A unique collaboration between heart surgeons and cardiologists/electrophysiologists at St. Paul’s has led to world-leading advances in care for heart patients
It is not often that a man can say he’s had his life saved twice, but that is exactly the case for St. Paul’s heart patient David Hebb. After two decades of having his chronic atrial fibrillation (AF) successfully managed by electrophysiologist Dr. Charles Kerr, Hebb recently had a pacemaker inserted by cardiac surgeon Dr. Jamil Bashir, and he credits the two St. Paul’s heart doctors with keeping him alive.
“I am absolutely indebted to both those men; they’ve prolonged my life and without them I wouldn’t be here. It’s not only their incredible acumen, it’s that they listen to their patients,” says Hebb. “I have the good fortune of being Dr. Kerr’s patient for the last 20 years and I’m convinced he’s the best arrhythmia specialist in Canada.
“Last November, before Dr. Bashir did my surgery, he got a special MRIcompatible pacemaker couriered to meet my medical needs,” says Hebb, a 74-year-old retired sales rep. “It is the first of its kind in BC, and I’m so grateful to Dr. Bashir for securing it for me.”
Collaboration of specialists
Hebb isn’t the only heart patient to benefit from the combined expertise of the cardiologists/electrophysiologists and cardiac surgeons at St. Paul’s provincial Heart Centre. Since 1994, thousands of people with AF and other heart arrythmias have been treated at St. Paul’s, where BC’s top heart specialists form the largest and most comprehensive cardiac care program in BC.
“The current [heart] program at St. Paul’s is really a hybrid of cardiovascular surgery and cardiologists who are electrophysiologists,” explains Bashir, a heart surgeon and Director of Laser Lead Extraction at the provincial Heart Centre at St. Paul’s. “Beginning with Dr. Kerr [who pioneered the program], we’ve worked hard over the years to create what is today a complete cardiac team.”
“In the 20 years since we began the program at St. Paul’s, it’s grown from one room to two full-time laboratories, and from one person [Kerr] to the six specialists we now have working here,” says Kerr. “In that time there have also been a lot of advances in technology [related to cardiology] and in that respect, I think we’ve been at the front of the curve over the last 15 years.”
The program’s continual exploration of new technologies related to heart care has allowed the team at St. Paul’s to accrue an impressive list of pioneering milestones. St. Paul’s was the first hospital in Western Canada to use computer cardiac mapping systems (which generate 3-D images of the heart) to detect the origin of abnormal heart rhythms.
St. Paul’s electrophysiology team also pioneered one of the first programs in Canada to treat AF with a technique called ablation. Through ablation, small wires are inserted in the upper leg and advanced into the heart. The areas responsible for the faulty electrical signals that cause AF are ablated (and therefore blocked), allowing the heart to beat normally again.
Groundbreaking heart procedure
Recently, St. Paul’s has become the nation-wide frontrunner in yet another groundbreaking heart procedure known as laser lead extraction. With this procedure, doctors use a precise device called an excimer laser to remove the wires that connect a pacemaker or defibrillator to the heart muscle. This innovative and minimally invasive approach, developed at St. Paul’s, has dramatically improved outcomes for patients and driven down mortality rates to almost zero.
“Leads can break or become infected, and when they get infected you’ve got to take them out,” says Kerr, who had headed up the divisions of cardiology at both St. Paul’s and UBC for much of his distinguished career. “This laser lead extraction has really revolutionized the process and is the state of the art.”
This year, the laser lead extraction program, spearheaded by Bashir, will perform its 1000th lead extraction at St. Paul’s – a milestone that underlines the program’s prominence as the largest of its kind in Canada, and highlights St. Paul’s as a major centre of research and innovation in this challenging specialty.
“We’re really a leader in the area of laser lead extraction, and our program is actually a western Canadian resource,” says Bashir. “If other provinces or territories have a problem case, they’ll send us those patients and we can almost always solve the issue.”
At St. Paul’s provincial Heart Centre, the cardiologists/electrophysiologists and cardiac surgeons work collaboratively, deftly tapping into each other’s unique expertise and skill sets in order to determine the best approach for every patient situation.
“In a lot of places the extractions are run by electrophysiologists, but because we’re a surgeon-led program at St. Paul’s, we can offer a whole breadth of different procedures,” says Bashir. “For example, on the rare occasion when we get into trouble during extraction, we can open the chest and fix the problem pretty much immediately.”
Bashir acknowledges that the spirit of interdisciplinary co-operation has been evident at St. Paul’s provincial Heart Centre since its inception: “It evolved very much under the direction of Dr. Charlie Kerr. He’s always been an excellent advocate for the team approach, always had the ‘rising tide floats all boats’ philosophy and the desire to make things better for everyone. Of course, by doing that, he makes things better for patients, and that’s the key.”
Kerr’s influence in guiding heart care reaches far beyond St. Paul’s and UBC, and has included terms as vice-president and president of the Canadian Cardio-vascular Society. This year, in addition to winning the annual achievement award of the Canadian Heart Rhythm Society, he’s been honoured with the establishment of a new UBC scholarship – the Dr. Charles Kerr Program. Sponsored by Medtronic, in partnership with St. Paul’s Foundation and UBC, the scholarship will allow St. Paul’s to attract and retain two brilliant young investigators and clinicians per year.
“It really is a great honour,” says Kerr, who himself has devoted most of his professional career to the care of patients with heart arrhythmias. “The recipients will greatly enrich our arrhythmia management program at St. Paul’s.”
In summing up an illustrious career spent studying and healing the human heart, Kerr provides a humble overview: “Compared to when I started out, with a homemade amplification system that occupied about half the room, to the technology we have now, it’s been pretty amazing to watch the changes in cardiology over 34 years of practice. It’s an honour to be part of it.”
Largest lead extraction program in Canada
Lead extraction is a procedure where electronic wires (called leads) connecting pacemakers and other implanted devices are removed from the heart. St. Paul’s operates the largest lead extraction program in Canada, accepting referrals for treatment from Saskatchewan, Alberta, Northwest Territories and the Yukon.
Implantable cardiac devices are designed to be permanent, but as with all medical devices, some circumstances, such as infection or breakage, require them to be removed. The lead extraction program’s top specialist, Dr. Jamil Bashir, is currently heading up a nationwide study aimed at developing a Canadian Lead ExtrAction Risk score (CLEAR score), which will standardize risk assessments across the country.
St. Paul’s owes much of the success of its lead extraction program to its use of a medical device called an excimer laser – a thin wand that generates a micro-thin beam of light that can cut through human tissue without generating any heat. Unlike with other more invasive surgeries, lead extraction using the excimer laser requires only a tiny incision in the patient’s chest.
St. Paul’s progressive model of an interdisciplinary extraction team is being adopted by other hospitals across Canada and abroad.
To learn how you can support heart care, research and teaching at St. Paul’s, please contact St. Paul’s Foundation at 604-682-8206 or visit www.helpstpauls.com.