Heart electrical systems evaluated

Lakewood cardiology specialist Dr. Layth Saleh categorizes what cardiologists do into two primary systems, that of the mechanical and electrical systems of the heart.

“The heart is a pump, which obviously has mechanical and electrical and plumbing considerations,” Dr. Saleh said. “We have electrophysiologists to … diagnose and treat issues with the heart’s electrical system. A type of cardiologist, electrophysiologists can do testing to identify causes of heart issues.”

Dr. Saleh, board-certified in clinical electrophysiology, is a clinic cardiac electrophysiologist for Colorado Heart & Vascular in Westminster and Golden, which contracts with CommonSpirit Health to provide cardiac services at Longmont United Hospital, a full-service acute care hospital that includes emergency transfer services. He also contracts with different medical groups and hospitals that provide services for St. Anthony’s Hospital and St. Anthony North Hospital, operated by Centura Health.

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Dr. Saleh focuses on cardiac electrical system procedures and cardiac implantable device procedures. 

“In general, we categorize what we do into general cardiac care and heart failure,” Dr. Saleh said. “Like a pump, if it breaks, how do we fix it? We are making sure the mechanical properties are in working order, like the valve and the muscle of the heart.”

With alterations in the heart’s blood supply, oxygen and glucose levels, a cardiologist needs to intervene to provide the necessary care, essentially serving as the heart’s plumbers, Dr. Saleh said. Tasked with treating diseases of the heart and blood vessels, or the cardiovascular system, they make sure the arteries are open and nothing is reducing the blood flow to and from the heart, he said.

The common conditions cardiologists treat include genetic heart defects, heart rhythm disorders, heart failure and coronary artery disease, which is the narrowing of blood vessels from the buildup of plaque and cholesterol.

“Longmont United is now considered one of the primary interventions. If someone has a heart attack in a remote area, they may not have access to a specialist or the lab staff, so they are sent here,” Dr. Saleh said.

Longmont United has an acute Cardiac Cath Lab able to provide diagnostic and interventional cardiac, peripheral catheterizations and permanent pacemaker and internal cardiac defibrillator implants, among other services. The cardiologists on staff work to avoid using thrombolytics for better outcomes, which are clot-busting drugs that break up and dissolve blood clots getting in the way of blood flow following a heart attack. 

“They are enzymes that kick up the process of breaking down proteins or fibrins that form clots,” Dr. Saleh said. “Thrombolytics, or clot busters, dissolve the clots so the blood supply to the heart is reestablished and the muscle damage is minimized; once the heart’s damaged, it doesn’t regenerate.”

Thrombolytics are a strong and aggressive blood thinner and increase systemic bleeding, even in the setting of a heart attack, Dr. Saleh said.

“We don’t typically love to do it if we have the ability of a heart cath lab, which has existed in Longmont for a long time,” Dr. Saleh said. “On its own, it’s a good thing. Patients get appropriate care for the size of the hospital and the town. The latest innovations and most exciting new things happen in bigger hospitals typically.”

Dr. Saleh specializes in the treatment of cardiac arrhythmias, including atrial and ventricular arrhythmias, and in-device implantations that include pacemakers, defibrillators and cardiac resynchronization devices. His specialty interest is in state-of-the-art care of atrial fibrillation with catheter ablation, a form of treatment for an irregular and chaotic heartbeat called A-fib, or atrial fibrillation. Atrial fibrillation ablation uses heat or cold energy that creates tiny scars in the heart to block the faulty electrical signals and restore the heart to its normal rhythm.

“We take care of irregular heartbeats; if the rate and form of the rhythm is not normal, we take care of that,” Dr. Saleh said.

With arrhythmia, the heart essentially is short-circuiting, and Dr. Saleh uses whatever invention is available to return the heart’s rhythm to a normal heartbeat. He focuses on the quality and quantity of the heartbeat and makes sure it’s in the right form. 

“Obviously the technology is exploding,” Dr. Saleh said. “It’s always been an evolving area. The technology has been revolutionizing in the past 15 years or so.”

Dr. Saleh aims to improve outcomes and, more importantly, reduce any complications with cardiac treatment.

“We always want to improve efficiency … so there’s no redundancy with time, resources or equipment,” Dr. Saleh said. “The more safe the procedures or techniques, ideally we will have better outcomes.”

For example with a pacemaker, physicians need to make sure it’s not harming the patient, while also educating them about the risks and benefits of implantation.

“We always want to reduce the risk of complications and increase the positive benefits,” Dr. Saleh said. “We have to be fiscally responsible in general … so we don’t over test when it’s not needed.” 

Dr. Saleh earned his medical degree at the University of Jordan-School of Medicine in 2005 and conducted his internal medicine residency at the University of Arizona. He then completed his fellowship in cardiovascular disease at the Sarver Heart Center-University of Arizona and his subspecialty fellowship in clinical cardiac electrophysiology at New York-Presbyterian/Weill Cornell Medical Center. He joined Colorado Heart & Vascular in 2018.

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