Right on Target

When Bob Gunderman’s heart went haywire five years ago, he was baffled. “I thought I’d done everything right over the years. I was 56 years old. I did not smoke or drink. I was not overweight. I ran every day. I’d completed eight marathons and numerous road races and led an extremely active lifestyle,” he said.  

In fact, Bob felt so good that he wanted to skip his annual wellness check-up that year. Fortunately, Cheryl Gunderman, Bob’s wife of 37 years, convinced him otherwise. A routine ECG (electrocardiogram) during the appointment revealed he had atrial fibrillation (A-fib)—the most common type of treatable heart arrhythmia. 

With A-fib, the heart’s upper two chambers beat erratically and out of sync with the lower two chambers. The condition can lead to blood clots, stroke, heart failure, and other complications. Symptoms can include heart palpitations, lightheadedness, extreme fatigue, shortness of breath, and chest pain.  

“I barely knew what A-fib was, and I did not recognize the symptoms,” said Bob, who was stunned by the diagnosis but also curious. As an entrepreneur with an electrical engineering degree who practices patent law, Bob is fascinated by how things work or, as in this case, don’t work.   

“I got a little bit obsessive about trying to figure out what caused this,” he said, admitting to “spending too much time” trying to find the answer. He conducted extensive research, contacted and visited experts in Rochester, NY, where he lives, and even underwent genetic testing, but nothing revealed the reason. A-fib can happen to anyone. And like many with the condition, the reason for Bob’s diagnosis still eludes him. 

In the meantime, Bob followed recommended treatment protocols over several months, including medication and multiple cardioversions—a procedure in which the heart is shocked to try to restore its normal rhythm. Nothing cured his A-fib. At that point, Bob’s cardiologist in New York, who had diagnosed him with persistent A-fib, told him the next step was a cardiac ablation. 

During a cardiac ablation, doctors typically insert a catheter through a blood vessel in the groin to locate and ablate (destroy or isolate) areas of the heart where electrical malfunctions are causing the A-fib. The resulting scar tissue blocks the faulty electrical signals, restoring a regular heartbeat. To pinpoint the areas for ablation, physicians will use catheters with electrodes at the tip to probe the heart and create a map of its electrical activity. As with any invasive procedure, this probing involves risks, and understanding the mechanisms that cause an individual’s A-fib may not be clear from data gathered solely from the catheter inside the heart.  

Contributing to the uncertainty is a common treatment approach that likely won't work for some patients. Because the tissue around the heart’s pulmonary veins is the source of approximately 80 percent of A-fib cases, Bob learned that many electrophysiologists will target those areas during an ablation. For patients in the other 20 percent, however, this approach will likely fail, requiring additional ablations to locate and address the actual source of the faulty electrical signals.  

Searching for a Treatment that Works the First Time

“Given that an ablation is heart surgery with long anesthesia times, I was not at all comfortable with a ‘try it and see if it works’ approach,” said Bob. “I kept thinking there had to be a non-invasive way to comprehensively identify the specific sources of the arrhythmia to develop a targeted approach to ablation that works the first time.” 

With an eye for innovation, Bob turned to what he knows best: the patent literature. His search revealed a promising patent that had led to the development of exactly what he’d hoped: an FDA-approved, commercially available technology for more precisely and less invasively identifying and ablating the sources of A-fib for individual patients. That technology is now Medtronic’s CardioInsight—a sophisticated imaging system that includes a single-use, disposable, multi-electrode vest worn by the patient to produce individualized electrical maps from the body’s surface. Combined with CT scan data, the vest enables real-time, non-invasive, three-dimensional mapping of the heart to pinpoint and target the regions driving A-fib. 

“From there, it was easy to find the handful of medical centers that had purchased and were using CardioInsight, UVA Health being one of them,” said Bob. 

Individualized Heart Care 

In fact, UVA Health was the second U.S. location to acquire the device, thanks to a gift from the Seraph Foundation. Moreover, Bob discovered that Mike Mangrum, MD, an electrophysiologist and the Ted Turner Professor in Atrial Fibrillation in the Department of Medicine’s Division of Cardiovascular Medicine, is one of its leading experts.

Dr. Mangrum performed the first procedure with the device at UVA Health in February 2017. He continues to develop best practices for using CardioInsight in clinical care and research to improve patient outcomes in cases of A-fib and other arrhythmias. 

“Dr. Mangrum was very approachable and willing to spend time explaining the procedure to me and answering my hundreds of questions,” said Bob. “After my first meeting with him, I felt confident that I had found not only a technology that could remedy my arrhythmia, but also a doctor and a medical center that were top-notch in every way.” 

Dr. Mangrum performed Bob’s ablation using CardioInsight in July 2020. “I have been in normal sinus rhythm ever since. Once again, I can pursue the activities I love to do with energy and enthusiasm,” said Bob. 

After his procedure at UVA Health, Bob learned he was in the 20 percent category of A-fib cases in which the electrical disturbances were not around pulmonary veins. “Without CardioInsight, I likely would have come out of the procedure with A-fib remaining and the dreaded prospect of another ablation,” he said.  

Bob is grateful to Dr. Mangrum for his dedication to state-of-the-art patient care and to UVA Health’s Heart and Vascular Center for investing in lifesaving technology. Through both annual giving and his estate plans, Bob now supports research on heart arrhythmias at UVA Health.  

“We have to keep working to win the battle over A-fib for patients,” said Dr. Mangrum. “Support like Bob’s is a crucial part of maintaining momentum and making this possible. I’m so appreciative and grateful,” he said.