OHVI Quarterly Newsletter Stories
World’s Smallest Pacemaker!
Orlando Heart & Vascular Institute now offers implantation of the world’s smallest pacemaker. The new Medtronic Micra device has been implanted by Dr. Weinstock directly in the heart for patients who only need a “single lead” pacemaker, most commonly due to chronic atrial fibrillation. This tiny device completely eliminates the need for a pacemaker wire and a generator typically placed on the chest wall. The new procedure typically takes less than 20 minutes. Dr. Weinstock is one of a small number of physicians at Florida Hospital trained in this procedure… and the only interventional cardiologist.
Cardiac Rhythm Management – Moving out of the Hospital!
Orlando Heart & Vascular Institute offers extensive cardiac rhythm management including implantation and management of both pacemakers and automatic implantable cardio-defibrillators (“AICD’s”). Additionally, OHVI offers implantation of implantable loop recorders, a tiny device easily placed under the skin that allows remote monitoring of patient’s cardiac rhythm for up to four years. An exciting new step forward is the development of the outpatient cardiac device implantation program. Most patients can now have their devices placed in the beautiful new Maitland Ambulatory Surgery Center. ASC patients are thrilled to avoid hospital admission and an overnight stay. Dr. Ranadive and Dr. Weinstock are the first cardiologists to offer this service in Orlando!
New Heart Failure Studies
Congestive heart failure (CHF) is the most common cause for hospital admission in the U.S. Orlando Heart & Vascular Institute is excited to participate in two new clinical trials that aim to reduce the need for hospitalization and improve quality of life for patients with CHF. One study focuses on a new medication designed to improve outcomes while the second study is a randomized trial (GUIDE-HF) that involves the implantation of a tiny CardioMEMS sensor in the pulmonary artery (placed during a heart catheterization) that allows OHVI physicians to monitor pulmonary artery pressures, which correlate closely with CHF status, remotely from home… on a daily basis! If you have diabetes, you monitor your blood sugar. If you have hypertension, you monitor your blood pressure. If you have CHF, now you can monitor your PA pressures! Changes in PA pressures allow physicians to recognize worsening CHF status before the patient clinically deteriorates requiring hospitalization. Adjusting medications based on this “early warning” can often avoid a trip to the hospital!
Peripheral Arterial Disease – OHVI pioneers new laser for clearing arteries!
Physicians at OHVI have been treating complex peripheral vascular disease for decades. Most procedures can be performed outpatient at the state-of-the-art Center for Cardiovascular Excellence. A wide variety of devices are utilized to get the best outcomes for our patients including SilverHawk and Diamondback atherectomy, drug-coated angioplasty balloons and a variety of stents. Specializing in opening totally blocked arteries, OHVI physicians can quickly relieve pain with walking experienced by many patients as well as open arteries to promote wound healing in patients with “critical limb ischemia”. OHVI was recently selected as one of eleven clinical trial sites for the Eximo Laser study. The study was successfully completed and OHVI was one of the leading enrollers in the trial. This exciting new device is now awaiting approval by the FDA but OHVI patients have already benefited from its use!
OHVI Specializes in Venous Disease – The “Other” Peripheral Vascular Disease
Many patients with varicose veins, venous stasis skin changes, edema, and leg ulcers are highly symptomatic from venous rather than arterial disease. Venous insufficiency, also called venous reflux, results from incompetent venous valves, typically in the greater saphenous vein but also in other veins. A simple radiofrequency ablation procedure done under local anesthesia in the office can solve the problem and lead to resolution of symptoms. OHVI uses the new state-of-the-art VenClose system for these procedures.
More recently, iliac vein problems have been identified as another cause of venous insufficiency symptoms. Iliac veins can develop narrowing or can be compressed by overlying arteries. This disease is far more common than previously recognized and can be accurately diagnosed in the catheterization lab with intravascular ultrasound (IVUS). Patients with severe narrowing, compression or even total occlusion can be effectively treated with a special stent. OHVI physicians have been among the earliest physicians to diagnose and treat this newly recognized problem, often providing symptom relief to patients who have suffered for years with no medical explanation.
OHVI is one of the few cardiology groups in Orlando that offers carotid stenting for treatment of carotid stenosis. Dr. Weinstock has been involved in carotid stenting since 1996 and has served as an investigator in numerous clinical trials. The introduction of distal protection devices years ago has made carotid stenting a very low risk procedure with comparable results to carotid surgery. Patients are followed closely before and after carotid intervention in the OHVI vascular ultrasound staffed by our highly qualified and experienced ultrasound technicians.
What’s Happening in the Hospital
OHVI Cardiologists continue to offer full consultative services for hospital patients at Florida Hospital Orlando and Florida Hospital Altamonte. Complex coronary and peripheral vascular intervention, pacemaker and defibrillator implantation, echocardiography, and nuclear stress testing are part of our everyday practice. Additionally, OHVI physicians offer specialized procedures such as catheter based thrombolysis for patients with pulmonary embolism (PE) as well as IVC filter placement (and removal!) for patients with DVT at high risk of PE.