Dr. Devi Nair, electrophysiologist with Cardiology Associates in Jonesboro and a member of the medical staff at St. Bernards, has performed a procedure that is a first in Northeast Arkansas. She recently performed an ablation procedure in a patient from Manila with Atrial fibrillation to restore normal heart rhythm.
The procedure, called Pulmonary vein ablation (also called pulmonary vein antrum isolation or PVAI), is a treatment for atrial fibrillation, is now being done at St. Bernards thanks to the construction of a new dedicated Electrophysiology Laboratory (EP Lab) located in the St. Bernards Heartcare Center.
Nair successfully treated the 43-year-old who suffered from atrial fibrillation – an irregular heart rhythm caused by abnormal electrical activity in the upper left chamber of the heart (left atrium).
A cardiologist with advanced training in treating heart rhythm conditions, she used a catheter-based procedure to correct the patient’s rapid heartbeat by destroying cardiac tissue that created abnormal electrical signals. Nair works in conjunction with a highly trained team of EP lab staff and anesthesia staff that assist her during the procedure.
Atrial fibrillation is the most common type of arrhythmia (or problem with the rhythm of the heartbeat) and can affect people of any age. It occurs when the upper chambers of the heart are fibrillating – or “quivering” – and it causes a rapid, irregular heart rhythm.
The normal heart rate of an adult is between 60 and 100 beats a minute. But when the heart is in AFib, the atria can beat more than 300 times a minute, Nair explains. That irregular rhythm means the upper and the lower chambers of the heart do not work together as they should.
The atrial fibrillation itself is not dangerous. But if the condition is left untreated, side effects of AF can be life-threatening.
When the atria are fibrillating, the blood flow to the lower chambers of the heart (ventricles) is slowed, and that increases the risk of developing blood clots. If a clot were to break loose, it could result in a stroke or a heart attack.
Another side effect of AFib is that it can cause the ventricles to beat too fast, and over time, that can weaken the heart muscle and lead to heart failure.
Because St. Bernards recently constructed a dedicated Electrophysiology (EP) Lab in its Heartcare Center, the two electrophysiologists on staff at St. Bernards – Dr. Devi Nair and Dr. Roosevelt Gilliam – now have the most sophisticated tools at their disposal to treat a wide range of heart rhythm problems.
In this instance, Nair used a catheter-based procedure that allows her to locate the exact sites within the heart where abnormal electrical activity is created in patients with atrial fibrillation. She then was able to destroy the tissue that was producing abnormal signals by cauterizing it using radio frequency energy.
In a lengthy procedure done under general anesthesia in the EP Lab, Nair inserted catheters (long, flexible tubes) into the blood vessels of the leg. Two of the catheters are guided into the left atrium through a small hole made with a needle in the atrial septum (wall between the right and left atria).
A transducer is inserted through one of the catheters so intracardiac ultrasound can be performed during the procedure. The ultrasound allows the doctor to view the structures of the heart and evaluate the position of the catheters during the procedure.
A catheter in the left atrium is used to find or map the abnormal impulses coming from the pulmonary veins using a highly sophisticated 3D mapping system. Another catheter is used to deliver the radiofrequency energy outside and around the pulmonary veins, thereby destroying connections of the pulmonary veins to the left atrium. Frequently, other areas involved in triggering or maintaining atrial fibrillation are also targeted.
Nair works closely with the anesthesia staff during this very lengthy procedure to keep patients comfortable and safe. Her specially trained EP team includes Jason Martin, Angela Ivy, Janet Chappell and Deanna Walker, who also work closely with her during the entire procedure.
The highly specialized procedure is possible because of an investment of approximately $2.5 million to create and equip a state-of-the-art lab dedicated to EP procedures.
The AF ablation is only one of the procedures used by St. Bernards electrophysiologists to treat heart patients from Northeast Arkansas and Southeast Missouri right here so they don’t have to leave home to receive world class care. Nair states that patients can get every procedure in cardiac electrophysiology performed anywhere in the rest of the country right here at St. Bernards.
In addition to the recent completion of the new EP Lab, St. Bernards has upgraded its two Cardiac Catheterization Labs, raising the bar for heartcare in the region and building on a heart program which was has grown steadily since its inception three decades ago.
St. Bernards offers the most comprehensive heartcare services of any facility in the region. It is the only medical center with electrophysiologists on staff, and it is the only facility with a dedicated EP lab.
St. Bernards is the region’s only medical center designated as a Blue Distinction Center for Cardiac Care by Blue Cross Blue Shield.
Nair completed her medical school in University of Kerala in India. She earned her M.D. degree from Columbia University College of Physicians & Surgeons in New York City at St. Luke’s Roosevelt Hospital Center. She completed fellowships in Cardiology and Cardiac Electrophysiology at Case Western Reserve University at MetroHealth Campus in Cleveland, Ohio, and is board certified in Cardiac Electrophysiology, Cardiovascular disease and Internal Medicine.
The first patient Nair treated at St. Bernards using pulmonary vein ablation was Brandon Harper, a 43-year-old Manila resident who was diagnosed with atrial fibrillation four years ago. He was treated with medication, but by late last year the medicine was not controlling his symptoms well.
So he and Nair discussed the pros and cons of the ablation procedure. And he underwent that procedure in mid-April. “Now,” he says, “I feel like my old self.”
Harper, who is a human resources manager at American Greetings in Osceola, says he feels better than he has in four years. And he feels like he has his life back.
Harper and his wife Jennifer have four daughters, Chelsea, 15; Anna Marie, 8; Eva, 3; and Katie Beth, 6 months.