Radiotherapy, normally used to treat cancer, is now being used to slow racing hearts.
Ray Brown, 70, a retired wood turner from Corby Hill, near Carlisle, was the first in the UK to have the treatment, as he tells Carol Davis.
About 12 years ago my heart would start racing for no apparent reason — suddenly I’d have a fluttering sensation.
It was happening two or three times a week, so my GP referred me to the Freeman Hospital in Newcastle, where I was diagnosed with atrial fibrillation, an irregular heartbeat caused by a problem with the electrical signals in my heart.
It can cause blood to pool in your heart, forming clots that could trigger a stroke, so I was given blood-thinners, plus beta-blockers to make my heart work more efficiently.
About 12 years ago my heart would start racing for no apparent reason — suddenly I’d have a fluttering sensation [File photo]
The doctors also found I had a second, even riskier, heart rhythm disorder — ventricular tachycardia — where at times the heart beats faster than normal.
Mine was racing at 230 beats a minute instead of a more usual 60 to 80, probably because of damage done by heart attacks I’d had 20 years earlier.
Ventricular tachycardia can cause your heart to stop — a terrifying thought, especially after another test detected a third problem: blocked coronary arteries were restricting the flow of blood to my heart.
I had a triple heart bypass in August 2008 and a month after that, they implanted a defibrillator to shock my heart back into the right rhythm when needed.
But while the other two conditions stabilised, the ventricular tachycardia got worse.
I had several bad episodes over the next few years when the defibrillator delivered a powerful shock to reset my heart. It felt like being tasered in the chest.
If that wasn’t bad enough, DVLA rules stopped me driving for six months every time it went off. My wife, Mary, can’t drive, so we had to put all plans on hold.
By 2015 I’d had two ablations, where they try to burn away the area triggering the abnormal rhythm using a heated electrode on a long wire. But my heart still kept racing, making me very tired and short of breath.
Last October, my cardiologist told me about a new treatment to burn out the faulty area with beams of radiation that can reach areas of the heart the ablation can’t.
I would be one of the first in the UK to have it, which didn’t worry me — they were running out of options.
I had the treatment in December. I lay on the couch in the radiotherapy machine while the radiographer positioned me to ensure the beams from the machine were directed at the right part of my heart.
The actual treatment took just five minutes and I didn’t even have to stay in hospital overnight. I was warned it would take a few months for the treatment to work and I had minor episodes for six weeks but since then I haven’t had any problems.
Dr Ewen Shepherd is a consultant cardiologist at the Freeman Hospital, part of Newcastle Upon Tyne Hospitals NHS Trust.
Ventricular tachycardia is where scars in the patient’s heart, often caused by heart attacks or disease, lead to a short-circuit in the normal electrical signals, causing faulty messages.
As a result, the ventricles, or lower pumping chambers of the heart, beat rapidly and cannot pump blood properly around the body. In some cases, it causes the heart to stop and sudden death.
Normally we fit a defibrillator to shock the heart out of this abnormal rhythm when necessary — more than 6,000 patients each year in the UK have one fitted.
We can also try ablation, burning out the rogue area that is sending the faulty messages.
This has a success rate of more than 90 per cent in simple forms of tachycardia affecting just the upper heart chambers but only works in 50 per cent of ventricular tachycardia cases because the key tissue is often out of reach, on the outside of the heart or deep inside one of its walls, which we can’t reach with a catheter (a long, thin tube with which ablation is administered).
Stereotactic ablative radiotherapy, or SABR, is a precise form of radiotherapy used to treat lung cancer. Doctors direct multiple fine beams of radiation from different angles through healthy tissue to converge on the tumour.
This means the tumour gets a high dose of radiation but healthy tissue gets a much lower dose from individual beams, minimising the damage. It can still cause side-effects, including tiredness and nausea.
Now, we have five years of observational studies from the U.S. and Europe showing that it can substantially reduce episodes of ventricular tachycardia, too. Six weeks after treatment, patients have a 90 per cent reduction in the shocks from their defibrillator. This is an excellent result.
We don’t fully understand how it works but it may be changing the cells in the tissue in a way that reduces the chances of them triggering a rapid heartbeat.
Before the procedure, we scan the patient’s scar tissue to pinpoint where the tachycardia is coming from. A team of 15 cardiologists, radiologists, physicists and oncologists then spends three weeks analysing the information to create an accurate map of the patient’s heart.
The procedure takes about an hour — positioning the patient in the radiotherapy machine and lining them up for the beams — although the treatment itself takes just five minutes.
The dose is about a third of the amount a lung cancer patient would receive during a whole course of radiotherapy. With cancer a big dose is needed to try to kill every cell but a lower amount is sufficient for heart tissue.
It is completely painless and there are no wires or incisions.
The patient can then go home, although we give them drugs to treat nausea and fatigue, as radiotherapy tends to always make patients feel tired and sick for a few days.
Over the next six weeks, patients have fewer attacks and the episodes they do have are shorter. In some people, the condition clears up altogether.
We are not sure why the improvement occurs gradually but think it takes time to change the cells, which are all at different stages in their life cycle.
It is probably not suitable for young people or those who respond to catheter ablation because we don’t know the long-term effects. But it is suitable for ventricular tachycardia patients who have no other options.
First used in the UK for ventricular tachycardia in the summer of 2019, SABR is now used on the NHS in Newcastle, Sheffield and Middlesbrough. Other trusts may follow soon.
The equipment is the same as that used for cancer, so all hospitals with SABR could in theory use it for hearts with the right training.
What are the risks?
There is a risk of causing an inflammatory response in the lungs and breathlessness, but both should settle with steroid treatment.
The stomach lining — which is very near the heart — might be damaged, causing a hole that would need surgery.
Radiotherapy could also weaken ribs in the long term.
‘This is a really promising treatment for a group of patients we struggle to treat otherwise, particularly those who have had a heart attack, and where we have difficulty reaching the area we need to treat,’ says Dr Lee Graham, a consultant cardiologist at Leeds General Infirmary and Spire Leeds Hospital.
Under the microscope
Actress Paula Wilcox, 70, answers our health quiz
Can you run up the stairs?
I run up the Tube stairs a lot. I like to feel fit — I do Pilates and go to the gym when I can. I also do a lot of walking — I haven’t wanted or owned a car since 2004.
Get your five a day?
Definitely. I make my own granola (annoying, I know!) and have loads of fruit with that. And I love vegetables.
Actress Paula Wilcox, 70, answers our health quiz
Gosh, yes. In my 20s I did faddy things like eating lots of cottage cheese and Ryvita. Now I pretty much eat what I like but try not to go mad on naughty treats. I am 8st and 5ft 3in tall.
Perhaps sloth — I have found it worryingly easy to do nothing for days at a time in lockdown.
Pop any pills?
Not religiously. I take omega-3, good for the brain and the heart. If I have a virus I take vitamin C, zinc, vitamin D and propolis — a compound made by bees — to boost my immunity.
Any family ailments?
Nothing special. My father is still going well, aged 95, and mum was well into her 80s when she died.
Cope well with pain?
I’ll face it but I don’t like it.
Had anything removed?
I had my tonsils out when I was about seven. At that time, if you had frequent sore throats, they just whipped them out. The nicest thing was being told to eat lots of ice cream afterwards.
A really bad bout of flu many years ago. I was in bed for two or three days. I was in Australia and I missed two or three shows of a charming comedy I was in called My Fat Friend.
Tried alternative remedies?
I have had acupuncture for a sprain. You get these little problems working in the theatre and as you are away from home, you often end up going to see someone who doesn’t know you. Sometimes it helps, sometimes not.
Ever been depressed?
Never. I have certainly been fed up but depression is something else entirely and has never happened.
Ever have plastic surgery?
No. Operations you don’t need are not a good idea.
What keeps you awake?
I am a poor sleeper. I start processing stuff that happened or that slightly worries me about the next day. My dad had the same problem and my granny used to say: ‘Just lie there because at least your body is resting.’
Like to live for ever?
I don’t think so. If you could live for ever having a great life and being fit and healthy, that would be lovely. But we all seem to be programmed for slow but sure deterioration.
Paula is starring as Elaine Jones in Coronation Street on ITV.