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Man with big heart makes US cardiac history at MUSC Health

Helen Adams | adamshel@musc.edu | March 8, 2017

Frankie Smith's heart before and after cardiac ablation
Images courtesy of Abbott
The less red and yellow, the better. The left ventricle of Frankie Smith's heart before ablation, on the left, shows a lot of injured areas highlighted in red and yellow. The purple areas are healthy. The image on the right shows his heart after ablation. There's more gray and less red and yellow. The newly gray areas show where the ablation intentionally caused scarring to keep the injured areas from causing short circuits.

Frankie Smith, who is literally big-hearted thanks to scar tissue from a massive heart attack, has become the first patient in the United States to be treated with a new device designed to reduce the odds that his heart will short-circuit again. 

His surgery took place February 28 at MUSC Health, the patient care side of the Medical University of South Carolina.

Smith, who hasn't been well enough to work since 2010, hopes that by going first he's opening the door for other patients. "I'm here for a reason," the Conway, South Carolina man said. "This might be to help someone else. If my case turns out to be a success, it will be worth the time." 

Frankie SmithPhoto by Helen Adams 
Frankie Smith hopes the procedure he had with the new ablation cathether will let him get back to enjoying his favorite hobby: working on cars.  

The device's name is a mouthful: the FlexAbility Ablation Catheter, Sensor Enabled. But the new, high-tech ablation cathether's purpose is simple: to improve doctors' ability to quickly pinpoint and treat areas of the heart that cause atrial flutter, a type of irregular heartbeat. 

Jeffrey Winterfield, the MUSC Health cardiologist who used the device on Smith's heart, was involved in the initial development of the catheter but has no financial stake in it. He said its sensor and magnetic field work together like a GPS to tell doctors exactly where the trouble spots are in people with ventricular tachycardia. 

"It enables, in concert with a new precision mapping system, much more rapid identification of potential targets for arrythmia. So it cuts procedure time and gives better long-term outcomes," Winterfield said. The mapping system he's talking about, EnSite Precision, became commercially available in January.

Winterfield said the new products are the latest advances in the rapidly advancing field of heart arrhythmia care, calling it substantially better than a decade ago. But not everyone is getting the message. "People with ventricular arrhythmias are all too often being treated with multiple drugs instead of ablation, which increase health care costs and aren't nearly as effective as catheter ablation."

Dr. Jeffrey WinterfieldPhoto by Brennan Wesley 
Dr. Jeffrey Winterfield says cardiac ablation, which creates intentional scarring to prevent short circuits in the heart, can be more effective than medication. 

Winterfield described what happens to a heart such as Smith's. When Smith suffered his initial heart attack several years ago, it affected the entire front side of his heart. "Unfortunately, he presented very late, and in the process, he lost a lot of heart muscle that was damaged by the acute blockage of the coronary artery," Winterfield said. "When the heart muscle dies, it's replaced by scar, and the heart begins to dilate out and fail."

That causes electrical problems. The scarred areas of the heart combine with little surviving bundles of heart muscle, Winterfield said. "They become electrically active and create short circuits. That can cause potentially fatal arrhythmias."

Those can be treated with defibrillators, as they were in Smith's case. "That can be life-saving," Winterfield said. "However, getting defibrillator shocks is associated with a longer-term, worse prognosis."

So in a patient who's been getting those shocks, a cardiologist may try to improve that prognosis with ablation, using radiofrequency energy to destroy the tissue that's causing the arrhythmia. MUSC Health is part of an international group of 12 high-volume ablation centers working together to study arrhythmias and improve patients' outlooks.

Winterfield, who did his fellowship at Brigham and Women's Hospital and Harvard Medical School, said he came to MUSC because of its potential to emerge as a national center for complex cardiac care. "As part of that, there has to be an embrace of early adoption of technology," he said. 

That embrace of new technology at MUSC Health is strong. 

  • In 2015, an MUSC Health patient was one of the first in the state to have a new device called the Watchman implanted, to reduce the risk that her atrial fibrillation would lead to a stroke.
  • In 2016, clinical trials testing the Corvia Medical InterAtrial Shunt for heart failure patients and whether heart stem cells can be used to reprogram malfunctioning cells got underway.
  • Three months ago, MUSC Health cardiologists with a history of expertise in therapeutic hypothermia used the cooling technique to help save the life of a young father who suffered cardiac arrest outside of his wife's obstetrician's office.

Smith is hoping the new catheter ablation technology used to treat his heart will allow him to get back to enjoying his life, despite his history of multiple large and small heart attacks. "I hope it keeps me where I'm at, or better," he said. "I feel like I'm a miracle by God."

Frankie Smith's left ventricleImage courtesy of Abbott 
The orange sections show magnetic sensor data from Smith's left ventricle, which helped Winterfield pinpoint the areas to target with the ablation catheter.  

Smith also credits Winterfield and the team of heart specialists. "I feel more comfortable here because it's a learning school," Smith said. "It has several people who come to look at your case as a group. They can make a good decision together, instead of one or two people who might make the wrong decision. That's one of my favorite things about the Medical University."

Ten years ago, Smith might not have made it this far, Winterfield said. "He'd probably have died of intractable heart failure from undertreated ventricular arrythmias. What we did helps stabilize him from an electrical standpoint."

Smith plans to make the most of the chance he's been given. "I want to be a joyful person, regardless of what happens."