Cutting Edge-Tools and Team Expertise

Jeffery Winterfield, M.D.Until recently, catheter ablation for ventricular tachycardia (VT) has been a niche subset of clinical cardiac electrophysiology, available in only a few centers nationwide. With top-notch specialists and cutting-edge mapping technology, MUSC Health is on the frontlines of efforts to make VT ablation a more accessible treatment option for patients with ventricular arrhythmia.

Watch a video about ventricular arrhythmia with ablation.

After training under clinical cardiac electrophysiology experts at Harvard Medical School in Boston followed by his first faculty appointment in Chicago at a world-renowned ablation center, MUSC Health Health electrophysiologist Jeffrey R. Winterfield, M.D., was recruited for his experience in treating complex arrhythmias to the MUSC Health Heart & Vascular Center. At MUSC Health, he now serves as director of Ventricular Arrhythmia Service.

Dr. Winterfield explains which patients might benefit from this treatment—and why timing and technology are two key components to ensuring successful outcomes.

Ventricular Arrhythmias: The Right Tools and a Team Approach

Dr. Winterfield says VT ablation procedures, while complex, can be done safely and effectively. The key to success is performing these procedures at a medical center that has the capabilities and the expertise to manage these complex arrhythmias as well as the advanced tools necessary to ensure its safety.

Cutting-edge technology is one way MUSC Health ensures safer VT ablation procedures, says Dr. Winterfield. MUSC Health was chosen as one of only 12 phase 1a sites nationwide to launch an advanced mapping system called Ensite Precision™, recently approved by the FDA.

Traditionally in VT ablation, specialists use mapping technologies to create detailed 3-D anatomic models of the ventricular chamber of interest where an arrhythmia originated. However, that process needed to be done point-by-point and can take up to an hour.

Now, Dr. Winterfield says, the high-density mapping allows him to use a catheter with multiple electrodes to take many points around the ventricular chamber simultaneously.

The result is more precise information, much faster, often in 10 minutes. Not only does that speed up the process, but it’s also made the procedure safer.

Ventricular Arrhythmias: When to Treat With Ablation

Timing is one of the most important factors in determining which ventricular arrhythmias to treat with ablation.

“What we know is that waiting until patients are storming with ventricular arrhythmias is associated with worse outcomes and a higher risk of mortality,” says Dr. Winterfield.

Dr. Winterfield and other researchers at MUSC are investigating multiple aspects of VT ablation, and he agrees that much evidence is still emerging.

What research about VT ablation shows thus far:

  • Earlier is better: Patients fare better with earlier intervention, requiring less frequent hospitalization.
  • Less medication: After VT ablation, there is lower usage of anti-arrhythmic and other complicated medications to treat patients’ arrhythmias.
  • Less hospitalization: It leads to fewer emergency room visits and longer survival overall.

Ventricular Arrhythmias: The Right Candidate

Patients best suited for this treatment include anyone who has undergone treatment for a ventricular arrhythmia through a high-voltage device such as a defibrillator or ventricular pacemaker defibrillator.

Other patients who have had premature ventricular contractions (PVCs) could also be good candidates for ablation, particularly if they’re currently on medication that is either not desired or tolerated well.

In some cases, a high burden of PVCs may exacerbate underlying heart failure. With ablation to reduce or eliminate PVCs, heart failure symptoms and prognosis may improve for some patients.

Research has clearly shown mortality and complications for VT ablation have diminished over the past decade. Dr. Winterfield and others continue to investigate other questions, such as how early VT ablation intervention compares to anti-arrhythmic drug therapy in long-term healthcare costs.

“What we have found in one economic analysis is that healthcare costs are reduced with catheter ablation of ventricular arrhythmia,” says Dr. Winterfield.

Advanced Heart Disease: A Partnership Approach

Dr. Winterfield knows his role as an electrophysiologist is just one facet of managing patients with advanced heart disease, particularly ventricular arrhythmias. Successfully managing these arrhythmias means strong collaboration with referring physicians, especially since some patients travel long distances, sometimes from out of state, for treatment at MUSC Health.

“We're here to help the referring physicians take care of these people who have very difficult problems but carry significant risk for cardiovascular morbidity and mortality,” Dr. Winterfield says. “It is important that we work together to treat them.”

Dr. Winterfield says he keeps the communication lines open and prioritizes calls, emails and questions from referring physicians. He’s certain patients are better off for it.

To reach Dr. Winterfield, email winterfj@musc.edu.