An abnormal heart rate or rhythm is called an arrhythmia and electrophysiology is the evaluation and treatment of heart rhythm problems and the accompanying complications. At LeBauer HeartCare, our electrophysiology specialists provide diagnosis, treatment and monitoring of potentially dangerous heart arrhythmias.
Arrhythmia Monitoring Physicians use arrhythmia monitoring to identify the cause, location and best treatment of irregular heart rhythms. An example of this is electrocardiographic (ECG) testing. Using ECG, physicians assess the heart's electrical activity under different circumstances using resting ECG, ECG stress test, and ambulatory ECG.
Electrophysiology (EP) Testing Physicians also use EP testing to diagnose arrhythmias. EP testing examines the electrical function of the heart from inside the heart itself using catheters. During the test, the patient’s abnormal heart rhythm is reproduced and different medications may be administered to determined which one might best control the condition. Sometimes an EP study is conducted before implantable cardioverter/defibrillator (ICD) placement to determine which device is best, and used afterwards to monitor treatment success.
Implantable Devices The two types of implantable, life-saving devices used to regulate heart rhythm are pacemakers and implantable cardioverter-defibrillators (ICD). They can be used as separate devices but are available in combination for patients who need both.
Pacemakers are cardiac devices that stimulate heart contraction and maintain a suitable heart rate. They are used for patients who have slow or absent heartbeats and consist of a battery-powered pulse generator, implanted under the skin or muscle, and electrical leads that connect to the atria and/or ventricles of the heart. The pacemaker continuously monitors the heartbeat and, when necessary, delivers tiny, imperceptible electrical signals to stimulate the heart rhythm.
An Implantable Cardioverter-Defibrillator (ICD) is similar to a pacemaker, using a pulse generator and leads, and is for patients who suffer from abnormally fast heart rates. When the ICD detects a heart rate that exceeds the programmed threshold, it shocks the heart to restore a normal rhythm. Some devices can also perform electrophysiological testing, and record and store data of the electrical activity of the heart that doctors can later download and evaluate for arrhythmias.
Cardiac Resynchronization Therapy (CRT) This therapy builds on the technology used in pacemakers and implantable cardioverter devices to improve coordination of the heart’s contractions. Cardiac resynchronization uses electric leads to correct an arrhythmia commonly diagnosed in patients experiencing heart failure. The leads electrically stimulate heart muscle to synchronize the contractions of the heart’s two lower chambers. These lower chambers must beat in harmony in order to create enough force to push blood through the body.
In addition to the two leads (right atrium and right ventricle) used by a common pacemaker, the CRT device has a third lead that is positioned in a vein on the surface of the left ventricle. This allows the CRT device to simultaneously stimulate the left and right ventricles and restore a synchronized pattern. This is sometimes referred to as bi-ventricular pacing because both ventricles are electrically stimulated (paced) at the same time. This results in a more coordinated and effective heart beat.
Radio Frequency Catheter Ablation (RFCA) Radio frequency catheter ablation is a medical treatment that uses electrical energy to destroy - or ablate - tissues in the heart that are causing rhythm disturbances. The procedure often uses three to five catheters simultaneously in order to trigger and map electrical disturbances in the heart. The physician locates which tissues in the heart are responsible for the rhythm problem by deliberately triggering an electrical disturbance, and then analyzing the recordings of it. A special ablation catheter is then maneuvered so that an electrode at its tip is in contact with the abnormal tissue. Radio frequency energy is turned on and the abnormal heart tissue is eliminated (ablated) by heat in excess of 50°C.
After ablation of tissue, testing is again performed to see if the catheter can trigger the problematic electrical disturbance. If so, the process of mapping continues in order to locate further abnormal tissue, which is then ablated. This mapping and ablation continues until the electrical disturbance can no longer be triggered by the catheters.
