Reprinted with permission from The Messenger.
By Lori Harrison, staff writer
Dr. Muhammad Akram stood before the white board, pen in hand, drawing diagrams of the heart.
With help of the illustrations, he led the four Japanese visitors through the intricacies of how implantable devices used in electrophysiology improve the lives of patients suffering from congestive heart failure.
"Even without this guidewire, you will know you are in the (coronary sinus) or not," Akram told the group gathered Monday in the conference room at Trover Health System's Cardiac and Vascular Center.
"But it takes experience," he said. "I remember when I started the first case, I was so panicked. I was nervous. It took me five or six months to reach this level."
The visitors included three Japanese men and one woman who work for Fukuda Denshi, a company that markets high-tech medical devices. They spent two days at Regional Medical Center last week to learn about electrophysiology, before traveling to Vanderbilt University Medical Center in Nashville.
The devices Akram implants -- those used in cardiac resynchronization therapy and implantable cardiac defibrillators -- will enter the Japanese market this month.
"We are here for observing some implantation cases from CRTs," said Shigeo Kamiyama, educational trainer for pacemakers. "We can't see it in Japan."
Cardiac resynchronization therapy treats congestive heart failure by delivering electrical impulses to the heart, causing both ventricles to beat at the same time. This causes contractions of the heart to become more efficient, lessening symptoms and sometimes stopping progression of the disease.
ICDs monitor heart rate, delivering electrical shocks to restore normal rhythmwhen needed.
The cardiologist compared ICD to the emergency 911 system.
"It's a 911 in the body, which monitors your slow heart rate and monitors your fast heart rate," Akram said. "It functions like a pacemaker, and to help improve the quality, quantity of life."
He emphasized that the devices don't provide a cure.
"You still have to continue the medical management," he said. "You do not want to get fooled by this thing. ... If you stop the medication at any time, it is going to reverse remarkably."
Currently, electrophysiology surgeries at RMC are conducted in one of the hospital's two cardiac catheterization lab suites. However, a dedicated EP lab will be installed by the end of the year. RMC is the only hospital in western Kentucky to offer this service.
The visit was arranged by Carol Hudgins, field clinical engineer with St. Jude Medical. She traveled to Tokyo in November to provide CRT training to the Fuduka employees.
"Because of Dr. Akram's skill -- and he's used all three companies (that make the devices), so it's not that he is predisposed to any of them -- but his skill as far as placing the leads to the left side of the heart, it really is outstanding," said Sue Sheppick, St. Jude sales representative.
"Even in larger institutions, success rates usually are around 90-93 percent," she said. "At this institution, it's right around 97-98 percent success rate. When Carol and I discussed that, that's what they wanted to see, because obviously it's easier to work with other physicians if you've seen someone that's extremely adept and good at teaching to be able to help them. That's why Regional Medical Center was selected."
The Japanese group observed two surgeries at RMC.
Akram compared physicians' competence levels with the frequency they perform the surgery -- similar to driving a car or riding a bicycle.
"Your confidence comes from the experience, your dedication and your trust in knowing the stuff that's going on," he said. "You need to know all the techniques...even if you don't implant them."
"For the two days that we're here with this lady and gentlemen, I may try some different techniques," said Akram. "We are going to take some time to show some different technology, different techniques."
The visit offered the Japanese visitors some hands-on experience and the chance to see the devices implanted, Hudgins said.
"They'll go back and help train their peers," she said. "It's kind of like training the trainers for them."
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