Dr. Shomu Bohora is presently working as a Consultant Electrophysiologist and Device Specialist at Baroda Heart. He is Assistant Professor in Cardiology; UN Mehta Institute of Cardiology and Research Centre and visiting Consultant in CARE Surat, SK Soni Hospital, Heart and General Hospital Jaipur, Wockhardt Nagpur, American Hospital Udaipur.
Dr. Bohora is a gold medalist from MS University, Vadodara and has done his DM in Cardiology from the Sree Chitra Tirunal Institute of Medical Science and Technology, Trivandrum. He completed his one year Post Doctoral Fellowship in Electrophysiology and Device Management from the same institute. He worked as a Consultant in Electrophysiology and has done more than 450 cases of radiofrequency ablation independently and over 700 cases as a team, including treatment of supraventricular tachycardias, ventricular and postoperative arrhythmias. He is experience in perdiatric ablations and using 3D anatomical mapping systems for treatment of atrial fibrillation as well as scar ventricular tachcardias.
He has an experience of implanting more than 200 devices, including pacemakers, Implantable Cardiac Defibrillators (ICD’s) and Biventricular pacing devices.
Electrophysiologic (EP) Study and Radiofrequency
ablation (RFA) is a procedure that is performed to
diagnose and correct disturbances in heart rhythm
Sometimes, the electrical impulses "short circuit" the
normal pathway and travel across the heart in an abnormal
way. ln other cases, arrhythmias arise when areas other
than the sinus node become active and begin to send out
impulses that either compete with or take over the
pacemaker function of the sinus node leading to
development of tachyarrhythmias.
Electrophysiologic (EP) Study is a procedure, in which
by using catheters, intra—cardiac
electrical signals are recorded on a special machine
Arrhythmias are induced, and based on the recordings from
catheters placed in both upper and lower chambers; they
are diagnosed and localized in almost all cases. Cause of
bradycardia can be documented in most of the cases. Such
studies give guidance to plan further management
strategies in patients with arrhythmias, syncope ant
survivors of sudden cardiac arrest.
EP study has been used for the following indications
- Diagnosis and Management of Bradyarrhythmia.
- Diagnosis and Management ofTachycardia.
- Evaluation of Syncope.
- ln primary prevention protocols (VTNF induction prior to ICD implantation)
- Miscellaneous Uses
- To select optimal ICD parameters for therapy in patients with VT/VF
- To assess the modifying (suppressive) effect of an antiarrhythmic drug or cardiac surgery on an arrhythmia.
Radiofrequency ablation can be done simultaneously along with an EP study. Radiofrequency energy is targeted toward the area(s) causing the abnormal heart rhythm, permanently damaging small areas of tissue. The damaged tissue is no longer capable of generating or conducting electrical impulses and thus prevents development of tachycardia.
Radiofrequency Ablation is used as therapy for
- WPW syndrome and AVNRT as the preferred therapeutic mode.
- Therapy of typical atrial flutter, idiopathic ventricular tachycardia, Bundle Branch Reentrant Tachycardia, and Focal Atrial Tachycardia if patient prefers permanent therapy over drug therapy or due to non responsiveness to drugs.
- Therapy of atypical atrial flutter, atrial fibrillation, inappropnate sinus tachycardia and scar ventricular tachycardia in patients who remain refractory to drug therapy.
Information regarding device implantation
A pacemaker is a lifesaving device used in patients who have symptomatic bradycardia, either because of sick sinus syndrome or conduction system disease manifested by heart block. It delivers electrical impulses when required to the heart internally, and makes the heart pump faster in these patients.
Implantable Cardiac Defibrillators (ICD) prevent sudden cardiac deaths due to arrhythmias and are used in patients of ventricular arrhythmias, survivors of sudden cardiac arrest or in patients who are at risk for the same, ICD’s are also implanted for primary prevention of sudden cardiac arrest in patients who have a left ventricular ejection fraction of less than 30% either due to a prior myocardial infarction or due to dilated cardiomyopathies. The ICD's recognizes a fast ventricular arrhythmia automatically and treats it, by either overdrive pacing or by giving a shock through the lead placed in the right ventricle, within seconds, so that precious time and life of the patient is saved. Anti- tachycardia pacing can be programmed successfully for termination of ventricular tachycardias so as to prevent
shocks and avoid patient discomfort during treatment.
Biventricular pacemaker devices are used in treatment of patients suffering from heart failure, who despite optimal medical therapy continue to be symptomatic. Patients who have a low left ventricular ejection fraction either due to ischemic or non ischemic causes and have wide QRS complex on ECG benefit from such a therapy. With the help of an additional left ventricular lead placed in the coronary sinus branch, by special techniques, synchronization of cardiac contraction is obtained, which improves the heart pumping and relieves symptoms in carefully chosen patients of advanced heart failure.
Device interrogation on follow-up is as important as implantation and helps to recognize battery depletion and j arrhythmias as well as
help troubleshoot and prevent complications at the earliest. Device interrogation and changing of parameters can be done on OPD basis noninvasively this helps to achieve optimal medical therapy and better patient compliance.