New heart drill may help angina patients

Web posted December 20, 1999

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By Lauran Neergaard
Associated Press

WASHINGTON -- Imagine a drill smaller than the tip of a ball-point pen, made out of a tiny needle that spins up to 2,000 times a minute.

Dr. Fayaz Shawl threaded this miniature drill inside a Maryland man's heart and, working between heartbeats, punched 15 tiny holes in his left ventricle in a mere half-hour, just like a carpenter would bore holes in wood.

Tube-like sections of the 53-year-old patient's diseased heart tissue slid out of the drill and into a little canister.

Minutes later -- still lying on the operating table -- the first American to undergo the experimental drilling made a surprising statement: He already felt relief from the excruciating chest pain and breathlessness that had left him disabled.

``I feel much better, I'm breathing better,'' said Norman Ridgeway, who was awake and watching on a video screen at Washington Adventist Hospital on Wednesday as Shawl drilled his heart.

Is he really improved or is this a placebo effect, where simply offering treatment makes some people feel better? There's no proof yet, since Ridgeway is just the first of 15 patients the Food and Drug Administration is allowing to undergo the new needle-drilling technique in a study.

And drilling holes into diseased hearts is one of the most controversial areas in cardiology, particularly since no one understands why it would work.

But Shawl, who first tried his drilling technique on nine patients in India -- he says they are doing well -- believes the relief is real. He predicts the needle drill could one day help nearly 1 million Americans crippled by the chest pain called angina.

The holes-in-your-heart approach isn't new; doctors first tried it by cutting open patients' chests and burning holes in the heart with a laser.

Many patients clearly felt better. Some who had been bedridden could now walk around the block. The FDA recently approved open-heart laser surgery as a last-chance treatment for severe angina.

But open-heart surgery is dangerous for very ill people, and some 8 percent of angina patients die during open-heart laser drilling, called ``transmyocardial revascularization.''

So doctors now are trying a less invasive method of burning holes, by threading a wire-like laser through an artery from the patient's groin up to the heart.

That procedure is still highly experimental. While Shawl has performed it and contends it helps patients who couldn't survive surgery, he says the laser wire is difficult to control, and flops around as it's positioned in the heart.

Good control is crucial to keep holes from boring so deep that they punch through the heart wall.

The new needle-drill is much easier to control, and would cost $20,000, far less than the $250,000 tab of a laser, Shawl said.

He sees another benefit: Instead of vaporizing heart tissue like the laser does, the needle-drill, made by Angiotrax Inc. of Sunnyvale, Calif., spits out little cores of heart tissue ready for scientific study. Shawl wants to eventually compare before-and-after tissue samples.

Why? It might help prove a theory that drilling the holes stimulates the heart to grow new blood vessels, much like a new scar on skin turns pink as blood vessels form during healing.

``The procedure Dr. Shawl's doing is still in its infancy,'' cautioned Dr. Richard Lange of the University of Texas Southwestern Medical Center.

He says scientists haven't proven that the benefit of laser drilling isn't just a placebo effect. After all, other studies have failed to find new blood vessels or better blood perfusion, Lange said.

Consequently, ``I'm not sure whether the new procedure will really offer any advantages or not.''

But Shawl points to Ridgeway as evidence of the needle-drill's promise. The Takoma Park, Md., man underwent bypass surgery and 13 angioplasties over the past 15 years but continued to decline until doctors had nothing left to offer -- another surgery would kill him.

Yet Ridgeway went home 24 hours after undergoing the experimental needle drilling, not cured but insisting he felt better, and Shawl has patients from as far away as England lined up to test it too.