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Doc Talk Doc Talk: There are several ways to re-establish a steady heartbeat

  • Published Monday, Oct. 8, 2012, at 11:37 p.m.

The heart is a hard-working organ, beating approximately 104,000 times per day, 38 million times per year in the average adult. For most of us, the heartbeat is regular and strong. But millions of people suffer from abnormal heart rhythms called arrhythmias. Ranging from mild to severe, arrhythmias can cause dizziness, weakness, fainting spells, shortness of breath, palpitations (a fluttering, strong or fast heartbeat), chest pain or discomfort. They occur most often in older people but can also occur in younger people, sometimes related to genetic defects.

Arrhythmia can result in death due to sudden cardiac arrest, which is not a heart attack. A heart attack occurs when a blockage in a blood vessel interrupts the flow of blood to the heart. Arrhythmias and sudden cardiac arrest are caused by problems with the heart’s electrical system, affecting its ability to beat properly. Approximately 1,000 people per day die of sudden cardiac arrest, most often people who also have heart disease.

To diagnose arrhythmia, a doctor may order an electrocardiogram (ECG or EKG), or have the patient wear a portable ECG monitor for one or more days while going about daily activities. When these diagnostic procedures do not provide all the necessary information, or when a specific arrhythmia is identified, an electrophysiologist may need to proceed with an electrophysiology study.

The detailed information provided by an electrophysiology study is important in helping the doctor plan effective treatment. Performed in an electrophysiology lab, an electrophysiology study usually is an outpatient procedure requiring only a local anesthetic and medications to help the patient relax. Longer procedures may need to be done under general anesthesia for the patient’s comfort. The physician threads one or more flexible wires, called electrode catheters, through a blood vessel starting usually in the groin into the heart chambers. X-rays allow the catheter to be viewed on a monitor. Specialized three-dimensional mapping systems also can be utilized to visualize the catheters without the use of radiation. The physician then is able to “map” the heart’s electrical activity, finding any abnormal electrical pathways or groups of cells that may be causing the arrhythmia. The catheters can then be removed.

There are several treatments for arrhythmias, depending on each patient’s particular needs. Medications often are prescribed to correct the heart’s electric signals. If medications are not effective, the doctor may recommend:

•  Ablation: After performing an electrophysiology study to locate the abnormal heart tissue, the doctor can insert a specialized ablation catheter to destroy defective tissue by burning or freezing it.

•  Pacemaker: Used to treat a slow heart rhythm, a pacemaker is a small battery-operated device that is permanently placed under the skin in the chest and is connected to the heart with thin insulated wires. It tracks the heartbeats and, when necessary, generates electrical signals similar to the heart’s natural signals.

•  Implantable cardioverter defibrillator: Like the pacemaker, this is a small device implanted under the skin. When it senses a rapid heartbeat, it can slow down the heart rhythm by brief overdrive pacing. It also can deliver electrical shocks to return the heart to normal rhythm.

For more information about arrhythmias and electrophysiology procedures, visit Galichia Heart Hospital’s website at ghhwesleymc.com/atrialfibrillationclinic.php.

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