The Operating Theatre Journal - Journal - Page 28
CUTTING EDGE MEDICAL
DEVICE DESIGN UNVEILED
AT MED-TECH 2023
Nottingham cardiologists perform first
new treatment for heart rhythm disorder
For more than 15 years Wideblue has been at
the forefront of medical device design. At this
year’s Med-Tech Innovation Expo the company
revealed its core product development skills
in this sector.
A team of cardiologists and cardiac surgeons
have performed a new open chest procedure
to treat a patient’s serious heart rhythm
disorder - the first of its kind in the city’s
hospitals and in the East Midlands.
One of Wideblue’s most recent projects has
been helping develop the next generation of
MRI scanners. It has been working with client
MR Coiltech who design, test and manufacture
specialised radiofrequency (RF) coils. The
sophisticated coils will enable greater
resolution brain scanning, helping researchers
to learn more about brain conditions such as
stroke, vascular dementia, brain tumours,
Parkinson’s and Alzheimer’s Disease in greater
detail than previously possible. Development
of the coils has been made possible through
partnerships with the University of Glasgow’s
Living Laboratory for Precision Medicine
programme.
The company also recently
achieved ISO accreditation (ISO 13485:2016)
with the support of InnoScot Health.
The team from Nottingham’s Trent Cardiac
Centre catheter lab based at Nottingham City
Hospital, used Cardiac magnetic resonance
imaging (MRI) to locate the cardiac scar
causing the patient’s dangerous heart rhythm
abnormality called ventricular tachycardia
(VT). This information was used to plan the
procedure before the operation and live
electrical data from the patient’s heart was
used to guide the procedure.
This, combined with the strength and expertise
of the different teams’ specialist skills, led to
a positive outcome for the 49-year-old male
patient from Lincolnshire who has remained
free from VT for 32 months following the
procedure.
Consultant Cardiologist Dr Shahnaz JamilCopley and her cardiology, cardiac surgical
colleagues performed this hybrid ablation
procedure – also known as catheter ablation –
to treat scarring in the patient’s heart, which
causes abnormal heart rhythms (arrhythmia).
The procedure works by correcting certain
types of arrhythmias by modifying the
electrical pathways or channels which can
cause dangerous cardiac arrhythmias.
The five-hour “hybrid” procedure, which
was conducted in the Cardiac Catheter
Laboratory within the Trent Cardiac Centre
at Nottingham’s City Hospital rather than in
a conventional cardiac operating theatre,
has now been published as a case report in a
leading cardiac medical journal, the European
Heart Journal.
Dr Jamil-Copley led the team that performed
the demanding operation, which involved a
multidisciplinary team including two cardiac
surgeons, two cardiologists, a cardiac
anaesthetist, cardiac technical and nursing
teams.
Barry Warden, managing director, Wideblue
said: “The MR Coiltech project is a great
example of how we collaborate with clients
and other partners, often in academia, to
bring medical technology to market. Being
part of the Pivot International group of
companies means we can handle projects at
all stages from design, prototyping and testing
to full-scale manufacture.
He added: “Our skills cover product design,
mechanical, electronic and software design,
physics and optics, with particular expertise
in photonics and system engineering. We have
successfully designed several first-of-a-kind
products. Our clients include individuals,
start-ups, technology research organisations,
charities and social enterprises as well as
global multinationals.
Medical devices have ranged from a personal
capnometer and heated stretcher to a device
for the early detection of sepsis and a lowcost ophthalmoscope.”
For further information about Wideblue please
visit www.wide-blue.com
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28
Dr Jamil-Copley commented: “This was
a highly innovative procedure to treat a
challenging medical condition replacing the
traditional percutaneous (passing through the
skin) access to the heart, which had previously
been tried but had failed with this patient.
“Recurrent ventricular tachycardia and ICD
shocks were having a significantly negative
impact on this patient, leading to them
needing regular hospital admissions. The most
important outcome here is that our patient
has remained free of VT and we have been
able to stop the poorly tolerated drugs being
used to treat his condition. This has meant a
major benefit to the patient’s quality of life.”
The European Heart Journal report written
by the Nottingham team, is the first case
study to describe the practicalities, safety
and feasibility of this hybrid procedure which
performed in a cardiac catheter laboratory
solely to treat ventricular tachycardia.
The procedure has been performed in other
hospitals in the UK and United States on heart
transplant patients who were having their
chests opened for other medical reasons.
THE OPERATING THEATRE JOURNAL
However, the Nottingham procedure was a
“first” because it was for the sole treatment of
VT and used live electrical data with surgical
tools and techniques to give it the best chance
of success.
The patient was initially admitted to the Trent
Cardiac Centre after recurrent VT required
frequent defibrillator shocks from their
implantable cardiac device (ICD), despite
being on the maximum permitted dose of
multiple cardiac drugs.
Standard cardiac catheter ablation for VT is
performed using tubes placed through the
veins in the groin or through the front chest
wall with catheters, X-rays and 3-D mapping
systems used to locate the scar and burn the
abnormal areas causing trouble.
When this procedure was tried but proved
unsuccessful for this patient, they chose the
more radical method of reaching the heart by
opening the patient’s sternum, which provided
direct access and greater visibility of the area
of scar.
The Nottingham City cardiac MRI team have
worked hard to establish an advanced imaging
“protocol” which improves visualisation of
scar tissue in the heart compared to historic
protocols. Before this patient underwent his
hybrid surgical ablation procedure, the team
performed an MRI scan, which located the
patient’s cardiac scar and helped guide the
surgical team in planning the procedure.
One of the major benefits of performing the
procedure in the Cardiac catheter laboratory
was the ability to capture and use the live
electrical data from the patients beating
heart to map and guide cryoablation (freezing)
therapy of scar tissue. Direct visualisation
of the area allowed the team to stay safe
by avoiding structures around the heart like
the coronary arteries during this precision
treatment approach.
The European Heart Journal case report is
available at:
https://doi.org/10.1093/ehjcr/ytad223
Dr Jamil-Copley is one of NUH’s winners of the
prestigious national ‘CARP’ (Clinical Academic
Research Partnership) Awards for her research
work. In this research, she is investigating
the use of artificial intelligence to develop a
3D ventricular scar model of patients’ hearts
to treat scarring that causes ventricular
arrhythmias – life-threatening heart rhythms.
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