Photo: Above, Dr. Rahul Doshi at the controls of Sensei robotic catheter system. (Register photo by Leonard Ortiz)
Craig 
Schumacher’s heart operation was nothing to be taken lightly, yet the mood in the operating room was upbeat.
- “Look at that!” Zap. “Amazing!”
- “What the hell is this?” Zap.
- “Come on, come on, come on!” Zap.
Those were some of the sounds and actions in the O.R. on the first day doctors at St. Jude Medical Center in Fullerton used a new Sensei robotic catheter system. Schumacher was one of the first patients operated on with it.
Cardiac electrophysiologist Dr. Rahul Doshi had no trouble dissipating tension that day, because the Sensei system required him to sit in front of three computer monitors and use a joystick, as if he were playing a video game.
For a description of Schumacher’s condition and what the new Sensei system means for cardiac patients, see the related story “Robotics turns heart repair into serious game.” For a play-by-play account of the operation itself, see below.
ROCK STAR
Doshi downed a can of Rock Star energy drink, then began the operation shortly after 2 p.m. First he inserted the catheter deep inside the Schumacher’s body, extending it from the groin to the heart.
In the past, for the duration of the operation Doshi would have held onto a manual catheter at the end where its movement controls were located.
This time, though, the new Hansen catheter was attached to a computerized movement-control device that looked like a small vacuum cleaner suspended from a mechanical arm.
ALICE IN CHAINS
At 2:30 p.m., Doshi stepped away from the operating table and sat at the new system’s work station, holding onto the Sensei catheter’s joystick. From an iPod in the corner came low-volume rock music, including Rolling Stones and Alice in Chains songs.
As Doshi tracked down and eliminated electrical abnormalities in Schumacher’s heart, his exclamations made him sound a bit like a computer gaming enthusiast. That kept spirits up in the operating room as he tackled a complex procedure that would determine Schumacher’s health for years to come.
On one screen Doshi could see the location of the catheter inside the heart, recorded by a five-foot C-shaped fluoroscope that encircled Schumacher’s upper body. Everyone in the operating room wore lead-lined garments as protection against the X-rays the fluoroscope used to create its moving image of the patient’s heart.
A second screen showed the patterns of electrical signals inside the heart.
NORAD
“It’s like we’re at NORAD,” Doshi said, comparing the Sensei video panel to a North American Aerospace Defense Command control center.
One screen showed a 3D computer simulation of the left atrial chamber of the heart, based on Schumacher’s recent CT scan. (Similar to the Hansen Medical graphic below.) Another screen (pictured at right) showed a real-time 2D image of the chest from the fluoroscope, which a computer simulation of the catheter superimposed on it.
Doshi moved the catheter methodically through the upper heart, again and again touching the atrial wall with the tip of the catheter and checking the screen for signs of the electrical activity there.
BAD ACTOR
“Look at that. There’s a potential bad actor,” he said, spotting a pattern of electrical activity that could leave the heart fluttering.
Depending on the type of electrical irregularity, the heart could be thrown into an irregular pattern, or arrhythmia. Irregularities can include incidents when the pulse rate exceeds 100 per minute, called tachycardias, and abnormal, disorganized rhythms called fibrillation.
When Doshi identified a suspect location, he pressed a control lever with his foot. In response, the tip of the catheter emitted a blast of radio waves to deaden that spot. Zap. A white oval appeared on the 3D image at the zapped location.
CLEAN-UP
“His arrhythmia just changed,” Doshi said. “What does it take to stop it?” Zap.
“There’s a lot of scarring. That doesn’t bode well,” he said. “Let’s clean up there.” Zap. Zap.
“That area has been blitzkrieged. That’s what you get with three ablations.”
It was 3:40 p.m.
“Mark that. And that. And that,” he told clinical engineer Simon Pranaitis, who worked on his own screen at Doshi’s side, controlling the heart monitoring and imaging system. The marks on the 3D image helped Doshi navigate through the heart and return to locations that might need further work.
“Come on, come on, come on. Here we are!” Zap.
“We’ve seen four different flutters. That’s surprising.”
GARBAGE FLUTTER
“What the hell is this? Garbage flutter. You just can’t win.” Zap.
“God, it’s taking forever,” Doshi said. “I’ll be worn out for playing Guitar Hero. My daughters are already beating my behind on it.”
At 4:45 p.m., Doshi decided that he should move the catheter tip into the right atrium of the heart, because he had discovered that Schumacher’s electrical irregularities weren’t limited to the left atrium.
There Doshi spotted more problems and briefly broke into song about a type of rapid heartbeat that he saw.
“Come on, come on, come on!”
BIZARRE
“I can’t get rid of it. It’s bizarre.” Zap. The irregular signal vanished.
At 5:25 p.m., he moved the catheter back to the left atrium, where more irregularities had popped up.
“What does it take? There’s no end to this guy’s tachycardias.” Zap. Zap.
“Look at that! That’s where we need to be.” Zap.
“It’s so diseased! The garbage is back. Amazing.” Zap.
Doshi moved the catheter to the roof of the left atrium.
FINAL TOUCH
“There’s something right there that we’re missing,” he said. Then he spotted one final irregularity. “That makes no sense at all, in the middle of the bloody roof!” Zap.
“Now we’ve done everything,” he said. “There’s nothing left to burn.”
The 3D image of the heart was dotted with dozens of white ovals that marked Schumacher’s newest ablation sites.
“It’s Miller time, kids,” Doshi said. “We’re done.” The time was 6:07 p.m.
Above: Hansen Medical photo of Sensei system’s controls
