Cardiac Electrophysiology, or EP, is a specialty within cardiology that focuses on the diagnosis and treatment of heart rhythm disorders, or arrhythmias.
Common arrhythmias include supraventricular tachycardia (SVT), atrial fibrillation (AFib), atrial flutter, PVCs, and slow heart rhythms. Usually, arrhythmias arise spontaneously, and may not have any connection to family history or other medical conditions. However, risk of developing some abnormal rhythms can be increased by other factors such as hypertension, diabetes, heart failure or coronary artery disease, obesity, and sleep apnea.
Evaluation of Arrhythmias
Symptoms of arrhythmias are wide and may vary greatly between individuals. The most common symptoms include palpitations (thumping sensation in the chest), shortness of breath, decreased functional ability, fatigue, chest pain, syncope (passing out), and lightheadedness.
When an arrhythmia is suspected, it needs to be conclusively diagnosed. In addition to a thorough history and physical, a 12-lead ECG can be done in many offices or the hospital and provides a snapshot of the heart rhythm at that time. If symptoms are episodic, then longer-term monitoring may be required with ambulatory monitoring from 24-hours to 30-days or more, depending on frequency.
Once the arrhythmia is diagnosed, then treatment can be determined. Options include observation, medication therapy, or interventional procedures, such as ablations, pacemakers, and defibrillator implantation.
Medical therapy depends on the rhythm being managed. Anti-arrhythmic medications are those that are designed to try to suppress certain fast rhythms. Selection of a specific drug depends on patient factors and the rhythm being treated.
For AFib and atrial flutter, medical therapy will also include potential use of an anticoagulant (blood thinner), as these rhythms are associated with a risk of clot formation and stroke. Examples of blood thinners include Coumadin (warfarin), Pradaxa (dabigatran), Xarelto (rivaroxaban), and Eliquis (apixaban). In cases where stroke risk is very low, use of low-dose aspirin may be appropriate instead.
An ablation procedure is an invasive procedure wherein small catheters are inserted into the veins in the legs and passed up to the heart. With these catheters, electrical stimulation can be performed to induce the arrhythmia, so that the abnormal tissue causing the rhythm can be found and treated.
The ablation catheter can then eliminate the tissue with radiofrequency energy, and for some arrhythmias can be curative.
Ablation is also a means for treating AFib, which is the most common heart rhythm disorder in adults. Success rates for AFib ablation depend on how long the patient has had AFib, patient age and other medical diagnoses.
Pacemakers are implantable devices which manage slow heart rhythms. Implant involves leads that go from the vein under the collar bone to the heart and are connected to the generator.
Defibrillators (ICDs) are also implantable devices, which do everything a pacemaker can do, but provides an ability to shock the heart if a potentially fatal heart rhythm occurs.
Loop recorders are small devices that are implanted just under the skin, and provide 3 years of heart rhythm monitoring, but cannot pace or shock the heart.
All devices are followed and checked by the device clinic, and can transmit data from home.
EP AT CVAOC
Evaluation and diagnosis, as well as treatment of heart rhythm abnormalities, can all be performed at Cardiovascular Associates. The EP service, under the direction of Adam Goldberg, MD, can provide evaluation and various treatment options that consider the patient’s specific condition, other medical concerns, and personal preferences.