Electrophysiology Procedures

Electrophysiology Study

An EP Study is the monitoring and recording of the electrical activity the heart. This test is used to help find out the cause of your rhythm disturbance and the best treatment option for you. During the test, the doctor may safely reproduce your arrhythmia to diagnose your specific type and locate the site of origin of the abnormal heart rhythm.

In most cases, EP testing and the Radio-frequency therapy performed during the same setting can cure the arrhythmia. The procedure takes approximately two to four hours to complete.

Implantable Defibrillators

Each year more than 300,000 people die suddenly in the United States. This is termed sudden cardiac death or sudden cardiac arrest. The most common arrhythmia leading to sudden cardiac arrest (SCA) is ventricular fibrillation (VF), an arrhythmia of the heart in which the heart quivers rather than beats effectively. When this happens, the heart no longer supports circulation, the patient loses consciousness and, if the normal rhythm is not restored quickly, the patient will not survive. VF is often preceded by another abnormal, fast rhythm called ventricular tachycardia (VT). In VT the heart usually maintains some pumping function although in the majority of patients it is not enough to support circulation either. VT usually degenerates into VF if the normal rhythm is not restored quickly.

There are several types and manufacturers of ICD. Generally, they consist of an oval-shaped device generator and two or three leads. The generator contains the small computer that monitors the rhythm, detects arrhythmia and determines if treatment is needed. It also houses the battery and the device that delivers the shock through the leads. The leads are essentially wires that are attached to the ICD on one end, with the other ends positioned in different locations within the heart chambers. Implanting an ICD is generally considered a minor surgical procedure and is usually done with sedation and local anesthetic. Following the implant, the doctor will monitor you and your device regularly to maintain proper functioning.

Pacemaker Clinic

The Stead Heart and Vascular Center Pacemaker Clinic evaluates and manages the care of patients prior to and following the implantation of cardiac pacemakers and automatic internal cardioverter defibrillator systems. The frequency of a patient's evaluation is determined by the patient's needs, the age, and type of pacing device, and the cardiologist's recommendations.

A typical schedule will include both clinical visits and telephone monitoring. Telephone monitoring utilizes specifically designed transmitter units that the staff to analyze how well the pacemaker is working while the patient is at home.

During a visit to the Pacemaker Clinic patients are seen by nursing professionals who check and record pulse and blood pressure, review current medications, inquire about symptoms such as sudden dizzy spells, lightheadedness, and fatigue and check the device insertion site.

Patients will receive an electrocardiogram and, using an electronic device, the nurses will interrogate or "read" information from the device to check for function and battery life and make any adjustments needed.

By identifying problems in advance, the medical staff at the Legacy Pacemaker Clinic is able to maximize pacemaker functioning. For example, patients who receive timely evaluations may find that they can prolong pacemaker life, anticipate and plan for their replacements when appropriate, and even identify changes in heart rhythms that necessitate pacemaker reprogramming.

Pacemaker Placement

A pacemaker is a small, battery-powered device that sends out weak electrical impulses that cause the heart muscle to contract. A pacemaker can be used to replace the function of the natural pacemaker of the heart when the heart is beating too slowly. It consists of wires (leads), which transmit electricity to the heart, and the pulse generator and battery, which generate the electrical impulses. The battery in a permanent pacemaker usually lasts 5 to 15 years. Your doctor will monitor your pacemaker regularly to decide when the battery should be changed.

Pacemakers are surgically placed into the chest (a permanent pacemaker) through a small incision. There are several types of implantable pacemakers.

• A fixed-rate pacemaker gives off electrical impulses at a steady, regular rate, regardless of your level of activity. A rate-responsive pacemaker changes the rate of electrical impulses as your activity level changes.
• A single-chamber pacemaker controls only the lower chamber of the heart (ventricle).
• A dual-chamber pacemaker controls both the top (atrium) and bottom (ventricle) chambers of the heart.
• Many times the pacemaker is set to work only when the heart rate falls below a certain predetermined rate (demand mode).

The surgery needed to implant a permanent pacemaker is considered a minor surgical procedure. It can usually be done using local anesthesia, which means part of your body is numbed, but you stay awake. A small incision is made in the chest wall. The pacemaker leads are usually threaded through the incision into a large blood vessel in the upper chest and into the heart. Using the same incision, a small pocket is created under the skin to hold the pulse generator. The leads are then hooked up to the pulse generator. The entire procedure usually takes about 1 hour.

Radiofrequency Ablation

A non-surgical procedure called radiofrequency catheter ablation is utilized to cure many heart rhythm disturbances. In this procedure thin, flexible wires are inserted into a vein in the groin and threaded up through the vein and into the heart. Through an electrode at the tip of the wires, radio waves can be delivered to selectively destroy heart tissue responsible for the abnormal heart rhythm.

Radiofrequency catheter ablation can also be used when persistent chronic atrial fibrillation does not respond to treatment with medication and symptoms continue to be bothersome. It is most often used in people who have difficult-to-control heart rates. The normal conduction area is ablated which then requires a pacemaker be implanted to maintain normal heart rhythm after the ablation. Ablation followed by pacemaker implantation reduces cardiac symptoms and improves exercise tolerance, quality of life, and the amount of blood pumped with each heartbeat.

Radio-frequency ablation has also been utilized to cure certain patients with atrial fibrillation. These patients, however, are usually younger who have had the arrhythmia for a short time.

For more information on Pomona Valley Hospital Medical Center's Stead Heart & Vascular Center, please call 909.865.9858.