Anatomy – electrophysiologist’s superpower
The heart is a dynamic internal organ, the actual work of which constitutes the simultaneous activity of several hundred elements. In the case of diagnostics and therapy of cardiac arrhythmias, perfect knowledge of anatomy allows us to conduct diagnostic process and perform therapeutic interventions in a safe, efficient, and more effective way – argues Mateusz Krystian Hołda, MD, PhD, DSc from the Department of Anatomy, Jagiellonian University Medical College, and Department of Diagnostics of John Paul II Specialist Hospital in Krakow.
– The heart is the most structurally complex organ of the human body. It is not only a moving organ (in which several hundred elements interact) but also combines both mechanic, hemodynamic and electrophysiological functions. The latter is the work of cardiac electrophysiologists who specialize in the diagnostics and therapy of cardiac arrhythmias. The character of minimally invasive electrophysiological procedures relies on the fact that during these treatments, operator does not act on the open heart but more ‘in the dark’, using catheters. For electrophysiological therapy to be as effective and safe as possible, perfect knowledge of anatomy is indispensable. One could say that this is the real ‘superpower’ of electrophysiologists – convinces dr. Mateusz K. Hołda.
According to dr. Hołda, anatomy is a field that should be included not only at the earliest stages of medical education but also in the path of further education and professional development of specialists.
Every physician is only exposed to classical anatomy in their first year of studies. Then there is an opportunity to take the dissected heart into the student’s hands to know its structure. However, at this very initial educational stage, not many future doctors know what they actually want to observe and what they want to tackle later. It would undoubtedly be beneficial to introduce refresher courses in anatomy at almost each postgraduate medical specialization stage. Constantly developing technology is excellent support for modern doctors however it cannot replace thorough knowledge – believes dr. Mateusz K. Hołda.
During EP FANS 2021 Conference, inaugurating a new educational initiative aimed at young cardiac electrophysiologists at the beginning of their careers, we organized anatomy workshops for ones in the early stages of specialization. Participants had the opportunity to refresh fundamental knowledge about the structure and function of the heart from the perspective of cardiac arrhythmias diagnosis and therapy. There was plenty of room to evaluate anatomical specimens and discuss the significance of specific structures.
– Excellent knowledge of anatomy comes into great prominence in the case of cardiac electrophysiology. It is worth remembering that ablation procedures of arrhythmogenic substrate are relatively new techniques concerning the invasive treatment of cardiac arrhythmias. Currently, the ablation options cover almost the entire heart area. We can ablate pulmonary veins, both atria and myocardium of ventricles, as well as areas of main valves. There is practically no area where the ablation procedure cannot occur that would not have an electrophysiological basis and could not be successful. However, two pillars such as safety and effectiveness of any therapy base on the knowledge of individual anatomical structures of the heart and their three-dimensional interrelationships, which in certain heart regions are extremely difficult – notes dr. Mateusz K. Hołda.
According to the expert, among other benefits, excellent knowledge of anatomy for electrophysiology procedures results in a shorter time to perform and little exposure to x-rays (both for the patient and medical staff). Echocardiography and cardiac computed tomography techniques help physicians in accurate electrophysiologic diagnosis and therapy with the latter being the powerful tool for assessing heart anatomy before the procedure. Three-dimensional imaging of the heart using modern electroanatomical systems is also becoming increasingly important.
– In preoperative mapping, we want to find out what the patient’s heart looks like morphologically, structurally, that is: what do heart chambers look like, where do the coronary vessels run, what are their mutual relationships and neighborhoods, are there any unusual anatomical variants. As far as intraoperative electrophysiological mapping is concerned, it is even more helpful from the electrophysiologist’s point of view because it allows us to capture exactly those places where the procedure should be performed and follow the whole ablation process live, in 3D. What is essential, thanks to the support of electroanatomical systems, the operator can continuously evaluate the results of the procedure and, if necessary, modify the adopted therapeutic strategy. Undoubtedly, this is an entirely revolutionary technique that supports the doctor, shortens the procedure time, and improves its results – says dr. Mateusz K. Hołda, MD, PhD, DSc.
The workshops titled ‘Anatomy for the Electrophysiologist’ was held as a part of the EP FANS Conference on October 8, 2021, in Krakow, Poland.
