In the Montefiore-Einstein arrhythmia center, 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 center at Montefiore including:
In addition, documented heart rhythm abnormalities can be due to one of many reasons, including:
Non-Invasive Diagnostic Testing
Patients who have been referred to the arrhythmia lab at Montefiore-Einstein Heart Center will be considered for a comprehensive battery of non-invasive testing, including the tilt-table and procainamide infusion tests designed to measure the patient's reaction to stress triggers in a lab situation.
If the information collected doesn't provide a full picture of a patient's problem, cardiologists in the arrhythmia center may prescribe one of two non-invasive tests that monitor the patient's heart over a longer period:
Holter monitor
The Holter monitor is a device that records every single heart beat 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 moments where the heart beat in a flurry of rapid beats.
Loop recorder
The loop recorder is a device that records information for 30-day testing. Patients wear it all the time, but the device erases itself every five to seven minutes; if patients feel symptoms, they push a button to preserve the data. Patients then transfer the information via telephone.
Information gathered from one or more non-invasive tests can be used to determine treatment or suggest a need for further testing.
Electrophysiology (EP) studies
When non-invasive tests are inconclusive, the arrhythmia center may recommend an electrophysiology study, or 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 piece of spaghetti into a vein in the patient's groin or neck. The catheter is advanced to the heart. The catheter 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 that controls the heartbeat. This map will provide 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 tested to determine whether the patient would best be served with medicine, surgical procedures, or implanted devices.
Treatments based on the EP study
If the EP study shows that the patient would benefit from treatment arrhythmia, your cardiologist will continue directly from testing to treatment. This reduces the psychological and physical strain of undergoing two procedures 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 collar bone. The pacemaker will monitor the heart beat and emit an electrical impulse when the beat slows beyond an acceptable level. In cases of severe desynchronization where 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 (ICD)
An 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 collar bone. ICDs are programmed with an acceptable speed for the heart beat. When the heart beats faster than that 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.
Patient comfort
During an EP study, patients are sedated so that they lie still. They also receive surface and intravenous painkillers. Montefiore-Einstein has a team of dedicated nursing staff who monitor patients to ensure they're comfortable during the entire procedure. Because Montefiore-Einstein interviews all patients the day after a procedure to determine their comfort levels, their procedures have been continually refined to address issues reported by patients who've been through the procedure. Because of this commitment to patient comfort, patient satisfaction with procedures in the arrhythmia lab at Montefiore-Einstein is very high.
Trust your hearts to the center that knows arrhythmia best. If you think the services at the Montefiore-Einstein arrhythmia lab may be right for you, contact Dr. John Fisher at 718-920-4292 or via e-mail at jfisher@montefiore.org.
© 2008 Montefiore Medical Center