might require urgent surgery to fix.

But that’s why we limit the amount of power that we use, and this risk is also less than 0.2%. There’s always a risk potentially of a fatal complication with any procedure that you have performed and ablation is no different. The esophagus, for example, is located very close to the left atrium, and there have been reports of burning in the left atrium causing damage to the esophagus, which could be life threatening. We however take precautions to avoid this from happening, like measuring the temperature in the esophagus, and the risk of a life threatening complication is one in a thousand or less.

In terms of the success rates, the success depends in part on the type of atrial fibrillation that you have. If you’re in and out of atrial fibrillation, which we call paroxysmal atrial fibrillation, your success rate is going to be higher. The chance of eliminating your atrial fibrillation after one attempt at the procedure is about 70 to 75%, and after two attempts at the procedure, 85 to 90%.

If you’re in atrial fibrillation all the time, however, we call this persistent atrial fibrillation, then your success rate is going to be lower. The chance of success after one attempt at the procedure is maybe about 65 to 70%, and after two attempts about 80 to 85%. Still quite good, but lower than the paroxysmal patients.

If you have further questions about your ablation procedure, feel free to ask your physician, nurse practitioner, nurse, or any other member of the atrial fibrillation team.

Presenter: Dr. Atul Verma, Electrophysiologist, Newmarket, ON

Local Practitioners: Electrophysiologist

Dr. Atul Verma, MD, FRCPC, Cardiologist, talks about how ablation therapy is performed in order to treat atrial fibrillation. Southlake Regional Health Centre

So atrial fibrillation is due to triggers, abnormal triggers that are developing usually in the left atrium of your heart. And these triggers then set off the irregular and rapid heart beating, which you know as atrial fibrillation.

So when we talk about ablation, we’re talking about a minimally invasive procedure that allows me to go into your heart, identify where these abnormal electrical triggers are coming from, and then basically to either to burn them away or freeze them away. And that in a nutshell is what ablation is all about.

To give you a little bit more detail, we perform the ablation by inserting small little tubes into the veins of both of your legs, as well as potentially into a small vein in your neck. Through those little tubes, we can insert special wires, as well as special catheters, which are basically small little devices that allow us to record your heart rhythm, identify the abnormal areas and then deliver energy to eliminate them.

So this is an example of one of the catheters that we would be inserting through your veins and into the heart. And you can see that the tip of the catheter is metal, so it can record electrical signals from the heart, but at the same time this connects into an energy source which allows us to burn those abnormal signals away. The catheters are also capable of moving, and this is the way we control where in the heart the catheters are going.

The ablation procedure on average takes about two to three hours to perform, and you are usually very heavily sedated during the procedure. Sometimes it can be done under a full general anesthetic. During the procedure we then insert the tubes, place the catheters in your heart and complete the procedure. And after the procedure is finished, you’ll go to our recovery area, where the nurses will then pull the tubes out of your leg and out of your neck. At this point you’ll have to be in bed rest for four to six hours, and usually we’ll keep you in one night after the procedure, and then you go home early the next morning.

If you have any more questions about your atrial fibrillation or whether you may be a potential candidate for ablation for your atrial fibrillation, feel free to contact your local health professional, your cardiologist, or have them refer you to the heart rhythm program here at Southlake Regional Health Centre, where we’ll be happy to do a consultation.

Presenter: Dr. Atul Verma, Electrophysiologist, Newmarket, ON

Local Practitioners: Electrophysiologist