Dr. Sumit Verma is a cardiologist with Baptist Heart & Vascular Institute in Pensacola. His specialty is electrophysiology. Verma, who received his electrophysiology training at Yale University Medical School, spoke with FLORIDA TREND about a new cardiac procedure available at Baptist Health Care to treat atrial fibrillation — a rapid, irregular heartbeat that is estimated to affect about 5% of the population — and other cardiac therapies.
FLORIDA TREND: What is the Concomitant Procedure as it relates to cardiology?
VERMA: The Concomitant Procedure combines catheter ablation of atrial fibrillation and the Left Atrial Appendage Occlusion (LAAO) procedure that reduces the risk of stroke by implanting through a vein in the groin a small umbrella-shaped, wire-mesh device that fits in the left atrium of the heart to form a barrier against blood clots.
FT: What changed that allows for the combination of these two procedures simultaneously?
VERMA: Catheter ablation of atrial fibrillation has been around for a few decades. We now have a new source of energy called pulse field ablation, which can be used to perform ablation of atrial fibrillation, which is an irregular, often rapid heart rate that commonly causes poor blood flow in and around the heart. Additionally, as operators have gained experience and familiarity with left atrial appendage occlusion, that procedure has also become relatively quick. It only makes sense to combine the procedures, as a large majority of patients meet criteria for both procedures.
FT: How does the Concomitant Procedure actually benefit the patient?
VERMA: Performing these procedures together not only limits how many times the patient has to go under anesthesia, but it may also potentially reduce the risk of complications. … From a hospital and physician standpoint, it will allow more procedures to be scheduled. This will have the effect of increasing patient access to care and reducing waiting times. So, it is vastly more efficient to do them together.
FT: Does the Concomitant Procedure require the performing cardiologist to undergo specialized retraining?
VERMA: Although it does not require specialized training beyond knowing how to perform each procedure individually, there are some nuances that the physicians must be aware of while performing the Concomitant Procedure. These are relatively quick to learn and overcome.
FT: Is the Concomitant Procedure more or less costly than having a LAAO and ablation procedure separately?
VERMA: The procedure is less costly to the patient compared to the two procedures being performed separately. There also should be reduced costs to the patient as well in terms of out-of-pocket deductibles, time away from work, recovery time and travel costs.
FT: What were the procedural developments that prompted the Center for Medicare & Medicaid Services (CMS) to approve the Concomitant Procedure?
VERMA: I think this reflects a recognition by CMS that a large number of patients require both procedures and it would provide significant cost reduction, safety and improve access for patients with atrial fibrillation.
FT: Looking ahead, what is the potential impact on the treatment of heart disease with induced pluripotent stem cells?
VERMA: The potential impact is huge. Pluripotent stem cells have the potential to regenerate cardiac cells. The challenge comes in organizing these cells in a proper structure that can allow cardiac contraction. Scientists have already figured out how to generate these cells in a biological scaffold and create a beating tissue in the laboratory. However, human testing and applications are still far away.
FT: On a similar note, do you see any realistic potential for the experimental drug Trodusquemine to be approved for use in treating plaque buildup in humans?
VERMA: Fat buildup in arteries is often preceded by inflammation that results in oxidization of the cholesterol and deposits in the arteries. Trodusquemine has the ability to reduce inflammation, and as a result, it can have several advantageous effects such as appetite suppression, promoting weight loss, treating metabolic syndrome, and also ... preventing calcification in the aortic valve. Large scale human trials will be necessary before the drug is ready for clinical use.