She was rushed by ambulance first to Uxbridge Cottage Hospital where emergency room staff stabilized her, then transferred to Southlake Regional Health Centre. Over the next few days Ms Adams’ heart continued to seize and doctors sought to have her
transferred to a cardiac centre in Toronto where she could have an implantable cardioverter defibrillator (ICD) inserted into her chest. But days passed with no confirmation on when that might happen.

“I was becoming anxious,” recalls Ms Adams. “My one daughter was still really young ... it was upsetting not to be home.”

Realizing her emotional state was taking a toll on his patient, cardiologist and medical director of the arrhythmia program, Dr. Zaev Wulffhart,  made the decision not to wait for Toronto to call; with the approval of hospital administration, it was determined  the procedure would be performed at Southlake. This decision would not only help Ms Adams, but would later make the same procedure available to other patients as well.

On Jan. 21, 2002, Dr. Wulffhart’s team inserted the pager-size device under Ms Adams’ collarbone. Once it was positioned, wires were inserted into her heart, enabling the ICD to automatically shock her heart into a normal rhythm when a life-threatening arrhythmia occurs.

With a 99 per cent effectiveness rate, ICDs are the most successful therapy to treat ventricular fibrillation, an abnormal rhythm in the lower chamber of the heart and major cause of sudden cardiac death. An ICD has a dual purpose, with the ability to act as a pacemaker for heart rates that are too slow, as well as deliver shocks if a dangerously fast heart rate is detected.

It was the first time in Ontario such a highly advanced cardiac procedure was performed at a community hospital and it cast a world spotlight on Dr. Wulffhart and his team.

The Southlake CEO and board of directors supported the development of this innovation, bringing essential cardiac services to the region. Less than two years later, Dr. Wulffhart and his team would begin to implant lifesaving ICD devices on a regular basis.

The arrhythmia team has grown considerably since then and now includes three cardiac special-ists (electrophysiologists), nurse practitioners, nurses and many other support staff who are equally important to the team.

Together they treat two main groups of patients: those with weak heart muscles, usually caused by disease and may need a defibrillator for potentially life threatening arrhythmias; and those with irregularities in heart rhythm, which can cause very debilitating symptoms.
Ms Adams fell into both categories.

Within three years of her ICD procedure, she underwent four ablation procedures and a fifth ablation in 2004, known as a pulmonary vein isolation (PVI), or atrial fibrillation ablation, to cure a condition known as atrial fibrillation (AFIB).
During ablation procedures, a catheter (a narrow, flexible wire) is inserted into a vein in the patient’s groin and moved to the heart. The damaged site is found with the help of live images, which are brought up on an x-ray type machine. Radio frequency energy, and sometimes a freezing technique called cryo ablation, is delivered from the tip of the catheter to burn the tissue.

During Ms Adams’ PVI, the tissue around her pulmonary veins were burned to prevent the area from giving off extra impulses that caused chaotic heart rhythms and increased her risk of complications, including stroke.  

“Pulmonary veins are vessels that drain the blood from the lungs back into the heart on the left side. They seem to be where most of the chaotic electrical activity comes from (with AFIB),” explained Marianne Beardsall, a nurse practitioner who helped Dr. Wulffhart start and develop the program at Southlake Regional Health Centre.

Ms Adams is one of about 200,000 Canadians who suffer from AFIB – about two per cent of those over 40 and six per cent of those over 60. When Southlake decided to develop the medical and clinical expertise to perform PVIs, it was a very important milestone for the arrhythmia centre because this approach can lead to such valuable results for patients.

Drs. Yaariv Khaykin and Atul Verma, electrophysiologists who both perform the procedure, joined the Southlake arrhythmia team in 2004 and 2005, respectively, after training at the Cleveland Clinic, one of the world’s most renowned cardiac centres.

“From a technical perspective, our strength is that Southlake has some of Canada’s most highly trained physicians,” said Dr. Wulffhart. “They have the expertise to perform extremely complex procedures that are not yet offered at all of the more established teaching centres.”

As atrial fibrillation ablation is still a relatively new procedure, Southlake receives referrals from across the GTA and Canada. The centre will perform approximately 200 PVIs each year, garnering a cure about 80 per cent of the time.

Although this procedure can take four hours to perform, a cardiac catheter ablation, used to burn abnormal electrical tissue, (what Ms Adams had four times before her PVI) can take less than an hour to perform in the electrophysiology (EP) lab at the hospital.

The procedure is used to treat rapid heartbeats that begin in the upper chambers or atria of the heart. It is often called re-entry or short circuit arrhythmia because the electricity in the heart moves in a circle, making the heart beat extremely fast, rather than starting from the top of the heart and moving towards the bottom and then starting over. A catheter ablation can quickly burn the area at each end of this extra pathway to create scar tissue that won’t allow the area to conduct electricity.
Southlake’s electrophysiologists perform approximately 600 ablations each year, (including AFIB ablations and PVIs), as well as implant 250 ICDs and 500 pacemakers, which are devices that will take over the heart’s rhythm when the heart rate is too low.

As sophisticated as the technology is to treat the conditions, the tools used to diagnose the problems are equally impressive.

The electrocardiogram (ECG) is the most common external test used to take a snapshot of the electric signals creating heart rhythms and the echocardiogram is an imaging machine that creates a videotape that shows the heart’s four chambers, valves and movements.

A holter monitor allows patients to leave the hospital wearing the walkman-size recording box that is attached to their chest by five electrode patches. It’s able to capture the heart’s rhythm over a 24-48-hour time period that can be downloaded for a continuous ECG. The technician can read it to see if there are any abnormalities.
However, unless the patient has an episode every day, the holter monitor won’t work. This is where a loop recorder, carried around for two-to-four weeks, can help because it stores a continuous four-minute loop of a picture that overwrites itself.

About the size of a pager with two wires on the chest, the recorder allows patients to press a button on the device when they feel an irregular heartbeat, allowing it to take a picture of the rhythm. The image is downloaded to the hospital through a phone line so the arrhythmia team can diagnose the problem.

These tests provide a snapshot of the rhythm problem but sometimes catheters need to be inserted into the heart to better determine the nature of the rhythm problem and the most appropriate treatment. This is called an electrophysiology study, or EPS, explained Ms Beardsall.

This procedure is performed in the EP lab and allows the specialists to see the heart from the inside, tracking the movement of electricity creating a three-dimensional image on the computer. The abnormal rhythm is stimulated so specialists can see where it starts. Often, an ablation procedure can be performed at the same time.

While cutting edge technology and highly-trained physicians and staff ensure the success of Southlake’s arrhythmia program, patient care also sets the program apart.
Ms Beardsall said the program was designed based on patients’ needs, with a view to providing this highly specialized service close to home.

A lot of effort goes into educating patients, not only by the physician at the initial stages of treatment but also by the nurse practitioner and other members of the team who reinforce what has been said and offer information that can be taken home. The team is also committed to a comprehensive follow up and tracking program, ensuring that patients don’t get lost after their procedure. Many patients, including Ms Adams, who were once so critically ill, are now cured. There is even talk about removing her ICD one day.

“My life is back to normal,” she said. “Before this was ever an issue, I never thought about my heart and went on with my life and I’m the same now. I’m not aware of my heart beating all of the time, which is a blessing.”

It’s these remarkable stories Dr. Wulffhart credits for making his work so important and fulfilling.  

“(The arrhythmia field of medicine) is the one situation where you can make a big difference and that’s what makes it so unbelievably rewarding,” he said. "There’s much in medicine where you can stabilize but you can’t really cure. In our field, you have an option to improve quality of life and length of life.”