Cardiac Electrophysiology

Symptoms

There are different symptoms associated with the various kinds of heart rhythm disorders. You may experience some of these symptoms, or none of them. Not all arrhythmias are accompanied by symptoms.

• Palpitations
• Rapid heartbeat
• Feeling that your heart skips beats
• Fainting
• Dizziness
• Lightheadedness
• Shortness of breath
• Discomfort in your chest
• Fatigue or weakness
• Cardiac Arrest

Diagnosis

To diagnose an arrhythmia, your doctor may ask about your signs and symptoms. He or she may ask about what symptoms you're having, whether you feel fluttering in your chest, and whether you feel dizzy or lightheaded.

Your doctor also may ask about other health problems you have, such as a history of heart disease, high blood pressure, diabetes, or thyroid problems. He or she may ask about your family's medical history, including:

• Does anyone in your family have a history of arrhythmias?
• Has anyone in your family ever had heart disease or high blood pressure?
• Has anyone in your family died suddenly?
• Are there other illnesses or health problems in your family?

Your doctor will likely want to know what medicines you're taking, including over-the-counter medicines and vitamin or mineral or nutritional supplements.

Your doctor may ask about your health habits, such as physical activity, smoking, or using alcohol or drugs. He or she also may want to know whether you've had episodes of strong emotional stress or anger.

Physical Exam

Your doctor will listen to the rate and rhythm of your heart and for a heart murmur (an extra or unusual sound heard during your heartbeat). He or she also will:

• Check your pulse to find out how fast your heart is beating
• Check for swelling in your legs or feet, which could be a sign of an enlarged heart or heart failure
• Look for signs of other diseases, such as thyroid disease, that could be causing the problem

Diagnostic Tests and Procedures

Electrocardiogram (ECG, EKG)

An electrocardiogram is the most common test used to diagnose arrhythmias. An EKG is a simple test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through each part of the heart.

A standard EKG only records the heartbeat for a few seconds. It won't detect arrhythmias that don't happen during the test.

To diagnose arrhythmias that come and go, your doctor may have you wear a portable EKG monitor. The two most common types of portable EKGs are Holter and event monitors.

Electrophysiology study (EPS)

An electrophysiology study is used to assess serious arrhythmias. During an EPS, a thin, flexible wire is passed through an artery in your groin (upper thigh) or arm to your heart. The wire records the heart's electrical signals.

Your doctor uses the wire to electrically stimulate your heart and trigger an arrhythmia. This allows the doctor to see whether an anti-arrhythmia medicine can stop the problem.

Treatment

Medication

A treatment for rhythm disorders is anti-arrhythmic drug therapy. For many patients, medications may be all that is required to control a heart rhythm disorder. These medications can slow the conduction of the rapid heart rhythms and/or convert them to a normal sinus rhythm. Medications, however, do not cure heart rhythm disorders, and they are not effective in all patients.

Cardioversion

Cardioversion is a brief procedure where an electrical shock is delivered to the heart to convert an abnormal heart rhythm back to a normal rhythm. Most elective or "non-emergency" cardioversions are performed to treat atrial fibrillation or atrial flutter, benign heart rhythm disturbances originating in the upper chambers (atria) of the heart. Cardioversion is used in emergency situations to correct a rapid abnormal rhythm associated with faintness, low blood pressure, chest pain, difficulty breathing, or loss of consciousness.

Ablation

In an ablation, a thin catheter is threaded through a blood vessel in the thigh and up to the heart. Abnormal electrical activity in the heart is blocked, or “ablated” with high-frequency electrical energy. After ablation, many patients never experience arrhythmia symptoms again.

Ablations can be done for the following arrythmias:

• Atrial fibrillation
• Atrial flutter
• Atrial tachycardia
• PSVT
• Wolff-Parkinson-White syndrome

Implantable Cardiac Defibrillators (ICD)

Certain heart rhythm disorders put patients at risk of their hearts suddenly stopping. An implantable defibrillator can reset the heart’s rhythm should this happen.

Pacemakers

Some people have heartbeat that is too slow (Bradycardia). A pacemaker may be used to help your heart maintain a normal heart rate. A pacemaker is a small, battery-operated device that senses when your heart is beating irregularly or too slowly. It sends a signal to your heart that makes your heart beat at the correct pace.

Cardiac Resynchronization

Some people who have heart failure may need a CRT-D device. This device combines a type of pacemaker called a cardiac resynchronization therapy (CRT) device with a defibrillator. CRT-D devices help both ventricles work together. This allows them to do a better job of pumping blood out of the heart.