The recent expansion of St. Tammany Health System’s Cardiology Clinic – including the addition of three more cardiologists and a satellite office in Mandeville – is undeniably good news for Northshore patients.
It’s also, however, good news for STHS cardiologist Dr. Paul Stahls, who – thanks to the additions – can focus full-time on his professional passion: electrophysiology.
But what does that mean, exactly? Top find out, we sat down for a chat with Dr. Stahls. Below is a transcript of our conversation, edited for space.
Let’s start at the beginning. What is electrophysiology?
The heart is a very complex organ, and when you think about it, it’s a muscular pump. But that muscular pump has to coordinate its actions, and with that coordinated muscular motion you get the optimized blood flow, or hemodynamics. The electrical side of the heart drives the hemodynamics. It’s really where the coordination of the muscular movement comes into play.
You’re looking at a field that didn’t exist when you and I were born. The 1980s and ’90s is really when electrophysiology started to catch stride. The mechanisms were being teased out. The understanding of the electrical side of the heart was really being honed and not just understanding what it is to be normal but abnormal – and then what the heck you do about it.
And what do you do about it?
Ablation is one of the top electrophysiology procedures to do to adjust the wiring within the heart. It involves going inside the heart through the veins, coming into the right side of the heart and passing very thin catheters, about the thickness of a piece of spaghetti, with little electrodes on them. Then I can study how the electricity flows through the heart, determine where the bad wires are, if there are any, or what area is diseased.
I then go in and modify with heat energy or freezing energy. The idea is to purposefully scar, because scarred or dead cardiac myocytes can’t conduct electricity. So it’s sorting how to block the flow of either the normal or abnormal electrical signals within the heart.
Recently you started doing the minimally invasive Watchman implant procedure. Can you talk about that?
It’s a new addition to our structural heart program. The Watchman device is about the size of a stack of four or five quarters, and it can compress and go into a small area of the left atrium called the appendage. It’s a small little outpouch in which we estimate 90 to 95% of the clots that form inside the heart develop.
So instead of using blood thinners – which are rife with their own issues – the Watchman device can occlude the area so blood doesn’t pool there any longer. The procedure takes about 30, 45 minutes and you’re home the same day. It’s really going to change the complexion of our ability to prevent clot formation within the heart.
Can it get people off blood thinners?
That’s the goal, and that’s actually one of the biggest things with electrophysiology in general I was attracted to: the ability to do a mechanical fix and remove the need for medicinal therapy. Now that’s not always the case, but in this case it is.
With the Watchman, instead of being on Coumadin or one of the very strong blood thinners we call NOACs or DOACs, you can come off of those medicines.
The point is really, within a day, we can take your stroke risk and your need of prophylaxis – using a strong blood thinner – and stop that, potentially for life.