The New Stanford Center for Arrhythmia Research:

The Division of Cardiovascular Medicine has launched the Stanford Center for Arrhythmia Research with the aim of bringing a larger multidisciplinary approach to build on the success of the longstanding Cardiac Arrhythmia Service.

In recent years, the Cardiac Arrhythmia Service has assembled a team that has significantly increased patient volume; grant and extramural support for research, presentations, publications, and patent submissions; as well as trainees who are supported by a variety of fellowship awards.

But by creating a research center, co-directors Paul Wang, MD, and Sanjiv Narayan, MD, PhD, plan to bump the achievements up a notch.

The center’s inaugural event was a September 8, 2017, symposium that brought together researchers and clinicians from varied departments, divisions, and centers to discuss the latest advances at Stanford.

“Our vision is to be an international magnet for arrhythmia research. This will allow us to develop novel technologies and to treat arrhythmias in a way that hasn’t been done before. We want to attract people from many disciplines in an effort to tackle some important problems,” says Wang, who also serves as director of the Cardiac Arrhythmia Service.

Interdisciplinary Approach

“It is our goal to make Stanford a leading arrhythmia research and clinical care facility where we can bring people from many disciplines together and work toward some really ambitious goals in advancing the treatment of arrhythmias,” Wang says.

He and Narayan believed that without a true interdisciplinary approach, it was unlikely their center would make the major breakthroughs that will be needed in the field. They had already attracted a large number of key faculty members, many of whom are leading experts in such diverse fields as mathematics, chemistry, pulmonary medicine, engineering, biology, social science, the humanities, imaging, stem cell biology, psychology, computer science, sleep medicine, cardiac surgery, and bariatric surgery.

Narayan is a good example of interdisciplinary expertise. After studying mathematics and biology and training as a computational biologist with plans to become a neuroscientist, he became fascinated with the heart and its electrical signals and decided to become a cardiac electrophysiologist—the specialty of all eight cardiologists in the Cardiac Arrhythmia Service.

“The Stanford Center for Arrhythmia Research provides a place where innovators can work in this exciting field. Other centers such as the Stanford Byers Center for Biodesign have been instrumental in creating such a vibrant and supportive community. It’s a model for how people from many disciplines at Stanford come together to promote innovations,” Wang says.

One of the center’s goals is to ensure that translational components are in place so that what is being discovered at the laboratory level is brought all the way to the patient.

Ablation

The current standard for treating arrhythmias is ablation. That involves locating a specific area of the heart that is malfunctioning, then destroying, or ablating, the problem cells.

Ablation can be done surgically or minimally invasively. Cardiac surgeons can approach arrhythmias by opening the chest cavity and precisely carving out parts of the heart and then carefully sewing the muscle back together, or they can use less invasive tools that provide direct access to the heart. An even less invasive technique is catheter ablation, which accesses the heart using catheters, then uses extreme heat or cold to kill the cells that are causing the arrhythmia.

Cardiologists also use medications to treat arrhythmias by affecting different ion channels of the malfunctioning cells.

Innovative Technologies

Cryoablation and focal impulse and rotor modulation (FIRM) ablation are two technologies that were invented by the Stanford team and have become standard arrhythmia treatments.

Wang is the coinventor of cryoballoon ablation, a cardiac catheterization procedure that uses extreme cold to treat the heart tissue that triggers arrhythmia. Cryoablation has been used to treat more than 250,000 patients with atrial fibrillation (AFib) worldwide. In the procedure, physicians insert a catheter through a blood vessel and guide it to the heart. They then inflate a tiny balloon at the end of the catheter with a special gas coolant to freeze the atrial tissue triggering the arrhythmia. During one application, the cryoballoon can treat a large surface of atrial tissue.

Applying his computational biology expertise using mathematical tools to understand the nature of arrhythmias, Narayan invented FIRM ablation, a mapping technology that cardiologists use to precisely target the electrical sources of AFib. With the help of sophisticated computer software, FIRM accurately identifies key areas of the heart for ablation. It is a very effective treatment that provides long-term relief of AFib and its symptoms.

Hybrid Program

One example of the center’s multidisciplinary collaboration is the Hybrid Surgical-Catheter Ablation Program, which combines the efforts of cardiac surgeons and cardiologists.

“We don’t think it comes down to whether it’s surgeons or cardiologists who are better at treating arrhythmias. We think the issue is how we can optimize our working together to achieve the best results for the patient,” says Wang.

A big part of that effort was the recruitment of Anson Lee, MD, a young cardiac surgeon who came to Stanford to specialize in arrhythmia surgery.

“Arrhythmia surgery largely went away as a standard technique for treating arrhythmias, so many of its tools are no longer available. We believe that surgical approaches can be very appropriate, and it’s important to rejuvenate this area of surgery. That’s why we are working to invent the next wave of technologies to enable arrhythmia surgeons to work with cardiac electrophysiologists,” Wang explains.

In hybrid surgical-catheter ablation, electrophysiologists and cardiac surgeons are working in partnership to treat the heart from both inside and out. This innovative approach provides better long-term outcomes and greatly improves patients’ quality of life.

During a two-step procedure, catheter ablation is combined with thoracoscopic surgery, a minimally invasive chest surgery in which a miniscule camera is placed into the chest through tiny ports. During that surgical step, the team can see the heart directly, but without having to open the chest cavity. The surgeon then uses specially designed equipment to treat those parts of the heart that are responsible for the heart rhythm problem.

In step two, the cardiac electrophysiologist inserts catheters into the heart from a peripheral vein well outside the cardiac area to identify and treat additional areas that are harder to access from the outside.

“This is a really exciting development that gives us the best of both worlds. Some things are more easily accessed from the outside, and some things are more easily accessed from inside. By working together, we can get better results than by either of our groups working independently,” says Wang.