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Doctors in Italy learn procedure by watching Hall doctors live via Internet
Dr. Joon Ahn, right, performs a cardiac ablation using robotic technology July 1 at Northeast Georgia Medical Center. Doctors in Milan, Italy, watched the procedure live via the Internet in order to learn the technique. - photo by For The Times


Dr. Karthik Ramaswamy talks about how technology is enabling doctors to collaborate from remote locations.


The idea of "telemedicine" — doctors using computers to interact with patients from a distant location — has been around for a while. But on July 1, Northeast Georgia Medical Center took the concept to a new level.

Dr. Karthik Ramaswamy, a cardiac electrophysiologist with Northeast Georgia Heart Center in Gainesville, was invited to give a presentation at a conference in Milan, Italy, on correcting abnormal heart rhythms.

While he was there, his colleague, Dr. Joon Ahn, performed a procedure at the hospital in Gainesville, which the cardiologists in Milan watched in real time via a special Internet connection.

Usually when a doctor presents a case at a conference, he displays pictures to document something that occurred in the past. For physicians to be able to watch a case as it happens, half a world away, is a big technological step.

"The ability to have these types of collaborative programs is really unprecedented," said Ramaswamy. "In Milan, I literally felt like I was sitting in my own lab at Northeast Georgia."

Ahn performed a procedure called ablation, which destroys the diseased heart tissue that is causing the arrhythmia. It’s done by threading a catheter from a groin vein up into the heart, similar to the way angioplasty is performed.

But when Ramaswamy or Ahn does an ablation, they’re rarely in the same room as the patient. Three years ago, the medical center installed Stereotaxis, a system that uses magnetic navigation to guide the catheter into a patient’s heart. Once the patient is set up, the electrophysiologist goes into a control room and performs the procedure robotically.

"It’s kind of like being in a cockpit," Ramaswamy said.

The robotic system allows for more precision, he said. And there are advantages for the patient.

"A traditional catheter is very stiff, and you have to be cautious not to perforate the heart," Ramaswamy said. "The magnetic catheter is much more flexible, so it’s safer. It has an unlimited range of motion."

Ramaswamy bases much of his work on the innovations of Dr. Carlo Pappone, who runs the Academy of Arrhythmology at San Raffaele Hospital in Milan.

"Dr. Pappone has been a pioneer in using ablation for atrial fibrillation," said Ramaswamy. "A lot of physicians around the world want to learn the technique from him."

The Gainesville doctors were invited to participate in the conference because they’ve been using Pappone’s methods to correct a different type of arrhythmia, superventricular tachycardia.

The case they presented on July 1 involved a patient who had atrial flutter, in which the heart beats too fast, but not as irregularly as with fibrillation.

Tom Edwards, director of cardiac services at Northeast Georgia Medical Center, said the hospital bought the Stereotaxis system three years ago.

"We didn’t realize how often we’d be using it," he said. "As far as I know, we’re still the only ones doing robotic ablations in Georgia."

Edwards said the first time he watched the procedure done robotically, it seemed almost like magic to watch the catheter moving even though there was no one in the room with the patient.

"It just blew me away," he said.

Ramaswamy said because the doctor doesn’t have to be in direct contact with the patient, there could be a future link between the Stereotaxis system and the telemedicine concept.

"A cardiologist anywhere in the world might be able to place the catheters, and then an electrophysiologist like myself could actually perform the procedure from a remote location," he said.

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