White Plains Hospital continues to advance and enhance its cardiology program to provide exceptional outcomes to patients locally, most recently expanding on world-class electrophysiology capabilities as part of its extensive complement of services.
This ongoing expansion builds on White Plains Hospital’s long-standing commitment to bringing comprehensive cardiac care to the region — a commitment that Roger Cappucci, MD, FACP, FACC, Chief of Cardiology at White Plains Hospital, has both witnessed and fostered since joining the cardiology program in 1995.
“In terms of diagnostic testing, we initially performed electrocardiograms and echocardiograms,” Dr. Cappucci says. “Over the years, we have progressed to include additional stress testing, and we have developed our own invasive cardiology program.”
Roger Cappucci, MD, FACP, FACC, Chief of Cardiology at White Plains Hospital, meets with patients and family members in the hospital’s newly renovated lounge and waiting area.
The creation of the invasive cardiology program enabled Dr. Cappucci’s colleagues to perform procedures such as cardiac catheterization and stent placement. Those procedures are often lifesaving — particularly for heart attack patients, who can now obtain high-level emergency care locally.
“The faster we can get the artery open, the more heart muscle we can salvage,” says Dimitrios Bliagos, MD, Chief of Interventional Cardiology at White Plains Hospital. “We know from research that when you can save more muscle, patients have better long-term outcomes.”
Another key step in the evolution of the cardiology program was the establishment of the first cardiac catheterization lab, which helped lay the foundation for further expansion. Today, the program boasts a second cardiac catheterization lab and provides emergency and elective services, electrophysiology procedures, and other advanced treatments to address a wide range of complex conditions.
Meeting a Growing Need
The growth of the invasive cardiology program in recent years has been in direct response to a demonstrated need for those services in the region. To achieve this growth, White Plains Hospital first had to prove that the community would clearly benefit from the services and technologies that would be added as part of the expansion.
“The New York State Department of Health wants to know the hospital is not duplicating existing services in the area or creating unnecessary facilities,” Dr. Cappucci says.
When the interventional cardiology program began, it specialized in emergency cardiac catheterization procedures alongside existing diagnostic exams. After a few years, White Plains Hospital began offering rotational atherectomy procedures for the removal of calcified atherosclerotic plaque from diseased arteries.
“We started an initiative a few years ago in which we introduced atherectomy devices to treat patients with severe coronary calcification,” Dr. Bliagos says. “Since introducing the Rotablator, we have added two other atherectomy devices, including laser atherectomy and orbital atherectomy.”
The cardiology program at White Plains Hospital has since expanded to include multiple state-of-the-art procedures that take advantage of novel technologies. These procedures include protected percutaneous coronary interventions using Impella devices — miniature heart pumps that temporarily support patients who are in cardiogenic shock.
“By having these types of devices available, we are able to provide patients with advanced coronary care in their backyard,” Dr. Bliagos says. “Usually, people outside urban areas who have advanced, complex coronary disease are not able to receive comprehensive local treatment because community hospitals do not offer these therapies. White Plains Hospital is an exception to that rule.”
Electrophysiology at White Plains Hospital
The electrophysiology program expanded in 2018, notes Daniel Wang, MD, MS, Director of Cardiac Electrophysiology at White Plains Hospital. The program incorporates the latest technologies and the most up-to-date 3D mapping systems, Dr. Wang adds, and a partnership with the Montefiore Health System adds to the spectrum of cardiac electrophysiology procedures White Plains Hospital can offer.
Available procedures range from gold standard catheter ablations for the treatment of atrial fibrillation to pacemaker and defibrillator surgeries, some of which can be used to treat congestive heart disease in addition to cardiac arrhythmias.
White Plains Hospital also judiciously incorporates technologies that are new to the market as well as effective conventional devices in order to offer the highest level of care. Among the novel therapies available at White Plains Hospital, according to Dr. Wang, are the leadless Micra transcatheter pacing system and His bundle pacing (HBP).
The Micra is the world’s smallest pacemaker — the first and only one of its kind. It does not require traditional surgical chest incisions or the implantation of leads in the heart.
“The Micra performs the same functions as a traditional pacemaker, except it has been miniaturized into a self-contained unit that is smaller than a AAA battery,” Dr. Wang says. “Because of that, it can be implanted in the heart via a catheter placed in the groin.”
“We pride ourselves on the fact that we are able to provide patients with advanced coronary procedures locally. We do not have to send them to a tertiary center far from home and family.”
— Dimitrios Bliagos, MD, Chief of Interventional Cardiology at White Plains Hospital
Dimitrios Bliagos, MD, Chief of Interventional Cardiology at White Plains Hospital, follows up with a patient after his recovery from a successful atherectomy procedure in the cardiac catheterization lab.
The main advantages of the Micra pacemaker’s size and noninvasive placement are that patients do not require the stitches or substantial recovery time associated with open surgery, and they do not face many of the short- and long-term risks associated with conventional pacemakers.
“Particularly, the Micra helps us avoid the risk of infection,” Dr. Wang says. “Moreover, we do not have to worry about problems such as thrombosed upper extremity veins, which can preclude traditional surgery for some patients.”
Whereas the Micra pacemaker’s innovations are most apparent in the way the device is implanted, recent advancements in HBP are related to how it generates and regulates a patient’s heartbeat.
“As opposed to conventional pacing, HBP has the potential to generate a heartbeat that much more closely resembles a natural heartbeat,” Dr. Wang says. “Ongoing research suggests that by producing a more natural heartbeat, HBP may be associated with a lower risk of developing cardiomyopathy.”
Drs. Cappucci and Wang consult on treatment options for routine as well as emergency cardiac care for outpatients and inpatients.
The electrophysiology department at White Plains Hospital also offers cardiac resynchronization therapy (CRT), which uses a special pacemaker for the treatment of congestive heart disease.
“Not only do some patients have weakened heart muscles and diseased muscle fibers, but the electrical fibers in their ventricles are also diseased, which can exacerbate heart failure,” Dr. Wang says. “For those patients, CRT uses electrical or pacemaker therapy to treat the diseased electrical conduction system. It can also help strengthen their ventricles and improve their heart failure.”
Other recently developed treatments available at White Plains Hospital include the subcutaneous implantable cardioverter defibrillator, which protects the heart against sudden cardiac arrest without the need for implanting leads into the blood vessels or the heart. Similar to the Micra pacemaker, this form of treatment allows Dr. Wang to avoid the risks associated with traditional transvenous defibrillators, including lead infection and fracture.
“As people become more educated about the different services that are offered in their area, they want to know that their hospital can provide a certain level of care so they do not have to travel long distances for advanced treatment. White Plains Hospital provides comprehensive cardiology care for Westchester residents.”
— Roger Cappucci, MD, FACP, FACC, Chief of Cardiology at White Plains Hospital
Dr. Cappucci is board-certified in internal medicine and cardiovascular diseases.
A Strategic Partnership
The partnership with the Montefiore Health System — of which White Plains Hospital has been a member since 2015 — is another reflection of the hospital’s commitment to reducing the burden of travel on patients who would benefit from cardiac electrophysiology procedures, Dr. Wang points out.
“For many types of therapies we offer in our field, patients would typically have to travel into Manhattan to receive care at one of the teaching hospitals there,” explains Dr. Wang, who is also on staff at Montefiore Medical Center. “Our partnership with Montefiore allows us to offer patients the entire spectrum of cardiac procedures, closer to home for patients in this region”
Teams, Technology and Outcomes
The expansive electrophysiology and other procedures now available at White Plains Hospital were made possible by incorporating innovative technologies into the cardiology program and marshaling a team of highly trained clinicians who know how to leverage those capabilities to improve medical outcomes.
“The hospital has made a commitment to hiring physicians who care about their patients and have outstanding training and reputations,” Dr. Cappucci says. “Any physicians or staff members we hire for our lab are board-certified in their particular field — cardiology, invasive cardiology or electrophysiology.”
The thoughtful process involved in bringing together an outstanding team of providers and equipping them with advanced technologies has paid off in exceptional door-to-balloon times within the STEMI program, which beat the 90-minute benchmark set by the American Heart Association (AHA) by more than 30 minutes.
“Our program is unique in the fact that our quality metrics are excellent, with our door-to-balloon time being below the national average,” Dr. Bliagos says. “We’re consistently under 60 minutes, as documented in the American College of Cardiology’s National Cardiovascular Data Registry.”
“Having two cardiac catheterization labs is more than twice as valuable as having one because it allows for collaboration between electrophysiologists and interventional cardiologists when caring for patients. In terms of logistics for our patients and for staffing, having two labs provides much more flexibility and availability for both elective and urgent procedures.”
— Daniel Wang, MD, MS, Director of Cardiac Electrophysiology at White Plains Hospital
Dr. Wang focuses on treating irregular heart rhythms, utilizing the latest in ablation, pacemaker and defibrillation technology.
The hospital is also in the top 10% nationally for risk-adjusted mortality rates for patients who undergo coronary stent procedures. These metrics are evidence of White Plains Hospital’s commitment to providing high-quality, cutting-edge treatment to patients.
“We are providing a level of care similar to that found at a university hospital,” Dr. Bliagos says. “We are able to care for the vast majority of patients with coronary disease, which is extremely rare for a community hospital.”
White Plains Hospital plans to continue elevating cardiology care in the area and is currently participating in the AHA’s Mission: Lifeline registry with local EMS providers.
“This is an attempt to treat heart attack patients within 90 minutes of the first medical contact between EMS providers and patients,” Dr. Bliagos says. “We are keeping track of our numbers and working with our EMS partners to get patients to the cardiac catheterization lab within this time frame.”
Although White Plains Hospital’s metrics already place it among some of the top cardiology programs in the nation, the commitment of its staff to continuous improvement and robust collaboration is unflagging.
“We hold ourselves to a high level of qualifications and standards,” Dr. Cappucci says. “For example, we routinely review complex cases and patient outcomes to really look at how we’re doing in terms of patient care and quality and what we can do better.”
Dr. Bliagos uses advanced interventional techniques to diagnose and treat blockages in the coronary arteries, as well as other heart-related conditions.
The emphasis on collaboration extends to local primary care physicians and cardiologists as well, including those located at the hospital’s more than two dozen outpatient locations. White Plains Hospital holds community meetings to inform area providers about current and future developments in the cardiology program and regularly gathers feedback to find new ways to improve.
“Vigorous collaboration among our physicians as well as outreach and communication efforts with providers around the region are key components of building the highest standard of care we can for our patients,” Dr. Cappucci says.
For additional information, visit wphospital.org/cardiac.