Cardiac electrophysiology, despite rapidly undergoing technological advances worldwide, is still in its infancy in the Middle East and faces a number of challenges.
A relatively new medical field, cardiac electrophysiology was first developed only 40 years ago. In the UAE, experts say that the first cardiac electrophysiology procedures were performed just over 15 years ago.
“Since then, the number and complexity of procedures performed in the country have grown exponentially. In certain highly specialised centres, the field has advanced to a high level comparable to some of the best tertiary care centres worldwide,” according to Dr. Mohamed Al Jaabari, Staff Physician, Cardiology at Cleveland Clinic Abu Dhabi’s Heart, Vascular and Thoracic Institute.
Some of the technologies introduced in the UAE over recent years include leadless pacemakers which are miniature-sized devices that are slightly larger than a medication pill. Advancements in the treatment of abnormal heart rhythms include the use of three-dimensional mapping technologies to minimise or eliminate the use of X-ray radiation during ablation procedures for the treatment of arrhythmias.
“During these procedures, small catheters are advanced through tiny incisions in the groin to enter the veins of the leg. These are then advanced through the veins into the heart and can create a three-dimensional model of the internal structure and electrical activity of the heart using technology similar to GPS,” explained Dr. Al Jaabari.
“Using this electrophysiology technology doctors are able to treat and eliminate abnormal heart rhythms with a high degree of success, with or without minimal exposure to X-ray radiation to the patient and physician.”
Another notable technology is that of remote monitoring with devices such implantable defibrillators. These can help monitor patients almost completely from the comfort of their homes, he added.
Dr. Omar Al Falasi, Consultant Cardiologist and Cardiac Electrophysiologist associated with the Emirates Cardiac Society, said: “Modern technologies have contributed greatly to managing heart diseases and have opened up direct communication between the patient and doctor.”
Giving an example, he said that the latest device, the implantable loop recorder easily enables the physician to diagnose arrhythmia. “This has played a very important role in diagnosing patients with palpitations which was difficult to diagnose before.”
Recent advancements in cardiac electrophysiology
Recent technological additions include smart watches or smart devices that can give an ECG tracing. Smartwatches have also received approval for the diagnosis of defibrillation with very high accuracy.
“The latest generation of defibrillators especially from Abbott and Medtronic allow telephone communication with the device that can also send alerts to physicians allowing for an accurate follow-up with patients in case of device or software failure,” said Dr. Al Falasi.
Three-dimensional mapping has also had a significant impact on patients in improving the safety of procedures by reducing radiation exposure and refining the precision of procedures and also improving success rates.
According to Dr. Al Jaabari, these technologies not only benefit the patient but also physicians by improving their ability to perform the procedures. “Other innovations such as leadless pacemakers allow electrophysiologists to perform pacemaker procedures on patients who may be too ill or frail to tolerate a standard pacemaker procedure,” he said.
“Remote monitoring has also had a significant impact on the quality of life for patients with devices as they no longer have to visit the hospital frequently for device checks. In addition, the monitoring allows physicians to identify issues or rhythm concerns earlier when the patient is under continuous monitoring.”
Dr. Al Falasi said that the patient just needs to have his phone in the same room as the device to send alerts directly to a physician.
“We noticed the utility of these inventions, especially during the Covid era where we could follow up with our high-risk patients on a regular basis using telecardiology-enabled devices.”
However, since electrophysiology is a developing field, there are several challenges, ranging from high costs to a lack of patient perception, that still needs to be overcome.
“Some challenges are related to patient perceptions due to a lack of understanding of this complex field. Patients often have a perception that electrophysiology procedures pose a high risk with low success rates, while on the contrary, this is not true. Most electrophysiology procedures are extremely safe and have high success rates. Unfortunately, these false perceptions may cause patients to avoid seeking the beneficial care of these procedures.”
He also said that due to the highly specialised and relatively young nature of the specialty, even some physicians may not be aware of the advances in the field and may not refer patients to an electrophysiologist when needed.
“The fact that electrophysiology is a field of rapid and frequent technological innovation often translates to a high cost for the equipment and devices, which can sometimes limit the accessibility and financial feasibility to certain patients or healthcare settings and networks,” added Dr. Al Jaabri.