“Me, that fascinates me”, admits Jérôme Horvilleur, cardiologist at the‘Paris Sud Cardiovascular Institute (ICPS), at the
Jacques Cartier private hospital from Massy (Essonne). Under the mask, the charlotte and the small round glasses, we read in his laughing eyes that after twenty years of operating on cardiac arrhythmias, he has not finished his passion for the mysteries of the heart.
To better understand the functioning of this particular organ, his team is testing cutting-edge software, based on artificial intelligence, which could revolutionize the management of certain disabling heart diseases. 20 minutes was able to follow this team and better understand what the AI is changing in the operating room in cardiology.
“It is the most common arrhythmia and the most complex to operate”
“The heart is plumbing, but we are the electricians”, introduces the cardiologist-rhythmologist. Then he grabs a sheet of paper and a four-color pen to draw diagrams of a heart: the two atria at the top, the two ventricles at the bottom, and how the sinus node between these parts serves as a “slower” for electrical waves. “All this sophisticated machinery can be threatened with minimal imperfections or disease”, illustrates the doctor.
In particular the atrial fibrillation, which interests him particularly. “It is the most common and the most complex arrhythmia to operate,” continues the doctor. It’s a bit like epilepsy of the atrium. The electric current is chaotic and constantly changing. The symptoms of this little-known disease are similar to those of a heart attack: chest pain, shortness of breath, heart beating strangely. “It’s terribly scary. But in some patients, this atrial fibrillation is completely asymptomatic. So when it is discovered, the heart has often already suffered. Not to mention that the pathology increases the risks of having a stroke or a heart attack.
Heart cards to better operate
Recently, research has been made to manage this arrhythmia. “In the 2000s, a team from Bordeaux discovered that atrial fibrillation starts in the left atrium,” continues Jérôme Horvilleur. And that electricity passes to the pulmonary vein ”. The sign that the heart is sick. “From there was developed an operation: the wall of the atrium is burned with a catheter so that the electricity no longer passes to the pulmonary vein. »Problem: only a part of the patients are treated using this technique. For the others, we have to find a solution.
This Friday morning, in the operating room, a patient suffering from atrial fibrillation is under general anesthesia and intubated. We can guess it between the sterile fields which cover it from bottom to top and under the various screens. “I sent you the report,” says a nurse to the doctor. Two doctors are in the operating room, headphones on to chat directly with Antoine, an application engineer, their eyes riveted on his screens.
Through a probe into the esophagus, doctors pass a needle through the septum between the left and right atrium. Then, they slip through this probe two catheters: one to map the entire left atrium, the other to burn the places that seem problematic. “This patient suffers from paroxysmal atrial fibrillation, which means that the” epileptic seizure “is not constant, explains Jérôme Horvilleur. Currently, she is in normal rhythm. “
On Antoine’s screen, the engineer, a 3D map is displayed. Thanks to the catheter, which takes careful measurements of the very weak electric current, it gradually outlines the contours of the left atrium. “There are already 3,000 points recorded in five minutes with a color code according to the volts.” “In pink, it’s holy fabric,” specifies Jérôme Horvilleur, his finger on the screen. It’s super beautiful, which does not spoil anything! “
How AI can help this kind of complex operation
This is where the AI-based VX1 software comes in. But here everyone calls her “Volta”. Developed by the Marseille start-up Volta Medical, it allows you to add a precise – and therefore valuable – map for physicians who are fumbling with their catheter. “The software, trained on hundreds of thousands of heart signals, sorts out the areas to be treated and those that can be left alone. This suggests that instead of relying on the experience, intuition and dexterity of a team specializing in this disease, the operation becomes reproducible. »The caregiver saves time and energy. And the operation could be democratized, taught and performed beyond the few centers specializing in this arrhythmia.
“” Volta “does not require an additional examination, it is just a software connected to the catheter, synthesizes Lydia Bouras, nurse in cardiology. For the patient, it does not change anything about the preparation before the operation and the care afterwards. The big difference is that he has a good chance of being cured during the procedure. “In almost all the operations that we have performed with” Volta “, the patient’s heart has returned to a normal rhythm during the operation, assures Jérôme Horvilleur. However, this only happens in about 30% of cases in an experienced center, and almost never for hospitals that are not experts… ”
Promising data which remains to be confirmed. This is also why the ICPS has integrated a large study on twelve hospitals. The goal? Prove that an operation with Volta heals better than without this AI software. “For the moment, we have about twenty patients included in the study, because we select difficult patients on whom we usually break our teeth,” says the cardiologist. Who can do the most can do the least! “