Radiation may reduce heartbeat danger

By Lauran Neergaard

Doctors are zapping the heart with radiation normally reserved for cancer in a highly experimental bid to better treat people with life-threatening irregular heartbeats who’ve exhausted other options.

Surprising early research suggests the method may reprogram misfiring heart cells to control heartbeats more like younger, healthier cells do.

“It may actually rejuvenate sick tissue, and that’s pretty exciting,” said Dr. Stacey Rentschler of Washington University in St. Louis.

An irregular heartbeat called ventricular tachycardia is a major cause of sudden cardiac arrest, blamed for about 300,000 U.S. deaths a year. Treating it with radiation is a radical approach — cancer doctors are trained to avoid radiating the heart at all costs for fear of collateral damage.

Now researchers are about to begin the first rigorous study to prove if a quick, onetime dose to fight this irregular heartbeat works well enough — and is safe enough — for more patients like Jeff Backus, who relapsed after standard care.

The Louisville man had already undergone an hours-long invasive procedure to keep his heart beating properly and had a defibrillator implanted as a backup.

Then this past winter, twice in about a

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4. Go 12 hours between dinner and your next meal to reap benefits that facilitate weight loss, fat burning, metabolism and month, Backus briefly passed out and awoke feeling like he’d been kicked in the chest. The defibrillator had to save him, shocking his heart back into rhythm.

“You’re always in the back of your mind thinking, ‘Is [another shock] going to happen?’” Backus said.

Out of other options to prevent another scary episode, he chose the experimental radiation in February — and so far, is doing well. “It gave me some hope.”

The traditional approach

The heart’s electrical system normally makes it beat with a steady lub-DUB, anywhere from 60 to 100 times a minute.

Ventricular tachycardia is a super-fast heartbeat, unable to properly pump blood. It happens when those electrical signals short-circuit in the bottom chambers, the ventricles, often because of damage from a prior heart attack.

The main treatment: Doctors thread catheters inside the heart to identify and burn the misfiring tissue, creating scars that block bad signals. Some patients are too sick for this “catheter ablation,” and for others, like Backus, the problem eventually returns.

Dr. Phillip Cuculich, a heart rhythm specialist at Washington University, came up with the idea for a no-incision alternative.

It takes a lot of up-front testing. Patients management of appetite and cravings. Those with a chronic health condition such as diabetes should consult with their healthcare provider. get a souped-up EKG, donning a vest covered in about 250 electrodes instead of the usual dozen to measure the heart’s electrical activity. Adding that to detailed medical scans gives Cuculich a three-dimensional map pinpointing where the heartbeat goes awry.

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How to reach it? Cuculich teamed with Dr. Clifford Robinson, who specializes in precisely focused radiation to attack cancer while avoiding nearby healthy tissue.

Aiming at the heart “wasn’t on my radar at all. My goal was to miss the heart,” Robinson said. After all, some lung and breast cancer survivors experience heart disease years later from tumor radiation that reached and inflamed heart tissue.

But he agreed to try, warning patients about possible long-term risks. His first arrhythmia patient responded, “You’re concerned about something that might happen 10 or 20 years from now? I’m worried about tomorrow,” Robinson recalled. “That was really eye-opening.”

Short procedure showed potential Patients lie in the same machine that normally blasts cancer, held in place and listening to music while customized beams hit just the right spot. It can take as little as 15 minutes.

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Cuculich and Robinson reported the first successes in 2017 and 2019, experiments with small numbers of desperately ill patients who showed dramatic improvement. They say some are doing well up to six years later.

While the procedure is not approved by the Food and Drug Administration, the duo has since gotten permission to treat about 80 more people on a case-by-case basis. And the St. Louis team has taught the technique to dozens of other hospitals in the U.S. and abroad that are cautiously trying it. But the FDA requires stronger evidence for more routine use — and the more hospi- tals offer “off-label” radiation to these heart patients, the harder it will be to get that proof.

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Now in an international study sponsored by device maker Varian, nearly 400 patients will be randomly assigned to either radiation or another catheter ablation to directly compare how they fare. Washington University just began recruiting potential participants; additional sites are set to open soon.

Making cells act young again

The bigger mystery: How the radiation prevents arrhythmias. Cuculich thought it would work by simply copying catheter ablation’s scarring, but was stunned when scans showed ‘’we weren’t actually causing a new scar — and that’s a big deal.”

Rentschler, a developmental biologist who also treats heart patients, took a closer look. Tests with donated human hearts and mouse hearts suggest the one-time moderate dose of radiation was prompting the misfiring cells to repair themselves.

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In areas that got zapped, heart muscle cells temporarily switched on certain genes that normally are dormant in adulthood. Among them: a signaling pathway called “Notch” that helps a developing heart form its electrical system.

Reactivating that pathway “is perking up those areas” so they conduct electrical signals more like when they were younger, Rentschler explained. “We’ve never had any treatment that could do that.”

That’s very different than how repeat radiation doses can obliterate tumors. Now Rentschler’s research team is testing human heart cells in lab dishes, measuring exactly how they conduct electrical impulses — in hopes that even lower radiation doses might work.

“It’s really important that we get this right...that we figure out what the safe doses are and if there’s areas that we should be worried about,” Cuculich said.

© 2023 The Associated Press. All rights reserved.

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Pickersgill assisted living residents are rarely in l their rooms! Instead, , theyy’re out and about— participating in a community activity or event or dining with friends.

A place of beauty

Living in n this community—ttucked d into a beautiful West Towson neighborhood —you or your loved one beau njoy a warm welcome and daily activities, and they’ll appreciate the will enj paths, beautifully landscaped grounds, lovely gardens and more. walking path

A place of caring

Each assisted liv g resident enjoys three chef-prepared meals per day, ing re y services, medication administration, help with daily housekeeping and laundry se quest, and all included in a reasonable monthly tasks and more—always by reques o all of the fee. Each h resi s dent also has access to all Pickersgill ameni l ties.

Our assisted living g residences include a priv wish. This is a lifestyle dedicated to encouraged to decorate their homes as they al staff. independence and assured by a caring, professionalfessionalstasttaff.

Call private, full bath, and residents are

Each of the nonprofit’s seven group homes is located in a safe community, and has the appearance of a typical single-family house.

In her decades as a Target client, Linda has been trained to work in food service, home maintenance and basic assembly roles.

How Target changes lives

With more than 230 employees, Target provides personalized care to 300 clients and their families, half of whom are from the Baltimore and Washington, D.C. metro areas.

“Our mission is to empower individuals with disabilities to live whole and productive lives through quality communitybased residential, educational, vocational, recreational and family-supported services,” said Dr. Matthew Ramsey, president and CEO of the company. “Each member of our community is unique and valuable.”

With offices in Westminster and Gaithersburg, Target provides not only group living but job services, finding paid employment or internships. In addition,

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Target provides adult day services and post-secondary education training.

Target’s services are not free, but the state of Maryland provides its clients with funding through the Maryland Developmental Disabilities Administration (DDA) and/or Medicare.

“We work collaboratively with families to organize services,” Ramsey said. “Our commitment to family involvement is one hallmark of the quality of our services.”

Graduate students act as staff

Since its inception in 1983, Target has maintained a close relationship with McDaniel College in Westminster. In fact, in addition to his role as leader of Target, Ramsey is a faculty member of McDaniel College and acts as adviser to students in its Human Services Management master’s degree program.

Graduate students in the program complete a two-year live-in internship at one of Target’s facilities in Westminster or Rockville, Maryland.

The program was established by Target’s original CEO and president, Dr. Donald Rabush, who had the creative foresight to develop relationships with McDaniel

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July 22 students who are studying to become Community Living Managers (CLMs).

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The students serve as home-based care managers of Target’s clients with disabilities in exchange for free college tuition, room and board, health insurance, and an annual stipend.

Rabush worked to “give special-needs individuals the maximum amount of independence and personal pride…while training the counselors who assist them to attain a lifetime of service in the field,” according to Ramsey.

Friends of Target

In a statement, Ramsey offered kudos to a community of parents, including the Harris family, who worked to ensure Target’s 40-year success.

“As these early advocates fought for their children’s rights, resources were made available to offer the kinds of services Target offers today.

“Additionally, families closely connected to Target helped shape our agency and programming through direct services.

These ‘friends of Target’ provided financial support, volunteer efforts, fundraising, and state and national advocacy,” Ramsey said.

In a sense, the organization was built on parental love.

“Milton Harris was a parent who worked relentlessly for his daughter’s needs, and generously gave his time, talent and social capital. Without friends like Mr. Harris, Target could not provide the quality services our individuals enjoy today.”

For more information about Target Community’s programs, visit targetcommunity.org or call (410) 848-9090.