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World-class cardiologist Wharton joins heart/vascular team by Cindy Abole Public Relations Treating heart rhythm disorders and understanding the details of its electrical pathways have greatly improved for South Carolinians and others thanks to the recruitment of renown cardiac electrophysiologist Marcus Wharton, M.D. Wharton is the latest specialist to join MUSC’s Heart and Vascular Center team which is committed to providing a full service, cardiac care center.  Wharton’s presence follows a course established by cardiology director Michael Gold, M.D., Ph.D., after his arrival to campus in 2002 to help build and establish MUSC’s position as the Southeast’s leading cardiac care center. With May’s opening of the institution’s new 24,000-square-foot facility housing the latest in cardiology and interventional radiology services and equipment, Gold, Wharton and their multidisciplinary team are a step closer to creating one of the strongest cardiac electrophysiology programs in the country. “It’s great to be able to recruit a world-class cardiac electrophysiologist who is among a handful of pioneers in the area of treatment of atrial fibrillation,” said Gold. “It brings our group to top 10 national status among heart centers overnight.”  The Alabama-born Wharton headed Duke University Medical Center’s clinical cardiac electrophysiology program for 15 years after completing a cardiac fellowship and joining staff in 1988. Prior to that, Wharton received his medical degree from Vanderbilt University in 1980 and completed his residency training at the University of California at San Francisco. Like Gold, Wharton’s expertise concerns the heart’s electrical signals. Normally, the heart pumps blood throughout the entire body guided by electrical signals between the upper (atria) and lower (ventricles) chambers, which work in succession allowing muscles to contract and pump blood to the arteries. If the signal becomes broken or disorganized within the upper chambers causing the heart to beat faster than 400 beats per minute, resulting in an irregular heartbeat, an individual may suffer from atrial fibrillation (AF), the most common of heart rhythm disorders.  A common condition In the United States, more than 2 million people live with atrial fibrillation. Another form of rapid heartbeat is atrial flutter which produces an irregular electrical signal in the atrium that, if left undetected, may cause serious health risks, including stroke, black out spells and heart failure. Nationally, about 750,000 new AF cases are diagnosed each year. But its likelihood increases with age. With Charleston’s temperate climate attracting more retirees, the prevalence of AF  among South Carolinians, ages 65 and older, has risen about 5 percent, according to Wharton. The condition is most fatal when it is combined with hypertension and coronary heart disease—the state’s number one cause of death among adults. Wharton’s specialty in treating arrhythmias has led him down a path which began with understanding early therapeutic options including pharmacologic and device therapies. More recently, curative options using ablative therapy to guide small, flexible catheters tubes into tight, critical areas of the heart to destroy specific heart muscle showed promise. “The number of arrhythmias we can ablate using catheters has remarkably expanded,” Wharton said. “Rapid advances in radiologic detection and catheter technology have allowed us to offer patients with an array of therapies for people suffering from a host of rhythm problems.” In the mid-1980s, electrophysiology was just evolving as a cardiology subspecialty using non-invasive ablative techniques. Some pharma-cologic or drug therapies were ineffective, causing problems with drug reactions among patients or even creating new, potentially fatal rhythm problems.  Advent of technology  As technology developed, specialists moved away from drug therapies and towards implantable devices like pacemakers and defibrillators (Gold’s specialty) to handle specific forms of tachycardia, while ablative techniques became more common. Currently ablation has proved to be a safer and effective technique for treating rapid  heart rhythm irregularities such as superventricular arrhythmia or ventricular tachycardia. Its success rate has increased to almost  100 percent. Design improvements to make smaller, flexible catheters using tips of varying temperatures and multi-dimensional cardiac imaging techniques have advanced the procedure to maintain better outcomes. Today’s combination of ablative and device therapies, featuring newer, more effective drugs have become an effective route for treating AF and other cardiac rhythm disorders.  Wharton found the success of temperature-controlled, catheter-guided techniques to safely eliminate cardiac rhythm problems both fascinating and exciting. He has also been in the forefront of ultrasound-guided cryotherapy research. Using hypothermic mapping, a cardiac ablationist can chill a catheter tip down to minus 20 degrees Celsius and place it at an appropriate site to temporarily block and evaluate electrical activity in a small part of the heart. The process can be reversed by simply warming the catheter tip.  This fall, the Heart and Vascular Center will unveil its new Stereotaxis System, a highly integrated interventional system used by cardiac electrophysiologists to map and direct an ablative procedure from a control console using an ultra-thin virtual catheter moved by powerful magnetic fields in and around heart muscle. “The technology today is really exciting,” Wharton said, a self-confessed gadget guy and techno geek when it comes to tools, information devices and gear. “Electrophysiology is a wonderful blend of medicine, procedures and engineering.” Interactive setting What is atypical for Wharton and other specialists in his field is the ability to work closely with device engineers, manufacturers and other institutions who create and manufacture medical equipment. Together, they discuss designs and modifications that will lead to improvements making Wharton's job easier, effective and safer for his patients. In this contiguous care environment, cardiologists, nurses, specialists and technicians are more interactive with each other than ever before. Cardiac ablationists rely on imaging technicians to import images of the heart through a CT/MRI scan and reconstruct the heart through X-rays in three-dimensions. In an ablative perspective, electro-physiologists are the electricians in a construction project, while imaging technicians are more like plumbers, according to Wharton.  As for his research interests, Wharton plans to continue his study on the pathogenesis of arrhythmia: What causes it and why. He wants to direct research towards basic science examining anatomy, molecular genetics, the muscular sleeve and other processes associated with arrhythmias that can’t be explained. Like any disease, he hopes that one day people can apply preventative efforts with AF or develop new therapies that could either slow or decrease its process.  “The more we understand the basics and causes of rhythm problems in people, the more we are able to prescribe the right type of therapy for our patients,” Wharton said. For now, Wharton and his team are challenged physically and mentally with long days and lengthy procedures. With his specialty in electrophysiology, Wharton maintains a wide patient base that is local, national and international, and currently booked six months in advance. A typical ablative procedure averages between four to six hours, performed about three days per week. During the procedure, each team member in the lab must wear a lead-lined apron weighing between 8-15 pounds to protect themselves from radiation.  An additional challenge is staffing. With the possibility of the center sponsoring an electrophysiology fellowship program in the future, Wharton will not only be involved training the best candidates in the newest technology and procedures, but he’ll have extra help and someone to talk to in the labs. “These are very exciting times for patients and practitioners working with atrial fibrillation,” Gold said. “In the past, we’ve had the ability to develop drugs to prevent bad outcomes like strokes. Now we’re able to develop new cures using technology and research that will make a difference in the quality of life for so many people.”       Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. 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