If you are scheduled for an electrophysiology procedure, your doctor will provide you with detailed information on what to expect. The brief descriptions below are only meant to provide an overview of the procedures we perform.
Certain types of rapid or irregular heartbeats, known as tachycardias or arrhythmias, are caused by abnormal electrical pathways in the heart that disrupt the cardiac electrical signal. An ablation procedure is a treatment using specialized catheters placed inside the heart, which delivers energy to destroy the abnormal pathways, restoring the normal heart rhythm.
Cardioversion is a way to restore the heart’s normal rhythm. Arrhythmias are problems with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. Medications are usually the first treatment used to correct arrhythmia. If medications don’t work, cardioversion may be the next step. During this procedure, patients are, after being moderately sedated for comfort, given a small, brief electric shock that can jolt the heart into a normal rhythm.
Pulmonary vein isolation is a newer, very effective option used to treat atrial fibrillation and may be most appropriate for patients who have continued symptoms of atrial fibrillation, despite treatment with medications, or who cannot tolerate anti-arrhythmic drugs.
During pulmonary vein isolation, a doctor inserts specialized catheters (long, flexible tubes) into the heart. Energy is delivered through the tip of this catheter to tissue that is targeted for ablation. At the points where this energy is delivered, small circular scars eventually form and prevent the abnormal signals that cause the atrial fibrillation from reaching the heart. PVI is more effective, faster, and offers dramatically fewer complications than other forms of ablation. This procedure is only available in a handful of hospitals.
A pacemaker is a small, lightweight electronic device that’s implanted in the body to keep the heart from beating too slowly (bradycardia). The pacemaker keeps track of your heartbeat and, when necessary, generates electrical signals that keep your heart beating at the right pace. Newer pacemakers can monitor your blood temperature, breathing rate, and other factors. They also can adjust your heart rate to changes in your activity. There are several different types of pacemakers:
- Single-chamber and dual–chamber pacemakers monitor and prompt either one or two chambers of the heart (generally the right atrium and right ventricle) to beat via leads that are placed in the heart chamber(s) and attached to the generator box of the pacemaker.
- Rate-adaptive pacemakers can be single- or dual-chambered, and change the rate of the heartbeat in cases where the heart rate does not speed up with physical activity.
Cardiac Resynchronization Therapy (CRT) and Biventricular Pacemakers
In the normal heart, the heart's lower chambers (ventricles) pump at the same time. This coordinated rhythm produces blood to the body in the optimal synchronized way. In a weakened heart, there may be a delay between the contraction of the two sides. When this happens, the walls of the left ventricle are unable to contract at the same time as the right ventricle, leading to worsened heart failure symptoms, such as shortness of breath, cough, swelling in the ankles or legs, weight gain, fatigue, or rapid or irregular heart beat.
Cardiac resynchronization therapy utilizes a device called a biventricular pacemaker. Biventricular pacemakers have leads in both the right and the left ventricle, allowing the pacemaker to literally resynchronize the action of the two chambers. This often results in notably improved cardiac function and symptoms.
Doctors also treat tachycardia (fast) rhythms, some of which are lethal, with an implantable cardiac defibrillator (ICD). An ICD is similar to a pacemaker. However, besides using low-energy electrical pulses, an ICD also can use high-energy pulses to treat life-threatening arrhythmias and abort episodes of cardiac arrest
CRT and ICD Therapies in Combination
Some patients with heart failure may benefit from a combination CRT and ICD device. This device combines biventricular pacing with anti-tachycardia pacing and internal defibrillators to deliver treatment as needed.
CRT/ICD combination devices obtain the following results:
- Resynchronizing the heartbeat
- Slowing down an abnormal fast heart rhythm
- Preventing abnormally slow heart rhythms
- Recording a history of the patient’s heart rate and rhythm