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Electrophysiology Procedures

Electrophysiology Study (EPS)

Your doctor may order an electrophysiology study to help diagnose and treat arrhythmias (abnormal heart beats or rhythms). Often, abnormal heart rhythms are intermittent-they can come and go. During your EPS, the electrophysiology team will attempt to provoke or induce your arrhythmia in order to diagnose its source and make the best treatment for it.

An EPS is an invasive procedure that requires inserting a catheter into a blood vessel in your groin and threading it into your heart under x-ray guidance. You will be sedated during the procedure, receiving a local anesthesia and other medications. You can expect to stay three to four hours or overnight after the procedure.

http://heartdisease.about.com/cs/arrhythmias/l/blepstudy.htm
http://www.webmd.com/heart-disease/electrophysiology-test

Pacemaker ImplantPacemaker Implant

What is a pacemaker implantation and when is it used?
A pacemaker implantation is a procedure in which the health care provider places a pacemaker in your chest. This procedure is most often done when your heart rate is too slow. As a result of the abnormal rate, your heart pumps less blood, causing symptoms such as fatigue, shortness of breath, or fainting.

What happens after the procedure?
You should plan for your care and recovery after the operation. Allow for time to rest and try to find people to help you with your day-to-day duties.

You will have an over night stay in the hospital, and you will remain in bed and your heart will be monitored. The day after the procedure you will be encouraged to walk in preparation for leaving the hospital.

Before you leave the hospital, your health care provider will check your pacemaker using a small table-top computer, called a programmer, and a wand. The wand is about the same size as a remote control. Your provider puts the wand on your body, about where the pacemaker is located. This allows your health care provider to get information from the pacemaker about what the heart is doing and how ell it is working. If needed, your health care provider can adjust the pacemaker using the programmer and the wand. It is not painful, and it usually takes just a few minutes.

Your health care provider may explain how having a pacemaker might affect your lifestyle and when the battery in the pacemaker may need to be replaced. Please ask your health care provider what other steps you should take and when you should come back for a checkup.

http://www.surgeryencyclopedia.com/Ce-Fi/Electrophysiology-Study-of-the-Heart.html

Loop Recorder Implant

A Loop Recorder is a small device that is implanted under your skin, near your breastbone. The purpose of the device is to detect abnormal heart rhythms (arrhythmias) that may be difficult to detect by other means.

Implanting a Loop Recorder takes about 1 to 20 minutes and can be done under a local anesthesia. The doctor makes a small incision (3/4 of an inch) on your chest, creating a pocket the same size and shape as the Loop Recorder device. The device is inserted in the pocket and is programmed to record your heart rate and rhythm (electrocardiogram or ECG) when you feel symptoms or during a fainting episode.

The Loop Recorder can remain in place for a period of time. Once it records an episode of arrhythmia or when your doctor can make a determination about your symptoms or fainting episodes, the device can be removed.

When is it used?
ICDs may be life-saving for people who have had some types o fast heart rhythm (arrhythmias) that can cause sudden death. They may also be used for people who are at high risk of having fast heart rhythms.

What are the risks and benefits?
There is risk with every treatment or procedure. Talk to your provider about how the risks apply to you. Once the ICD is put in, you will need regular checkups to make sure the device is working right and how much power is left in the batteries.
The most common problem with the device is that is sometimes gives shocks when you do not need them. You can feel each shock, even though it lasts only a very short time. Your provider should be notified of every shock you feel. When the batteries have run down, the device must be replaced. Replacement of the device is a short procedure, because the wires stay in place.
The ICD does not fix existing heart problems, but lowers the risk of dying from an abnormal heart rhythm. For many people, the device provides peace of mind and can help people live longer.

Defibrillators ImplantDefibrillators Implant (ICD)

What is an implantable cardioverter defibrillator (ICD)?
The implantable defibrillator is a device made to shock the heart back into a normal rhythm to prevent sudden death. The ICD system consists of:

If the heart is beating normally, the ICD does nothing. When an abnormal fast heart rate, known as ventricular tachycardia, is detected, the ICD will first try to control the heart rhythm. If this doesn’t work, or the rhythm gets worse (ventricular fibrillation) the ICD sends electric shock signals to the heart. The electric shock changes the abnormal rhythm to a normal rhythm. The device is put under the skin in the chest, with wires that connect it to the heart.

Biventricular pacemaker Implant

What is a biventricular pacemaker?
A biventricular pacemaker is a type of permanent pacemaker placed in your chest. It improves the function of the heart. The heart has four compartments, or chambers. The upper chambers are called atria, and the lower chambers are called ventricles. For biventricular pacing, one wire goes from the pacemaker to the right ventricle. Another wire goes from the pacemaker to the left ventricle. This helps the heart work more efficiently by helping the two pumping chambers of the heart work together properly. This procedure is also called cardiac resynchronization therapy.

Biventricular pacemaker is different from pacemakers that treat slow heart rates. Pacemakers that treat slow heart rates have a wire that leads only to the lower right side of the heart 9right ventricle). These pacemakers also sometimes have a wire that leads to the right atrium (upper chamber on the right side of the heart) is well.

When is it used?
Biventricular pacemakers are used to treat people with heart failure. It may help if you still have shortness of breath even though you are taking medicine for the problem and if your heart’s electrical signal is slower than it should be. This is detected with an electrocardiogram or ECG.

What happens after the procedure?
You will have an overnight stay in the hospital depending on your condition. You will remain in bed and your heart will be monitored. The day after the procedure you will be encouraged to walk in preparation for leaving the hospital.

Before you leave the hospital, your health care provider will check your pacemaker using a small table-top computer, called a programmer, and a wand. The wand is about the same size as a remote control. Your provider puts the wand on your body, about where the pacemaker is located. This allows your provider to get information from the pacemaker about what the heart is doing and how well it is working. An echocardiogram may also be done as part of the check of your pacemaker. If needed, your provider can adjust the pacemaker using the programmer and the wand. It is not painful, and it usually takes just a few minutes.

You may learn how to check the function of the pacemaker using the telephone. The function of the pacemaker can also be checked at follow-up visits with your health care provider.

Your health care provider may explain how having a pacemaker might affect your lifestyle and when the battery in the pacemaker may need to be replaced. Ask what other steps you should take and when you should come back for a checkup.

What are the benefits?
You will probably have less shortness of breath than you did before the procedure. Your heart may beat in a healthy rhythm, and you may resume a more normal lifestyle. The benefits may be greater several months after the pacemaker is placed in your chest.

AblationsAblations: (Arrhythmia)

What is an arrhythmia?
An arrhythmia is a change in the rhythm of your heartbeat. Exercise or emotions can make your heart race or skip a beat. This is usually not a cause for concern. Arrhythmias are more serious if you have other heart problems.

What is Ventricular Fibrillation?
Ventricular fibrillation (VF) is an abnormal heart rhythm that causes death. It is responsible for 75% to 85% of sudden deaths due to heart problems. Normally, heart muscle cells squeeze 9contract) in rhythm at the same time to pump blood. These groups of cells are located in the bottom two pumping chambers of the heart (ventricles). In someone with ventricular fibrillation, some heart cells contract while others are relaxing, and blood stops flowing. VF starts very suddenly. With no blood flow, brain death occurs within three to five minutes.

How does it occur?
VF can occur whenever the supply of oxygen to the heart muscle is decreased. The most common cause of ventricular fibrillation is a heart attack. Other causes include:
Narrowing of coronary arteries by atherosclerosis
Some medicines and drugs such as cocaine
Electrical shock

How is it treated?
If you see someone suddenly lose consciousness or collapse, take prompt action to help the person:

If available, use a computer-controlled device called an automatic external defibrillator (AED). AEDs allow a person without medical training to pass a quick electric shock through the chest to change the VF to a normal rhythm. AEDs are available in many public places and on some airplanes.
Continue DPR until help arrives.

When help arrives, they examine the person and medicines that stabilize heart rhythm and function, may be given through a vein as needed. Normally, the person will be taken to an emergency room and possibly stay in the intensive care unit for server days. Once the VF has been treated and normal heart rhythm restored, the doctor will look for and treat the causes of the abnormal rhythm.

By Donald L. Warkentin, MD

Artrial Fibrillation

What is atrial fibrillation?
Artial fibrillation is a heart rhythm disturbance. It causes an irregular and sometimes a very fast heartbeat.

What are the symptoms?
The most common symptoms are:

Some people may have chest pain. When atrial fibrillation affects the pumping of your heart, your blood pressure may fall and you may feel lightheaded or faint. Occasionally, the first symptom is a stroke, caused by a blood clot that formed in the fibrillating atrium and traveled to the brain. Some people have no symptoms.

How is it diagnosed?
Your health care provider will ask about your symptoms and examine you. The diagnosis can be confirmed with an electrocardiogram (ECG). This measures the electrical activity of your heart. It will show a special pattern for atrial fibrillation. Your provider will use your medical history, physical exam, and blood tests to look for a treatable cause of the abnormal heartbeat.

A helpful additional test is an echocardiogram. This test uses sound waves to make images of your heart. It is a way to check for structural problems, such as an abnormal mitral valve, which might be causing fibrillations.

How is it treated?
Initial treatment depends on the severity of your symptoms, the cause of the fibrillation and your history of heart problems or stroke.

Usually your doctor will prescribe an anticoagulant (blood thinner) medicine. Thinning the blood is very important to prevent strokes in people with arial fibrillation. If your symptoms are mild, you may be given medicine by mouth or through a vein before our doctor tries to convert the rhythm to normal. For most people, medicine can keep the heart from beating too fast.

If a medical problem is casing atrial fibrillation, treating the problem usually causes the rhythm to go back to normal. If the heartbeat does not go back to normal, you may need to take medicine for a long time to control your heart rate. Avoid using stimulants such as caffeine and alcohol.

If the medicine does not convert the heart rhythm to normal within a day or so, or if fibrillation causes severe symptoms, you may be treated with cardioversion (electrical shock).

What are the complications?
The most serious complication of atrial fibrillation is a stroke caused by a blood clot in the brain. When the flow of blood slows down in the fibrillating atrium, the blood may form a clot. Clots may then travel in the bloodstream to the brain, where they can block blood flow to a part of the brain and cause a stroke.

How do I prevent atrial fibrillation?
It can be prevented by keeping your heart as healthy as possible. Eat a healthy diet, stay fit with the right kind of exercise for you, do not smoke, and limit your use of alcohol. If you have any form of heart disease or high blood pressure, follow your health care provider’s advice closely.

Developed by McKesson Provider Technologies

Artrial Flutter (AFLutter)

What is atrial flutter?
Atrial flutter is an abnormality in the beating of the heart. Such abnormalities, whether in rhythm of heartbeat or speed of heartbeat, are known as arrhythmias. Atrial flutter may be caused by abnormalities of the heart, by diseases of the heart, or by diseases elsewhere in the body that affect the heart. Atrial flutter may also be caused by consuming substances that change the way electrical impulses are transmitted through the heart.

Atrial flutter is usually well tolerated initially (a high heart rate is for most people just a normal response to exercise), however, people with other underlying heart disease or poor exercise tolerance may rapidly develop symptoms, which can include shortness of breath, chest pains, lightheadedness or dizziness, nausea and, in some patients, nervousness and feelings of impending doom.

Prolonged fast flutter may lead to decompensation with loss of normal heart function (heart failure). This may manifest as effort intolerance (exertional breathlessness), nocturnal breathlessness, or swelling of the legs or abdomen.)

How is it treated?
In general, atrial flutter should be treated the same as atrial fibrillation. Because both rhythms can lead to the formation of thrombus in the atria, individuals with atrial flutter usually require some form of anticoagulation or anti-platelet agent. Both rhythms can be associated with dangerously fast heart rate and thus require medication for rate and or rhythm control. Additionally, there are some specific considerations particular to treatment of atrial flutter.


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