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  • Lucy De La Cruz
    January 20, 2022

    The renowned 39-year-old breast surgeon becomes youngest Latina woman to lead breast surgery program in U.S. at major academic medical center

    WASHINGTONLucy Maria De La Cruz, MD, has joined MedStar Georgetown University Hospital as chief of its Breast Surgery Program and director of the Betty Lou Ourisman Breast Health Center. Dr. De La Cruz is a fellowship-trained breast surgeon who specializes in advanced breast surgery procedures, including wireless lumpectomies, hidden scar technique, oncoplastic breast conservation, and nipple-sparing mastectomy. She has been published in more than two dozen peer-reviewed scientific journals, and her pivotal papers on nipple-sparing mastectomy and oncologic outcomes have been cited worldwide. She will also direct the hospital’s breast surgery fellowship program.

    Lucy De La Cruz

    “I am honored and excited to lead the breast surgery program and the Betty Lou Ourisman Breast Health Center at MedStar Georgetown University Hospital,” said De La Cruz. “It has been my life-long dream to bring my passion for medicine, helping others and building a state-of-the-art breast surgery program to advance breast health. I look forward to working with our multidisciplinary team of breast health experts to compassionately care for, educate and empower my patients in their health journey.”

    Dr. De La Cruz is an academic breast surgeon who conducts outcomes-focused research, and among her special interests are the impact of genomic mapping to guide breast cancer treatment and male breast cancer treatment. Her work is guided by a long-standing commitment to promoting equity and efficacy in breast cancer care delivery, using the principles of value-based health care.
      
    “The Betty Lou Ourisman Breast Health Center and MedStar Georgetown University Hospital are thrilled to have Dr. De La Cruz lead the breast surgery program. Her commitment to patients, their journey, and their outcomes are unmatched; and her expertise in novel surgical techniques brings new and beneficial options to patients,” said David H. Song, MD, MBA, FACS, Physician Executive Director, Plastic & Reconstructive Surgery, MedStar Georgetown University Hospital, Professor and Chair Department of Plastic Surgery, and Interim Chair, Department of Surgery, Georgetown University School of Medicine.
     
    Dr. De La Cruz’s story

    Dr. De La Cruz, 39, started her journey towards becoming the youngest Latina woman to lead a breast cancer surgery program at a major academic medical center at young age. As the daughter of international physician researchers, she spent a lot of time in labs where her parents worked, sparking her passion for medicine and “making a difference in people’s lives.” She grew up in Cuba, Mozambique, Spain, and Miami.
     
    In college, she studied abroad in the Dominican Republic at the Universidad Central Del Este School of Medicine, where students were involved in patient care very early in their education and training. There, she completed her medical degree, founded an American Medical Student Association chapter and raised scholarship funds to help those who couldn’t afford tuition.

    After graduation, she was told becoming a surgeon would be nearly impossible as a foreign medical graduate and a female. Despite this, De La Cruz obtained research fellowships from the University of Miami and George Washington University in Washington, D.C. She continued her journey by obtaining a one-year residency internship at Jackson Memorial Hospital at the University of Miami, where she earned the Intern of the Year award and an AOA medical honor society membership for her dedication to medical student teaching. During her residency, she worked on an award-winning oncologic outcomes research project for nipple-sparing mastectomy that continues to be cited worldwide.
     
    That same year, Dr. De La Cruz started her breast surgery fellowship at the University of Pennsylvania. Following graduation, she worked in private practice for a year before returning to the University of Pennsylvania as a faculty member in the associate program director of the breast cancer surgery fellowship program.
     
    After relocating to Washington, D.C., to be close to her family, she founded the breast cancer fellowship program curriculum at the Inova Health System. Now at MedStar Georgetown University Hospital and The Betty Lou Ourisman Breast Health Center, she continues to teach residents and fellows, pursue research, and care for patients – the fulfillment of her lifelong dream. 

    About MedStar Georgetown University Hospital

    About the Betty Lou Ourisman Breast Health Center


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  • March 19, 2019

    Leonardtown, Maryland — Children expect to share many memories with parents as they grow older. What they never plan to share? Diagnoses of cancer — or pre-cancer, in Janet Langley’s case.

    Janet, 46, began experiencing stomach pains last summer. She saw multiple doctors to puzzle out what was causing them before arriving at the office of U.K. Shah, MD, board-certified gastroenterologist at MedStar Shah Medical Group. Dr. Shah ran multiple tests to ascertain the source of her discomfort.

    “At the same time I was experiencing this, my father had similar symptoms,” said Janet, of Solomons. “He went in for a colonoscopy and found out he had colon cancer. I had a colonoscopy myself just to make sure that had nothing to do with what I had going on.”

    Regarded by many adults as an uncomfortable but necessary rite of passage, colonoscopies are procedures in which a clinician uses a flexible instrument to examine images of the colon and rectum. This view can reveal swollen and irritated tissue, ulcers, and polyps — common growths involving the lining of the bowel.

    An estimated 15 to 40 percent of adults may have polyps, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and most are not dangerous. However, some polyps will turn cancerous over time — and removing them can help prevent colorectal cancer, the second leading cause of cancer death in the United States.

    Testing revealed a large polyp in the bend of Janet’s colon. Due to its location, it could not be removed during the colonoscopy or an additional procedure known as a polyp resection.

    Janet was referred to Tushar Samdani, MD, colorectal surgeon at MedStar St. Mary’s Hospital. Dr. Samdani was simultaneously treating Janet’s father, J.C. Tubbs, for colorectal cancer.

    For those at average risk, colorectal screenings are recommended to begin at age 50 by the U.S. Preventive Services Task Force. At 46, Janet — with no known history of colon cancer until her father’s concurrent diagnosis — would not have been flagged for testing.

    Janet had surgery to remove the polyp in 2018. A biopsy confirmed it was an adenoma — a precancerous growth.

    “If I had waited, it would have definitely been cancer,” said Janet. “And I feel very fortunate because I probably would not have followed up attempting to remove the polyp if my dad hadn’t been going through the same thing. I would have procrastinated, and it’s a good thing I didn’t.”

    “Around 10 to 20 percent of patients who develop colorectal cancer have other family members who have had it. Patients with a history of colorectal cancer in a first-degree relative (parent, sibling, or child) are at twice the increased risk,” said Dr. Samdani. “The risk is even greater if the relative was diagnosed when they were younger than 45, or if more than one first-degree relative is affected.

    “It is important that patients with colorectal cancer or even precancerous (adenomatous) polyps inform their close relatives so that they can talk with their doctor about starting screening at an earlier age,” he continued. “With regular screening, colon cancer can often be found early when it is most likely to be treated successfully.”

    Today, Janet and J.C. are both doing well. They will continue to undergo regular screenings to monitor any polyps that may develop.

    “The colonoscopy itself was simple compared to the preparation for it,” said Janet. The cleansing process necessary to ensure a clear view during a colonoscopy can be challenging for patients, but Janet said the discomfort is “well worth it.”

    “If I could convince somebody to just get beyond that preparation, the rest is just to breathe,” she continued. “It’s all worth it if you consider what could happen if you didn’t catch a problem in time.”

    March is Colorectal Cancer Awareness Month. Visit MedStarStMarys.org/Colon to learn more about the risk factors for colorectal cancer, including recommended screenings.

  • March 18, 2019

    The U.S. Food and Drug Administration’s approval today of atezolizumab (Tecentriq®, Genentech) in combination with chemotherapy for the initial treatment of extensive-stage small cell lung cancer (SCLC) marks the end of numerous failed attempts to improve survival for people with the deadly disease.

    “This is monumental for lung cancer patients,” says Stephen Liu, MD, an oncologist at MedStar Georgetown University Hospital who specializes in treating lung cancer and co-led the clinical trial leading to today’s approval through the Georgetown Lombardi Comprehensive Cancer Center. “Atezolizumab allowed us to achieve what for we thought for decades was beyond reach: an improvement in survival for these patients.”

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    Small cell lung cancer makes up about 10 to 15 percent of all lung cancers in the United States.  Almost all people who develop small cell lung cancer have a history of smoking, and, according to the American Cancer Society only about six percent of people with the disease survive five years or more.

    “Since the 1980s, our standard treatment for small cell lung cancer has been platinum-based chemotherapy. This regimen reliably provides an initial response that is often dramatic, but almost always short-lived,” says Liu.

    The regimen of carboplatin, etoposide and atezolizumab was first explored in an investigator-initiated trial at Georgetown Lombardi in 2016. It soon gave way to the global phase III IMpower 133 trial. Liu and Leora Horn, MD, of Vanderbilt University Medical Center, served as co-principal investigators of the study.

    Results were first presented by Liu at the World Conference on Lung Cancer in September 2018 and simultaneously published in The New England Journal of Medicine.

    The international, randomized, double-blind, placebo-controlled trial, compared standard chemotherapy alone or given concurrently with atezolizumab, an anti-PD-L1 antibody. The addition of atezolizumab extended overall survival for a median of 10.3 months to 12.3 months without notably increasing side effects. As of now, there has only been about one year of follow-up so the full potential of atezolizumab is not yet known, Liu says.

    “In the context of over 40 failed phase III clinical trials, the improvement in survival seen with atezolizumab represents an important achievement,” Liu says.  

     “As SCLC is an unforgiving disease,” says Liu, “our first attempt at treatment is often our only chance to impact the natural history of this highly lethal cancer.”

    The National Comprehensive Cancer Network (NCCN) has added atezolizumab to its treatment guidelines as the preferred treatment for extensive stage SCLC.

     “With the addition of atezolizumab to chemotherapy, we have finally moved the needle in SCLC,” says Liu. “It is now our charge to build upon these results and ensure that the next major advance is not another 20 years away.”

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    Disclosure: Liu reports having received advisory board/consulting fees Apollomics, AstraZeneca, Bristol-Myers Squibb, Celgene, Genentech, Lilly, Merck, Pfizer, Regeneron, Taiho, Takeda.


    Click the video below to watch Dr. Stephen Liu talk about cancer of the lung, head & neck and explain why getting involved in clinical trials for these conditions can be of great benefit for some patients, regardless of the stage of their disease.

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  • March 13, 2019

    WASHINGTON  — Laboratory analysis from the first arm of a phase II clinical trial testing the use of nilotinib in patients with Parkinson’s disease demonstrates precisely how the agent increases levels of dopamine in the brains of study participants, says a research team at Georgetown University Medical Center. Symptoms of Parkinson’s, such as motor dysfunction, are a result of a dopamine loss.

    In the journal Pharmacology Research & Perspectives, investigators report that a single low dose of the leukemia drug, nilotinib (Tasigna® by Novartis), reduces levels of a toxic protein that prevents the brain from utilizing dopamine that is stored in tiny vesicles, or pockets, in brain areas that may control movement.

    The researchers say nilotinib appears to rev up the ability of immune cells within the brain to reduce the constant flow of the misshapen alpha-synuclein protein produced by damaged neurons, allowing normal alpha-synuclein to facilitate release of stored dopamine. 

    “We detect the drug in the brain producing multiple effects, including improving dopamine metabolism reducing both inflammation and toxic alpha-synuclein. This is unprecedented for any drug now used to treat Parkinson’s disease,” says the study’s senior author, Charbel Moussa, MBBS, PhD, director of the Laboratory for Dementia and Parkinsonism, and scientific and clinical research director of the Translational Neurotherapeutics Program at Georgetown University Medical Center.

    The research team examined cerebral spinal fluid (CSF) and plasma collected from patients participating in the clinical trial to examine Parkinson’s disease biomarkers. The CSF was collected after a single dose of nilotinib or placebo was administered.

    Researchers examined levels of dopamine breakdown products, 3,4-Dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) in the CSF that bathes the brain and spinal cord of patients, after nilotinib or placebo. They also looked at levels of TREM-2, which reflects the immune response to inflammation.

    Without nilotinib treatment, DOPAC and HVA were at low levels in the CSF of all patients. These molecules are produced when dopamine is broken down, or metabolized. A low level suggests a low level of dopamine is being used in the brain.

    Investigators divided participants into five groups to test different drug levels (150, 200, 300 or 400 mg.) or a placebo. After a single dose of nilotinib, they found DOPAC and HVA were elevated in patients who received nilotinib compared to placebo, suggesting the brain was utilizing substantially more dopamine. The optimal dose of nilotinib for elevating DOPAC and HVA, they found, was 200 mg.

    “When the drug is used, levels of these breakdown molecules quickly rise. This is what we also found in our preclinical studies and proof of concept clinical trial,” says Moussa. “This is exciting because this kind of potential treatment for Parkinson’s could increase use of a patient’s own dopamine instead of using or periodically increasing drugs that mimic dopamine.”

    They also found 150 mgs dose of nilotinib treatment led to a significant reduction of alpha-synuclein in the blood, outside of the CSF. Alpha-synuclein is typically very high, and may be toxic, in the blood of Parkinson’s disease patients.

    In addition, the single dose of nilotinib (200 mg.) significantly increased the CSF level of TREM-2 in patients. “This suggests an elevated beneficial immune activity that targets misfolded alpha-synuclein for destruction.

    “The TREM-2 findings fit neatly with DOPAC and HVA findings,” Moussa says.

    He explains that under normal circumstances, the brain stores as much dopamine neurotransmitter as it can and uses it regularly to transmit messages across neurons. Research suggests that normal alpha-synuclein helps maintain the vesicles that dopamine is stored in and helps release the neurotransmitter when needed. But in Parkinson’s disease, dopamine-secreting neurons produce alpha-synuclein that is folded up (misfolded), and so cannot mediate dopamine re-cycling and breakdown. Eventually, more and more dopamine-secreting neurons emit the tangled protein and die.

    In preclinical studies, Moussa says nilotinib appears to trigger brain cells (including immune cells and neurons) to attack the misfolded protein that is being produced, allowing normal alpha-synuclein to access and release dopamine from storage vesicles. Hence the increase in TREM-2 and dopamine breakdown chemicals in the central spinal fluid, Moussa says. Dopamine produced in the brain is then recycled, stored in vesicles and available for future use. The cycle repeats itself over and over.

    Dr. Fernando Pagan
    Dr. Fernando Pagan

    Fernando Pagan, MD, principal investigator of the clinical trial and first author of the paper says the scientific evaluation of nilotinib’s effect suggest it can reduce toxic alpha-synuclein and brain inflammation, while protecting dopamine and dopamine-secreting neurons. Pagan is medical director of Georgetown’s Translational Neurotherapeutics Program and director of the Movement Disorders Clinic at MedStar Georgetown University Hospital.

     “Whether or not, or how much, the drug demonstrates improved clinical outcomes will be determined when the phase II clinical trial results are in,” he says.

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    Additional study authors included Michaeline L, Hebron, MS, Barbara Wilmarth, CRNP, Yasar Torres-Yaghi, MD, Abigail Lawler, MD, Elizabeth E Mundel, MD, Nadia Yusuf, MD, Nathan J Starr, DO, Joy Arellano, RN, Helen H. Howard, RN, Margo Peyton, Sara Matar, BS, Xiaoguang Liu, MD, PhD, Alan J. Fowler, Sorell L. Schwartz, PhD, and Jaeil Ahn, PhD.

    Georgetown holds an issued US patent for the use of nilotinib for the treatment of certain neurodegenerative diseases and has other pending patent applications in US and foreign jurisdictions. Moussa is also the named inventor on this related intellectual property.

    This study was supported by the Lasky-Barajas Family Fund and other donors. Novartis, the maker of nilotinib, provided nilotinib and matching placebo free of cost to Georgetown University for all participants while on the study.

  • February 26, 2019

    WASHINGTON – The first cancer patient to be treated as part of a CAR-T cell clinical trial at MedStar Georgetown University Hospital through Georgetown Lombardi Comprehensive Cancer Center is still in “complete remission” six months after receiving the treatment.

    Diggs receiving her car-t cell therapy
    Daisy Diggs

    Daisy Diggs, 67, of Laurel, Maryland volunteered for the experimental treatment after a lengthy battle with stage-three non-Hodgkin lymphoma, a type of blood cancer. Following her diagnosis in 2015, the mother of two and grandmother of four developed several tumors that could not be eliminated with chemotherapy alone.

    “I had tumors in my lymph nodes, hip, pelvis, neck and right kidney. They couldn’t get a handle on it,” Diggs says. “I’ve been getting chemo for two and a half years. Each time I would have some [tumor] shrinkage and then they would grow. I thought, ‘Well, the chemo isn’t working for me, let me try this.’ I’m glad I did. I see these T-cells as Pac-Men circulating in my body and eating up the cancer.”

    “We don’t know if others will have the same or similar response or for how long the treatment will be effective,” says Pashna N. Munshi, MD, associate clinical director of the Stem Cell Transplant and Cellular Immunotherapy Program, a joint program between MedStar Georgetown and the John Theurer Cancer Center at Hackensack/Meridian Health.

    “Still, hers is exactly the early result we had hoped for. The fact that she is still in complete remission six months after her CAR-T infusion signals a promising chance for a long-term remission for Ms. Diggs.”

    “I feel great,” says Diggs. “I’m so relieved to receive this latest news. For me, the CAR-T cells were 100 times better than chemo in terms of how I felt during the treatment. I’m just so happy. I thank God and I thank Dr. Munshi.”

    Ms. Diggs receiving CAR-T cell infusion
    Ms. Diggs receiving CAR-T cell infusion on July 23rd, 2018

    Diggs joined the phase 2 CAR-T cell (axicabtagene ciloleucel or KTE-C19) clinical trial to test its safety and effectiveness, which had only become available two years after her diagnosis of follicular lymphoma. Starting in the summer of 2018, she began receiving the experimental therapy, which uses her own immune system to destroy the cancer.

    CAR-T cells are made in a medical lab using a component of the patient’s white blood cells. There, the patient’s natural, disease-fighting T-cells are genetically modified to express synthetic receptors that target proteins commonly found on the lymphoma cells.  About two weeks later, the patient receives lymhodepleting chemotherapy for three days and the CAR-T cells are then infused into the patient. Thereafter, the CAR-T cells are expected to attack the tumors. The goal is that the CAR on the T cells will bind to and kill cells that express CD19, a protein that is found on B-cell lymphomas.

    “Once the CAR-T cell engages the tumor, it gets activated and proliferates multifold thereby eradicating the lymphoma rapidly,” says Dr. Munshi.

    CAR-T cell therapy carries many risks. Patients can experience drops in blood pressure, high fevers, neurological problems and even death as the body reacts to major changes in the immune system.  For Diggs, the risks of the experimental treatment were outweighed by the potential benefit.

    “While we’re very pleased with the results of Ms. Diggs’ treatment through this clinical trial, it’s important to remember that this is only a single experience of the 80 participants who will be enrolled nationwide. We have enrolled an additional five patients in this study here at Georgetown.  

    “I had to meet all the criteria for this - go to the dentist, get all these tests done, biopsies,” Diggs recalls. “At first I was nervous because I didn’t know how it would turn out. They explained the risks and told me all the bad things that could happen. But I figured that nothing else was working and that whatever happens, happens but if it’s good, it’s going to be wonderful.”

    Diggs has reported few side effects limited to only muscle pain. After her first PET scan in October, doctors could no longer find any evidence of cancer. In only three months, her tumors had disappeared.

    Ms. Diggs hugging Dr. Munshi after learn that her cancer is in “complete remission” thanks to her car-t cell treatment.
    Ms. Diggs learns that her cancer is in “complete remission” on October 18th, 2018.

    Diggs has reported few side effects limited to fevers and muscle pain. After her first PET scan in October 2018, doctors could no longer find any evidence of cancer. In only three months, her tumors had disappeared. Her second PET scan in January 2019 also found no evidence of cancer.

    “We’re giving it the ol’ one-two punch,” Diggs says. “I always say we’re shutting that party down. Now it’s hopefully going to be shut down for good.”

    Axicabtagene ciloleucel, is approved by the U.S. Food and Drug Administration as Yescarta for relapsed/refractory diffuse large B-cell lymphoma, transformed follicular lymphomas and primary mediastinal B-cell lymphomas, but is not approved for low grade lymphomas (follicular lymphoma, marginal zone lymphoma) that this clinical trial tests.

    Very common side effects include cytokine release syndrome with symptoms including fever, nausea, headache, rash, rapid heartbeat, low blood pressure, and trouble breathing. Most patients have a mild reaction, but sometimes, the reaction may be severe or life threatening. Anemia (lack of cells that carry oxygen) and neutropenia (a decrease in white blood cells) are also very common.

    This clinical trial is sponsored and designed by Kite Pharmaceutical, a Gilead Company. Dr. Munshi occasionally serves as a paid scientific consultant for Kite Pharmaceutical.

    For more information about this trial, please contact Julie Verna at 202-444-0960.

  • February 22, 2019

    MedStar Heart & Vascular Institute Hosts National Heart Valve Disease Awareness Day Flagship Event to Increase Awareness about Heart Valve Disease

    Washington, D.C., February 22, 2019 – In recognition of National Heart Valve Disease Awareness Day on Feb. 22, MedStar Heart & Vascular Institute hosted a flagship event at MedStar Washington Hospital Center to raise awareness about heart valve disease, which affects thousands of people in the Washington, D.C., area and millions nationwide.

    MedStar Heart & Vascular Institute physicians, along with U.S. Surgeon General Vice Admiral Jerome M. Adams, MD, MPH and WebMD Chief Medical Officer John Whyte, MD, MPH, spoke at the event to discuss the importance of early detection and effective treatments available to repair or replace malfunctioning heart valves, often without open surgery.  

    Heart valve disease involves damage to one or more of the heart’s four valves. While some types are not serious, others can lead to major complications, including death. Fortunately, heart valve disease can be successfully treated with valve repair and replacement, often using minimally invasive techniques. 

    MedStar Heart & Vascular Institute is home to some of the latest technologies available for heart valve procedures. It was one of the earliest sites in the United States to test some of the advancements in the valve procedures.

    “MedStar Heart & Vascular Institute has been the site for every major clinical trial, including testing the effectiveness of transcatheter aortic valve replacement, or TAVR, which is a minimally invasive procedure to replace a narrowed heart valve without surgery,” said Stuart F. Seides, MD, physician executive director, MedStar Heart & Vascular Institute. “We have performed more than 2,000 TAVR procedures and because TAVR is less invasive than open-heart surgery, patients recover faster and typically go home in two to three days, compared to a week for surgery.”

    “We are the only provider within 50 miles of the greater Washington area that offers all of these latest treatments for heart valve disease. With all of the latest technologies available to us in the numerous trials, we have the capability to sometimes treat patients who are otherwise untreatable,” added Vinod H. Thourani, MD, chairman of Cardiac Surgery, MedStar Heart & Vascular Institute at MedStar Washington Hospital Center. “As always, the earlier in the disease that we start treatment, the more likely it is that patients can avoid surgery and prevent the disease from becoming severe.”

    Heart valve disease can be there at birth, or develop from damage later in life from calcification, radiation to the chest, other cardiovascular diseases and conditions, or infection. It is estimated that as many as 11 million Americans have heart valve disease and each year, more than 25,000 people in the U.S. die from the disease. 

     

    Watch the video of the Valve Disease Day kickoff event at MedStar Heart & Vascular Institute at MedStar Washington Hospital Center or click here.

    https://www.facebook.com/MedStarWashington/posts/10157526407285931?__tn__=-R


    About MedStar Heart & Vascular Institute:
    MedStar Heart & Vascular Institute is a national leader in the research, diagnosis and treatment of cardiovascular disease. A network of 10 hospitals and 150 cardiovascular physicians throughout Maryland, Northern Virginia and the Greater Washington, D.C., region, MedStar Heart also offers a clinical and research alliance with Cleveland Clinic Heart & Vascular Institute, the nation’s #1 heart program. Together, they have forged a relationship of shared expertise to enhance quality, improve safety and increase access to advanced services. MedStar Heart & Vascular Institute was founded at MedStar Washington Hospital Center, home to the Nancy and Harold Zirkin Heart & Vascular Hospital. Opened in July 2016, the hospital ushered in a new era of coordinated, centralized specialty care for patients with even the most complex heart and vascular diagnoses.

     

  • February 15, 2019

    New Algorithm May Aid in Adoption of Better Heart Pacing Method

    BALTIMORE—(February 15, 2019)—An algorithm created by cardiac electrophysiologist Aditya Saini, MD, of MedStar Heart and Vascular Institute at MedStar Union Memorial Hospital, may pave the way for a superior method of installing pacemakers to become more widely adopted around the world.

    In an article published in the medical journal Circulation- Arrhythmia and Electrophysiology released last week, Dr. Saini proposes an algorithm that solves a practical barrier to the adoption of a method of pacemaker installation, known as His bundle pacing (HBP). His bundle pacing takes advantage of the natural conduction fibers to pace the heart, allowing a coordinated and perfectly timed contraction of the heart, as opposed to traditional pacing, which simply paces from one spot in the heart, leading to an uncoordinated contraction. This electrically coordinated- or synchronized- contraction makes all the difference when it comes to mechanical properties of the heart pump.

    Recent studies have found HBP to be a safe, feasible and superior pacing technique, reducing the combined endpoint of death, hospitalizations for heart failure or need for future pacemaker upgrades when compared to traditional cardiac pacing.

    However, HBP increases the complexity of routine patient follow-up, adding time and effort and disrupting busy clinics because lengthy device interrogations are needed while correlating them with simultaneously recorded electrocardiograms (ECGs). Moreover, no existing device algorithms specific to HBP can accurately diagnose device malfunction or guide adjustment of pacemaker settings, making remote monitoring of patients challenging.

    The algorithm, which was developed as part of a multicenter effort and in collaboration with Medtronic, which manufactures His Bundle Pacemakers, can be incorporated into the devices. It can also be used immediately in clinics, allowing doctors to ensure the devices are performing properly –even without an EKG. When the algorithm is incorporated into the devices, doctors can monitor patients remotely and accurately diagnose and treat potential pacemaker problems. The application of the algorithm may help make patient follow-up safe and efficient, removing a principal obstacle to widespread adoption of HBP.

    “As His Bundle Pacing becomes prime time, there were certain challenges, including the time-consuming and cumbersome nature of the follow up,” said Dr. Saini, who is the first author on the Circulation article. “Those challenges definitely acted as a barrier for His Bundle Pacing to become widely adopted. This study is the first novel step toward an algorithm that can resolve those issues.”

    Pacemakers control slow heart rhythms by generating electric currents. The traditional device is implanted in the chest and sends current through wires embedded in the upper and lower chambers of the heart. With a His Bundle pacemaker, one of the wires that would normally be implanted in the right ventricle (lower chamber) of the heart is implanted into the bundle of His, a collection of cells which are part of the normal electrical wiring of the heart.

    With a traditional pacemaker, the constant electrical current can cause the heart to wear out, resulting in heart failure and also increase risk of development of atrial fibrillation. His Bundle Pacing, by comparison, results in a more natural method of restoring regular heart rhythm by essentially ‘rewiring the heart’ .

    “The electrical activation is natural, and in the ideal case can look exactly like it would without a pacemaker,” Dr. Saini said. “It should not give you heart failure that can develop with a traditional pacemaker, and is also a superior pacemaker if you already have heart failure.”

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    About the MedStar Heart & Vascular Institute

    MedStar Heart & Vascular Institute is a network of highly acclaimed and nationally recognized cardiac experts and care programs spanning all 10 MedStar Health hospitals in the mid-Atlantic region. In the Baltimore area, MedStar Heart & Vascular Institute experts are accessible at MedStar Franklin Square Medical Center, MedStar Good Samaritan Hospital, MedStar Harbor Hospital, MedStar Union Memorial Hospital, and more than a dozen community locations.  MedStar Heart & Vascular Institute at MedStar Union Memorial Hospital is allied with the Cleveland Clinic, the nation’s #1 heart program, giving patients accelerated access to the most advanced research, technologies and techniques in cardiology and cardiac surgery. This alliance also strengthens excellent clinical care and enables high-level collaboration on research.

     

    About MedStar Health

    MedStar Health is a not-for-profit health system dedicated to caring for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. MedStar’s 30,000 associates, 6,000 affiliated physicians, 10 hospitals, ambulatory care and urgent care centers, and the MedStar Health Research Institute are recognized regionally and nationally for excellence in medical care. As the medical education and clinical partner of Georgetown University, MedStar trains more than 1,100 medical residents annually. MedStar Health’s patient-first philosophy combines care, compassion and clinical excellence with an emphasis on customer service. For more information, visit MedStarHealth.org.