For Patients
Procedures
Electrophysiology is based on minimally invasive (non-surgical) processes that provide relief for people with serious heart problems. Our practice has a great deal of experience and success with procedures such as:
Permanent Pacemaker implants
Pacemakers are small electronic devices designed to be placed inside your body to generate electrical signals that are like the natural ones in your heart to re-set and keep your heart beating in the right rhythm and at the right speed. They are usually called for when the heart is beating too slowly and can’t be corrected with medication.
Normally, our heart’s electrical system creates a regular pace that keeps your blood and oxygen flowing at the right rate. But, if your heart slows down or develops an uneven rhythm, you may feel faint, dizzy, lightheaded, short-of-breath or run-down. If that situation continues – you may need a permanent pacemaker implant to keep your heart beating at just the right speed..
A pacemaker has three parts:
- A generator that is contained inside a small, smooth case. The generator consists of a miniature computer with a battery. The generator creates signals that help the heart to beat at the correct speed.
- The connector is simply that – the place a lead or leads are attached
- The leads, one or two thin flexible plastic-covered wires that provide communication to and from the heart.
There are two types of pacemakers.
A pacemaker with one lead is called a single-chamber pacemaker. A pacemaker with two leads is called a dual-chamber pacemaker. The leads can end in the right atrium and/or right ventricle, depending on where the signal problem is in your heart and how many leads are used.
Implanting the Pacemaker
This is NOT done with open-heart surgery. It’s actually considered a minor procedure, but is done either in the operating room or in a cardiac catheterization facility.
The procedure is done with a local anesthetic to numb the insertion area. A very small incision will be made in your skin below your collarbone and a lead is threaded through the incision into a vein in your upper chest. Using a simple but very accurate process, the lead is then guided into your heart’s chambers.
Electrical measurements are taken to determine a good position for the lead in the heart. If there is a second lead, the process is repeated. When the lead or leads are correctly positioned, the generator is attached to the lead(s) and is placed under the skin and the pacemaker’s settings are programmed to help your heart beat at the proper setting.
The whole procedure usually takes no more than last two to three hours.
Implantable Cardioverter Defibrillator implant
A Cardioverter defibrillator is used when there is a possibility of damage or death due to cardiac arrest. The device delivers an electrical impulse to the heart if a life-threatening rhythm disturbance develops and can correct the rhythm quickly. Because it has a pacemaker built into it, a defibrillator also has the capability of stimulating the heart like a pacemaker, to help stop fast rhythms, at times, and to prevent the heart from getting too slow.
The ICD monitors the heart rhythm, identifies abnormal heart rhythms, and determines the appropriate therapy to return your heartbeat to a normal heart rhythm. Your doctor programs the ICD to include one or all of the following functions:
- Anti-tachycardia Pacing (ATP) – When the heart beats too fast, a series of small electrical impulses are delivered to the heart muscle to restore a normal heart rate and rhythm.
- Cardioversion – A low energy shock is delivered at the same time as your heartbeat to restore a normal heart rhythm.
- Defibrillation – When the heart is beating dangerously fast, a high-energy shock is delivered to the heart muscle to restore a normal rhythm.
- Bradycardia pacing – When the heart beats too slow, small electrical impulses are sent to stimulate the heart muscle to maintain a suitable heart rate.
Why you need an ICD
ICD’s are used for:
- people who have had an episode of sudden cardiac death or ventricular fibrillation
- people who have had a heart attack and are at high risk for sudden cardiac death
- people who have hypertrophic cardiomyopathy and are at high risk
- people with at least one episode of ventricular tachycardia
Bi-Ventricular Cardioverter Defibrillator implant
This type of ICD is most often used to re-synchronize the heart beat after very serious heart issues and when medication is still used. This is used to treat patients with heart failure. Medication will still be required.
Radiofrequency Catheter Ablation - atrial and ventricular arrhythmias
Although the heart is usually very efficient, even when somewhat less than perfect, sometime the electrical flow that creates normal rhythm gets disturbed by a “short circuit.”
Medicine often helps, but may not be totally effective or may have serious side effects. The best treatment to get rid of the short circuit may be to have a non-surgical electrophysiological procedure (involving using a catheter with an electric lead.)
The catheter is guided to the heart, then the electrophysiologist can get readings which pinpoint the location of the short circuit. Once the site is confirmed, an electrical impulse is used to deactivate (ablate) a small amount of tissue, ending the disturbance of electrical flow through the heart and restoring a healthy heart rhythm.
Most often, cardiac ablation is used to treat rapid heartbeats that begin in the upper chambers, or atria, of the heart. These issues are known as supra-ventricular tachycardias, or SVTs, and include (among others):
- Atrial fibrillation
- Atrial flutter
Ablation may also be used to treat heart rhythm disorders that begin in the heart’s lower chambers, known as the ventricles. The most common of these disorders, ventricular tachycardia, may also be the most dangerous type of arrhythmia because it can cause sudden cardiac death.
