Cardiology Associates Arrhythmia Center is committed to providing access to a complete spectrum of cardiac rhythm care to the residents of the Gulf Coast region. Our board certified and fellowship trained Cardiac Electrophysiology Physicians at Cardiology Associates Arrhythmia Center provide comprehensive evaluations and treatments for all arrhythmias and other heart circuitry complications.
The Cardiology Associates Arrhythmia Center provides arrhythmia patients the opportunity to remain close to home for their treatment and follow-up care. With over 50 combined years of training and experience, each specialty trained cardiac electrophysiology physician provides state-of-the-art treatment for arrhythmia conditions using a comprehensive approach to cardiac electrophysiological care that is unmatched in the area. They offer cutting edge treatment for complex arrhythmias and other cardiac circuitry complications using advanced medical therapies and 3-D computerized mapping techniques, all rhythm devices and fully equipped facilities.
What is Cardiac Electrophysiology?
Electrophysiology (EP) is a specialty focusing on the heart’s timing or electrical system and in the diagnosis and treatment of irregular heartbeats or arrhythmias.
The sub-specialty trained, board certified cardiologists at the Arrhythmia Center have completed an additional one to two year fellowship training program in clinical cardiac electrophysiology. This is in addition to their fellowship training in cardiology.
When to see a Cardiac Electrophysiologist?
Patients with simple palpitations to complex arrhythmias are referred to the Arrhythmia Center by their primary care provider or cardiologist for consultation regarding their rhythm condition. These could be newly diagnosed patients with Atrial Fibrillation (AFIB) or one that may need additional treatment options to manage their arrhythmia.
Patients may schedule an appointment with one of our electrophysiologists, however, please note that some insurance companies may require that the initial consultation have a referral from your primary care physician.
HEART RHYTHM CONDITIONS
Atrial Fibrillation (AFIB)
The most common form of arrhythmia occurs when the electrical signal that causes the atria to contract in an organized way becomes irregular and disorganized. AFIB can occur from time to time (paroxysmal) or it can be a permanent or persistent condition. It can be a factor for a stroke especially for patients who are over 65, have been diagnosed with high blood pressure, congestive heart failure, diabetes, or peripheral vascular disease.
- High Blood Pressure
- Coronary Artery Disease
- Sleep Apnea
- Congestive Heart Failure
- Peripheral Vascular disease
- Post Cardiac surgery
- Weakened Heart Muscle – low ejection fraction
- Heart Valve Disease – even if corrected
- Excessive alcohol or caffeine
May differ in each patient but may feel like a sudden flutter of the heart, heart beat becomes irregular and more rapid than normal.
- Shortness of Breath – especially during exertion
- Weakness and difficulty exercising
- Chest Pain
May have no apparent cause or could be linked to other medical conditions such as:
- Coronary Artery Disease
- Sleep Apnea
- Structural Defects of the Heart or Valves
- Lung Disease
- Thyroid Disease
- Inflammation of the Heart
Atrial Tachycardia (AT)
Atrial Tachycardia is a sustained, regular heart rhythm that occurs in the upper chamber of the heart and causes it to beat too rapidly.
Atrial Flutter (AFL)
Atrial flutter is similar to AT, characterized by a rapid heartbeat. Instead of rapid disorganized signals in the atria, however, AFL is caused by an electrical circuit that circulates rapidly in the right atrium about 300-400 cycles a minute, leading to a very fast, steady heartbeat.
Supraventricular Tachycardia (SVT)
This term describes several other types of fast heart rhythms that are not typically dangerous, but can cause symptoms of palpitations, fatigue, or shortness of breath. They typically start suddenly and stop suddenly, and may last for minutes or hours, with a rapid but steady pulse during the episode. The fast rhythm is usually caused by either an irritable spot that fires rapidly called atrial tachycardia, or by an electrical “reentry circuit” that involves an electrical connection between the top and bottom chambers of the heart (atrioventricular node reentry, AVNRT, or atrioventricular reentry with an accessory pathway, AVRT). Treatment options include medications or a catheter ablation procedure.
Ventricular Tachycardia (VT)
Typically seen after a patient has undergone coronary artery bypass surgery (CABG) or has had a coronary interventional procedure, VT is characterized by a very fast heart rate and can be life threatening. Occasionally, if can occur in people who have not had heart complications. If it does not stop on its own, VT usually requires prompt treatment with either medication or an electrical impulse to the heart (electrical cardioversion). Further treatment of VT may involve anti-arrhythmic medications or a catheter ablation procedure. Often, people with VT and heart disease are protected by implantation of a defibrillator (ICD). Because VT may lead to ventricular fibrillation, it is considered a serious condition that warrants aggressive monitoring and treatment.
Ventricular Fibrillation (VF)
The most common cause of cardiac arrest is an arrhythmia called ventricular fibrillation — when rapid, erratic electrical impulses cause your ventricles to quiver uselessly instead of pumping blood. Without an effective heartbeat, your blood pressure plummets, cutting off blood supply to your vital organs. Ventricular fibrillation, poses the greatest threat of all arrhythmias, and accounts for half of all cardiac deaths. In VF, the heartbeat is rapid and chaotic, which prevents the lower heart chambers, or ventricles, from pumping blood to the brain or body. During VF, the blood pressure falls to zero, and the person falls unconscious. A prompt, life-saving shock (defibrillation) must be delivered to the heart to restore a normal rhythm. Sometimes, VF can happen during a heart attack (myocardial infarction), because the heart muscle is irritated by the sudden blockage of an artery. VF can also happen at other times, and be caused by previous heart damage or an inherited (genetic) heart condition. It is important to realize that VF is an electrical disorder of the heart (not the same thing as a “heart attack”) and may or may not be related to a problem with clogged arteries that supply the heart with blood.
VF is sudden and happens without any warning. It stops all heart functioning. The lack of blood and oxygen throughout the body, and especially to the brain, is deadly within a few minutes if not treated promptly with defibrillation. Although CPR can provide temporary benefit, the only truly effective treatment for VF is defibrillation, which relies on paddles or electrodes to "shock" the heart back to normal rhythm. Without treatment, loss of consciousness comes in seconds, and death is inevitable within minutes.
Sudden Cardiac Death (SCD) or Sudden Cardiac Arrest (SCA)
The immediate cause of SCD or SCA is usually an abnormality in your heart rhythm (arrhythmia), the result of a malfunction in your heart's electrical system, caused by VT or VF. This usually occurs in patients with a low pumping function.
Fainting, or feeling as if one might faint, can be caused by multiple conditions, ranging from mild to serious heart rhythm disorders, so it needs to be evaluated carefully. Sometimes the cause is not heart-related but still can be dangerous. Certain arrhythmias can cause a drop in blood pressure and lead to syncope, including medications or certain nerve reflexes to the heart and blood vessels. No matter what the cause, fainting can be dangerous and should be evaluated by a cardiac specialist.
Sinus tachycardia is a normal increase in heart rate that happens with fever, excitement and exercise. It does require treatment aside from treating the underlying problem, such as anemia, infection, or hyperthyroidism. At times, the sinus node can cause the heart to beat faster than it should without any underlying cause. If symptoms result, the condition is known as “inappropriate sinus tachycardia,” and some treatment options are available.
Specialized Treatments and Procedures for patients with Arrhythmias
Most arrhythmias are treated with a high percentage of 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.
Diagnostic 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 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) – 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, evaluate the effectiveness of medications that may be in use to control the heart rhythm disorder, and 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 heart’s electrical activity. These are typically worn for a period of 24 to 48 hours
Device Clinic and Transtelephonic Monitoring – Used to record heart rate and rhythms for brief periods, which are sent to a recorder by telephone.
Medical Therapy - Certain rhythm disorders are treated with antiarrhythmic medications only prescribed by a licensed electrophysiologist. Inpatient monitoring during the initiation of these medications is used for rhythm management and antithrombotic therapy.
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 on the patient’s chest under the skin.
Permanent Pacemaker – Small electronic device that “paces” the heart when it is beating too slow (bradycardia). The pacemaker is implanted in the chest just under the skin and has insulated leads which are placed inside one of the heart's chambers. The electrode on the end of a lead touches the heart wall and when an irregularity is detected, the lead delivers electrical impulses to the heart. A pacemaker can take over for the sinoatrial node, or the heart’s natural pacemaker, 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 that is placed on the chest under the skin. 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 SCD. ICDs continuously monitor the heart rhythm, functioning as pacemakers for heart rates that are too slow, and deliver life-saving shocks if a dangerous heart rhythm is detected.
Devices for Heart Failure – There are multiple devices available to patients with low ejection fraction or low pumping 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 pumping function of the weakened heart.
Radiofrequency Ablations with 3-D mapping
Ablation – is blocking or scarring the abnormal electrical circuits or 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 nerve cells in a very small area to die, which blocks the area of circuit and stopping the area from conducting the extra impulses that causes the heart to beat too rapidly. Candidates for ablations now include atrial fibrillation where drug therapy is ineffective or not tolerated.
Pulmonary Vein Isolation Procedure – Atrial circuits in the left atrium or pulmonary veins are ablated for a potential cure of Afib. This procedure is appropriate for patients who have paroxysmal or persistent AF that fail medical treatments, have had complications or cannot tolerate antiarrhythmic medications.
AV Node Ablation - This ablation procedure improves symptoms when the cause of atrial fibrillation (Afib) cannot be corrected. The ablation procedure will block the AV node, which is the area in the heart where the atrial and ventricular electrical systems, so the atria can no longer send signals to the ventricles. Following an AV Node Ablation, a permanent pacemaker will be implanted to stimulate the ventricles to beat. This will help improve the symptoms of Afib and also allow any medications to be stopped.
Cardioversion – Refers to the process of restoring the heart's normal rhythm from an abnormal rhythm. Most elective cardioversions are performed to treat Afib, a heart rhythm disturbance originating in the upper chambers (atria) of the heart. This is an outpatient study done with conscious sedation. During a cardioversion, a direct current is used to momentarily depolarize most cardiac cells allowing the sinus node to resume normal pacemaker activity.
The Arrhythmia cENTER Team
D. Scott Kirby, MD, FACC
E. Matthew Quin, MD
Robert P. Robichaux Jr., MD, MPH
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