Best Doctors 2012: Beat Maker
If not for the steady beeps of heart monitors, it would be easy to forget that Dr. Mauricio Arruda is at the controls of a complex heart procedure rather than a video game.
From a room lined with six computer screens — a sort of mission control for this surgery — Arruda watches the procedure through a wall of plate glass, controlling the equipment with four joysticks.
It is part of an operation known as radio-frequency catheter ablation. It's a treatment for heart arrhythmias, a condition in which the heartbeat becomes irregular and inhibits the heart's efficiency.
It's a common condition from which some patients don't even experience symptoms. But for others, arrhythmias can cause stroke or sudden cardiac death. Prevalence of an irregular heartbeat isn't known, but the most common variety, atrial fibrillation or A-fib, affects 2.2 million Americans every year.
"We used to get the [defibrillator] paddles and plug them into the catheter and give them a shock," Arruda says of the technology that was first developed in the mid-1980s. "It helped a lot of people, but it caused a lot of side effects too."
Using the latest technology, Arruda created the Electrophysiology and Atrial Fibrillation Center at University Hospitals in 2008. The center performs an average of 300 procedures a year, says Arruda.
Before stepping up to the machine, Arruda feeds a catheter, which travels through the femoral artery in the patient's groin, all the way into the heart. The catheter looks like a long piece of spaghetti with a squirming worm at its tip, one that will respond to Arruda's remote-controlled instructions to explore the heart and pinpoint the cause of the arrhythmia.
Once the catheter arrives in the heart, Arruda must wait. Only during irregular heartbeats can he determine the arrhythmia's source. Once Arruda locates it, he can put the catheter to work isolating and ablating the dysfunctional portions that are causing the arrhythmia.
For now, the culprit is hiding behind a steady heartbeat. At times Arruda and his team have waited as long as six hours for an arrhythmia to begin. "But that's very rare," he says.
While they wait, the mood of the operating room is light. Arruda and his fellow, Dr. Peter Mikolajczak, engage in friendly conversation with the two RNs and one radiology technician in the room. Everyone is wearing their own lead suit to protect themselves against the X-rays used in the procedure, looking as though they are ready to head into combat together.
A mix of pop tunes plays in the background. Today it's Rihanna, Taio Cruz and Shakira, but some days it's Brazilian music in honor of Arruda's homeland.
Arruda grew up in a small town called Porto Ferreira, with a population just more than 50,000, in Brazil's Sao Paulo state. His father sold furniture, appliances and electronics and taught himself to repair electronics with young Mauricio by his side.
"Growing up I played around a lot with stereos, TVs, electronics," says Arruda, now 52. "[My father] would open it up so we could see inside."
Dr. Mauricio Arruda
As a student at Pontificia Universidade Catolica de Campinas in Brazil, Arruda became fascinated with arrhythmias, and spent his early career studying under the pioneers of radio-frequency catheter ablation at the University of Oklahoma, University of Chicago and Loyola University.
He came to Cleveland in 2005 to take a position with the Cleveland Clinic's cardiovascular department, until the opportunity to build his own center at University Hospitals came along in 2008.
He sees the irony in the fact that his childhood knack for electronics has brought him to leadership of UH's electrophysiology practice, where he finds himself just as much behind a computer as he does at the patient's bedside.
That's where he is today when the heart's metronome finally skips a beat about an hour into the procedure. It skips again. As the arrhythmia begins, the monitor's red lines jump crazily, the lights are dimmed, and the room kicks into action.
Arruda dons a headset and assumes his position behind a console in the adjacent glass-walled room.
X-ray technology helps Arruda see where the catheter needs to go. Using remote magnetic navigation powered by two 400,000-pound magnets, the metal-tipped catheter explores the heart, creating data over the next 30 minutes that will generate a rainbow-colored 3-D model of it. With a few mouse clicks, Arruda can rotate, flip or resize this on-screen heart, which glows with red and purple splotches that guide him to the sources of the arrhythmia. He ablates — or cauterizes — the location, which will develop into scar tissue that in about 80 to 90 percent of patients will eliminate future arrhythmias.
After a few hours, the procedure is over. One overnight stay and the patient heads home. After a week of recovery, she's back to a normal life.
"It's very dramatic when you find the spot [where the arrhythmia originates]," says Arruda. "It's considered a cure for most patients."
12:00 AM EST
February 20, 2012