Hospital Services
Cardiac Electrophysiology Procedures
(Diagnose and/or Treatment of Heart Rhythm Disorders)
The Electrophysiologists ('EP's) of Associated Cardiologists
provide 24-hour expert arrhythmia consultative care in all area
hospitals. Dr. David Scher, Dr. David Man, and Dr. Safwat Gassis
all implant permanent pacemakers, defibrillators, and heart failure
devices (biventricular defibrillators). They perform catheter ablation
for control and cure of arrhythmias. Dr. Man is the areas most experienced
'EP' performing curative catheter ablation of atrial fibrillation.
The EP physicians also assist in the arrhythmia care of patients
of other referring cardiology groups in central Pennsylvania. The
EP division of Associated Cardiologists, P.C. has been involved
in landmark arrhythmia and device (pacemaker and defibrillator)
research since 1991.
Electrical Cardioversion
An electrical cardioversion procedure used to convert an irregular
heart rhythm to a normal heart rhythm by applying high-energy shock.
Your doctor uses cardioversion to convert an irregular or fast heart
rhythm back to a normal rhythm. Common rhythms that require cardioversion
include atrial fibrillation and atrial flutter. Your blood needs
to be adequately monitored prior to a cardioversion to make sure
it is properly thinned, in order to avoid a stroke during or after
the procedure. It is an outpatient procedure using intravenous short
acting anesthesia. The patient generally does not feel or remember
anything about the procedure which takes just an instant to perform.
Electrophysiology (EP) Study
Normally, electricity flows throughout the heart in a regular, measured
pattern. This electrical system brings about heart muscle contractions.
A problem anywhere along the electrical pathway causes an arrhythmia,
or heart rhythm disturbance. By accurately diagnosing the precise
cause of an arrhythmia, it is possible to select the best possible
treatment.
Why an EP study?
While electrocardiograms (ECGs) are important tests of the heart's
electrical system, they are brief tests that record only the events
that occur while the tests are running. Arrhythmias, by their very
nature, are unpredictable and intermittent, which makes it unlikely
that an ECG or electrocardiogram will capture the underlying electrical
pathway problem. Even tests that stretch over longer time lengths,
such as Holter monitoring, may not capture an event.
During an EP study, a specially trained cardiac specialist
may provoke arrhythmia events and collect data about the flow of
electricity during actual events. As a result, EP studies can help
locate the specific areas of heart tissue that give rise to the
abnormal electrical impulses that cause arrhythmias. This detailed
electrical flow information provides valuable diagnostic and, therefore,
treatment information.
EP studies most often are recommended for patients
with symptoms indicative of heart rhythm disorders or for people
who may be at risk for Sudden Cardiac Death.
The Value of an EP study
An electrophysiologic, or EP, study provides information that is
key to diagnosing and treating arrhythmias. Although it is more
invasive than an electrocardiogram (ECG) or echocardiogram, and
involves provoking arrhythmias, the test produces data that makes
it possible to:
- Diagnose the source of arrhythmia symptoms
- Evaluate the effectiveness of certain medications or procedures
in controlling the heart rhythm disorder
- Predict the risk of a future cardiac event, such as Sudden Cardiac
Death
- Assess the need for an implantable device (a pacemaker or ICD)
or treatment procedure (radio frequency catheter ablation)
An overview of the procedure
While ECGs are non-invasive, an EP study is somewhat invasive. The
study is performed after giving local anesthesia and conscious sedation
(twilight sleep) to keep the patient as comfortable as possible.
The procedure involves inserting a catheter - a narrow, flexible
tube - attached to electricity monitoring electrodes, into a blood
vessel, often through a site in the groin or neck, and winding the
catheter wire up into the heart. The journey from entry point to
heart muscle is navigated by images created by a fluoroscope, an
x-ray-like machine that provides continuous, "live" images of the
catheter and heart muscle. Once the catheter reaches the heart,
electrodes at its tip gather data and a variety of electrical measurements
are made. These data pinpoint the location of the faulty electrical
site. During this "electrical mapping," the cardiac arrhythmia specialist,
an electrophysiologist, may instigate, through pacing (the use of
tiny electrical impulses), some of the very arrhythmias that are
the crux of the problem. The events are safe, given the range of
experts and resources close at hand and are necessary to ensure
the precise location of the problematic tissue.
Once the damaged site or sites are confirmed, the specialist may
administer different medications or electrical impulses to determine
their ability to halt the arrhythmia and restore normal heart rhythm.
Based on this data, as well as information garnered before the study,
sometimes the specialist will proceed to place an implantable cardioverter
device (ICD) or a pacemaker or will perform radiofrequency ablation.
In any case, the information proves useful for diagnosis and treatment.
Throughout the procedure, the patient is sedated but awake and
remains still. Patients rarely report pain, more often describing
what they feel as discomfort. Some watch the procedure on monitors
and occasionally ask questions. Others sleep. The procedure usually
takes about two hours. The patient remains still for four to six
hours afterward to ensure the entry point incision begins to heal
properly. Once mobile again, patients may feel stiff and achy from
lying still for hours.
The Importance of the flow of electricity
Each heart has it own normal rhythm brought about by the seamless
flow of electrical impulses throughout the organ. This electrical
flow begins in the heart's natural "pacemaker" (also know as the
sinoatrial node or sinus node) in the upper right heart chamber,
the right atrium. The electricity flows through the upper chambers
(atria), crosses the bridge between upper and lower chambers (atrioventricular
node) and travels to the lower chambers (ventricles.) The passage
of electricity culminates in a carefully coordinated contraction
of heart muscle that pushes blood through the human body. Problems
in the precise flow of electricity are the cause of arrhythmias.
Who performs the test and where
Since potentially dangerous arrhythmias are provoked during an EP
study, it is crucial that specialized staff are present to handle
all situations. A physician electrophysiologist, with advanced training
in the diagnosis and treatment of heart rhythm problems, performs
the EP study. The electrophysiologist leads a team of specially
trained health care professionals, technicians and nurses, who assist
during the procedure. The team performs the EP study in an electrophysiology
laboratory, or EP lab, a well-equipped, controlled clinical environment
usually located within a hospital or clinic. As a result, the test
is quite safe and complications are rare.
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