At the Arrhythmia Program at the Montefiore Einstein Center for Heart and Vascular Care, cardiologists and technicians understand how frightening it can be for patients to learn there is something interfering with their normal heart rhythms. There are a number of reasons patients might be referred to the Arrhythmia Program, including:
Heart-rhythm abnormalities can be caused by conditions such as:
Patients who have been referred to the laboratory at the Arrhythmia Program at the Montefiore Einstein Center for Heart and Vascular Care will be considered for a comprehensive battery of noninvasive testing, including the tilt-table and procainamide infusion tests, designed to measure the patient's reaction to stress triggers in a lab situation.
Cardiologists in the Arrhythmia Program may prescribe one of two noninvasive tests that monitor the patient's heart over a longer period:
Holter Monitor
The Holter monitor is a device that records every single heartbeat over a 24-hour period. When the patient returns to the hospital, the information is downloaded to a computer that searches the data for anomalies such as skipped beats or a flurry of rapid beats.
Loop Recorder
The loop recorder is a device that records information for 30-day testing. Patients wear it continuously, but the device erases itself every five to seven minutes. If patients feel symptoms, they push a button to preserve the data. Patients then transmit the information over the telephone.
Information gathered from one or more noninvasive tests can be used to determine treatment or suggest a need for further testing.
When noninvasive tests are inconclusive, the Arrhythmia Program may recommend an electrophysiology (EP) study to pinpoint the exact cause of a patient's arrhythmia and determine the most effective treatment.
During an EP study, the cardiologist inserts a catheter that is roughly the width of a single strand of spaghetti into a vein in the patient's groin or neck. The catheter is advanced to the heart and is attached to electrodes that monitor the heart during the length of the procedure.
First, the cardiologist takes baseline measurements of the electrical system within the heart, which controls the heartbeat. This map provides the cardiologist with information about where the arrhythmia problem likely originates. Using controlled electrical impulses, the cardiologist will trigger an arrhythmia. By doing this, the cardiologist pinpoints the exact cause of the patient's arrhythmia. When the cardiologist is certain of the problem area, treatment options can be tried to determine whether the patient would best be served with medicine, surgical procedures or implanted devices.
If the electrophysiology (EP) study shows that the patient would benefit from arrhythmia treatment, the cardiologist will begin treatment. This reduces the psychological and physical strain of having to return for a second procedure and returns patients to their active lifestyles more quickly.
Treatment options will be determined by the result of the individual patient's EP study. Treatments generally fall into four main categories:
Pacemaker
A pacemaker may be inserted if the EP study shows evidence of a slow pulse. A pacemaker is a small device implanted beneath the skin near the collarbone. The pacemaker will monitor the heartbeat and emit an electrical impulse when the beat slows beyond an acceptable level. In cases of severe desynchronization in which the left ventricle squeezes on one side and then the other instead of simultaneously, a biventricular pacemaker may be used to resynchronize the heart and improve blood flow.
Implantable Cardioverter Defibrillator
An implantable cardioverter defibrillator (ICD) may be inserted if the cardiologist was able to induce a ventricular arrhythmia during the EP study. Like the pacemaker, an ICD is a small device implanted beneath the skin near the collarbone. ICDs are programmed to manage heartbeat speed. When the heart beats faster than the chosen level, the device emits a small shock to slow the heart.
Ablation
Sometimes, when the EP study shows that the arrhythmia is starting from a specific point in the heart, it's possible for the cardiologist to ablate, or remove, that area. During ablation, cardiologists direct a continuing low level of radio frequency at the area causing the problem. In most cases, cauterizing the problem area will put an end to abnormal rhythm. Ablation can also be a stand-alone treatment for patients who already have clear diagnoses of their arrhythmias.
Patients are sedated during an EP study. They also receive surface and intravenous painkillers. The Montefiore Einstein Center for Heart and Vascular Care has a team of dedicated nursing staff who monitor patients to ensure they're comfortable during the entire procedure. Because the Heart and Vascular Center interviews all patients the day after a procedure to determine their comfort levels, our procedures are continually refined to address issues reported by patients who've been through them. As our staff are committed to patient comfort, patient satisfaction with procedures in the Arrhythmia Program is very high.