Q&A: J. Michael Mangrum, MD, on UVA's Work with CardioInsight

J. Michael Mangrum, MD

Over the past year, the University of Virginia (UVA) Health System has put a new emphasis on improving their approach and practices to treating cardiologic conditions. Along with implementing a team of cardiologists, radiologists, and biomedical engineers to collborate, they've introduced newly-approved devices to their repetoire.

One such device—CardioInsight, from Medtronic—has introduced new measures by which the team can combat heart rhythm conditions such as atrial fibrillation. In an interview with MD Magazine®, J. Michael Mangrum, MD, a heart rhythm specialist with the UVA Advanced Imaging group, explained how this non-invasive device is bettering their care.

MD Mag: What is this next cardiac imaging device?

Mangrum: The tool is called CardioInsight. It’s a product Medtronic owns, and it’s a vest that has 252 electrodes on it. We use that to map the heart rhythm externally. It’s a non-invasive way of mapping heart rhythms. We’ve got a lot of experience here using it for atrial fibrillation, which is the most common abnormal heart rhythm, but we also have experience using it for PVCs, ventricular tachycardia, even for patients getting ventricular devices—which is another potential application for it.

It’s not an experimental tool, it’s a clinical tool that is currently available. But there’s limited release of it. We’re the second site in the country to have acquired it and do procedures with it, and we probably have the most clinical experience with it in the country.

Can we talk about the emphasis of need for such a device?

If we talk about it specifically for atrial fibrillation—atrial fibrillation is the most common heart rhythm in the US. We have had clinical focus on it here at UVA for about 20 years now. Most of our clinical focus and research done here is on atrial fibrillation. We learned a lot about this system before it became US Food and Drug Administration (FDA) approved. We learned about it through some experimental work in Europe.

There’s a type of atrial fibrillation called persistent atrial fibrillation, which represents the largest subgroup in atrial fibrillation. This tool is being used for that particular group. You can non-invasively map the atrial fibrillation and note certain rotations or circuits in the electrical system of the heart that can be targets for ablation. The ability to identify these areas is the one big value in this particular tool. The additional plus is that it’s non-invasive.

We have used it a lot in that particular patient cohort, in which the typical ablation strategy may not be adequate to a lot of those patients.

Certainly, an emphasis has to be put on non-invasive procedure for these type of patients where it’s applicable.

It’s the actual mapping where there’s value in this device. It allows us to do the mapping prior to doing invasive procedure, and it identifies the targets that haven’t been targeted before. Looking at clinical outcomes, we’ve had improvements by using this. That’s the primary reason why we have put a lot of focus on this.

Is there opportunity for future endeavors or expanded indications with this device?

What we’re using it for now is in this complicated patient group in which current ablation approaches are not adequate. This is providing new information and some good clinical outcomes. We would continue that track of use. The applications I mentioned earlier, purely from a research basis, are looking at it, identifying the best area to place a ventricular lead for CRT therapy, for patients with congestive heart failure.

We have some research projects related to that, and we have research projects related to atrial fibrillation involving the vest.