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Specialized Treatments and Procedures

arrhythmia complicationsMany arrhythmias are treated with a high percentage of a cure rates and a low percentage of complications. There are a variety of therapies available in the treatment of arrhythmias. The different therapies are dependent on the arrhythmia condition or cause. Some arrhythmias can be treated with medical therapies where others may require special monitoring to aid in diagnosis. The information presented from the monitoring will aid in the determination of treatment methods and whether an invasive procedure may be necessary.

 


 

 

Testing

EP StudyDiagnostic Electrophysiologic study (EPS) – Conducted to identify the location of your heart’s abnormal electrical pathways. Electrical wires are inserted into a catheter and guided through blood vessels in your arm or leg to your heart. , providing information that is critical to diagnosing and treating arrhythmias. While inside the chambers of the heart, the wires record abnormal impulses or heartbeats. Once the abnormality is discovered, it may be treated with radiofrequency catheter ablation.

Electrocardiogram (EKG or ECG) – it involves provoking arrhythmias and produces data that makes it possible to determine the source of arrhythmia symptoms, predict the risk of a future cardiac event, evaluated the effectiveness of medications that may be in use to control the heart rhythm disorder, assess the need for an ablation procedure or the use of an implantable device such as a ICD or pacemaker.

Holter Monitor – These are external devices that are worn by an individual who may be at risk for heart circuitry complications.  The monitor automatically records a continuous ECG or EKG of the hearts electrical activity.  These are typically worn for a period of 24 to 48 hours.

Transesophogeal Echo (TEE) – A special type of ultrasound imaging procedure. A transducer placed on the end of a tube is passed down a person's throat and into the esophagus. The esophagus is close to the heart, and images from TEE can give very clear pictures of the heart and its structures.

Device Clinic and Transtelephonic Monitoring – Used to record heart rate and rhythms for brief periods, which are sent to a recorder by telephone.

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Medical Therapy

Certain rhythm disorders are treated with antiarrhythmic medications only prescribed by a licensed electrophysiologist, and inpatient monitoring during the initian of these medications used for rhythm management, antithrombotic therapy.

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Device Implants

These devices deliver a controlled electric impulse to the heart. A defibrillator may actually “shock” the heart back from a deadly rhythm into a normal heart rhythm.  In emergency situations the devices are external however most often they are implanted in the patient’s chest.

Permanent Pacemaker – Small battery-operated devices that “pace” the heart rate when it is too slow (bradycardia). They can take over for the heart’s natural pacemaker, the sinoatrial node, which connects the top atrium to the bottom and takes over for the atrial ventricular node when it is functioning improperly. Pacemakers monitor and regulate the rhythm of the heart and transmit electrical impulses to stimulate the heart if it is beating too slowly.

Implantable Cardioverter Defibrillators (ICDs) – An ICD is a small electronic device, about the size of a deck of cards that is placed inside the body. It constantly monitors your heart rhythm. If it senses a dangerous rapid heart rhythm, it delivers pulses or shocks to the heart and restores a normal rhythm. ICDs are 99 % effective in stopping life-threatening arrhythmias and are the most successful therapy to treat ventricular fibrillation, the major cause of sudden cardiac death. ICDs continuously monitor the heart rhythm, automatically function as pacemakers for heart rates that are too slow, and deliver life-saving shocks if a dangerous fast heart rhythm is detected.

Devices for Heart Failure – There are multiple devices available to patients with low functioning hearts which can be augmented with certain pacing patterns. Electrophysiologists are able to implant into both the left and the right sides of the heart to resynchronize muscle contractions and improve the efficiency of the weakened heart.

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Radiofrequency Ablations with and without 3-D mapping

Ablation – is blocking or scarring the abnormal electrical circuits or irritable areas that are triggering the problem. This is done by threading a catheter through the blood vessels to the heart by heating or freezing the problem cells. This causes heart muscle cells in a very small area to die, which stops the area from conducting the extra impulses that causes the heart to beat too rapidly.

Candidates for ablations now include symptomatic atrial fibrillation where drug therapy is no longer effective as an alternative to drug therapy.

Pulmonary Vein Isolation Procedure – Atrial Flutter circuits in the left atrium or pulmonary veins are ablated for a potential cure of Atrial Fibrillation. This procedure is typically appropriate for patients who have chronic or paroxysmal xxx or have continued symptoms despite medical treatments or have had complications or cannot tolerate antiarrhythmic medications.

AV Node Ablation – This procedure improves symptoms when the cause of atrial fibrillation can’t be corrected. Energy is used to destroy the AV node — which is the place where the atrial and ventricular electrical systems meet — so the atria can no longer send signals to the ventricles.  A permanent pacemaker must be implanted to stimulate the ventricles to beat.  Although symptoms improve, the atrial fibrillation continues in the top chambers, so you would need long-term blood thinners.

Cardioversion – Refers to the process of restoring the heart's normal rhythm from an abnormal rhythm. Most elective cardioversions are performed to treat atrial fibrillation, a heart rhythm disturbance originating in the upper chambers (atria) of the heart. This is an outpatient study done with conscious sedation.

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