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Loyola offers its heart patients a range of electrophysiology
devices and treatments for abnormal heart rhythms including:
Cardioversion
Implantable cardiac defibrillator (ICD)
Pacemaker
Lead extractions
Radio frequency catheter ablation
Cardioversion
A cardioversion is an outpatient procedure using an external defibrillator to deliver a supply of energy to shock the heart back to a normal rhythm. The patient is sedated for a few minutes while the energy is delivered, and he/she will not remember the shock. The patient is allowed to go home after a brief period of monitoring. Prior to cardioversion, the patient receives blood thinner medication for a specific length of time. Lab tests will be drawn prior to the procedure. Some medications may need to be adjusted on the day of the cardioversion.
Occasionally, a patient will need a combination of a cardioversion and follow-up medication to maintain normal sinus rhythm. Drug selection is based on the patient's cardiac history. Cardioversion may be repeated without harming the heart.
Implantable Cardiac Defibrillator (ICD)
An implantable cardiac defibrillator (ICD) is a small automatic device that detects and treats dangerous rapid heart rhythms, such as ventricular tachycardia and ventricular fibrillation. While antiarrhythmic drugs may prevent the occurrence of an antiarrhythmia, an ICD is the only treatment that can stop an existing arrhythmia once it has started. An ICD, like medications, does not cure the underlying cardiac disease that causes the arrhythmias. However, an ICD can terminate the life-threatening arrhythmia and store a record of the event for medical personnel to evaluate at the time of interrogation of the ICD. An ICD is a life-saving device that can allow the patient more freedom to participate in normal activities.
An ICD is used when a patient has survived a cardiac arrest or if an electrophysiology study has shown that the patient has a rapid, dangerous heart rhythm. Also, a patient waiting for a heart transplant may have an ICD implanted to provide protection from a dangerous rhythm. The implantation of the ICD involves a minor surgical procedure, or it may be implanted during another cardiac surgery. The device usually is implanted in the upper left chest area. An incision is made to create a pocket in which the generator is implanted. The leads are inserted into a vein and threaded into the heart. The ICD is tested and set depending on the rhythm problem of the patient. Most patients go home the day after ICD implantation. However, it may take several weeks for the incision site to heal and for the patient to feel comfortable in returning to normal activities.
A patient with an ICD must have the device monitored several times each year in an ICD clinic that has the equipment to communicate with the device. A nurse will use a programmer to retrieve reports of any therapies that the ICD delivered and to make any necessary adjustments. The battery status is also checked. ICD batteries usually last five to eight years.
An ICD may be programmed in several ways to provide treatment. It may attempt to pace the patient out of a fast rhythm, or it can deliver a shock. The patient's physician determines the settings. An ICD also has a back-up pacemaker in case the heart beats too slowly. An ICD also may be combined with a pacemaker when two devices are needed to provide therapy.
Pacemaker
A pacemaker is a small, lightweight electronic device implanted in patients with slow heart rates or prolonged pauses between heartbeats in order to pace the heart. It monitors and stimulates the heart with precisely timed electrical pulses that will keep the heart beating at the proper rate. The pacemaker consists of leads (wires) and a generator (containing the battery and circuitry). The average life of a pacemaker is 6 to 10 years.
The pacemaker is inserted during a surgical procedure, usually performed in the cardiac care unit procedure room, in either the left or right collarbone area. The patient is usually lightly sedated during the implantation. The skin is numbed and a pocket is made under the skin. The leads are threaded through a vein into the heart. The patient is required to spend one night in the hospital after the procedure.
Patients are limited somewhat in their arm movements on the pacemaker side until the surgical site is healed. Thereafter, very few restrictions are placed on a pacemaker patient. The patient receives post-operative instructions and teaching from a nurse or technician from the Pacemaker Clinic concerning his/her device.
The device is monitored several times throughout the year. A programmer is used to gather information from the pacemaker and to adjust its settings as needed.
Lead Extractions
If a pacemaker or implantable cardiac defibrillator (ICD) is not functioning correctly, your physician may recommend that you undergo a surgical procedure known as a lead extraction. A lead is one of two or three thin, flexible wires that is placed inside a vein to deliver energy to the heart muscle from the pacemaker or ICD. These devices are designed to help the heart keep a regular rhythm, but if the area around the leads become infected or damaged, a mechanical problem may occur. Held in place by scar tissue, leads must be surgically extracted by an electrophysiologist. Reasons for lead extraction include infection, damage (the leads no longer provide reliable connections to the heart), or blockage. The surgery is inpatient, but minimally invasive, and patients typically can leave the hospital within a day or two of the procedure.
Radio frequency catheter ablation
Radio frequency catheter ablation is a non-surgical technique that destroys (ablates) parts of the abnormal electrical pathway causing abnormal heart rhythms. Prior to the procedure, the electrophysiology clinical nurse will inform the patient if any medications need to be stopped or labs need to be drawn, as well as any other pre-procedure instructions.
The patient is sedated prior to the procedure. During the ablation, the electrophysiologist inserts special electrode catheters (long, flexible wires) into the heart and positions them so that they lie close to the abnormal electrical pathway. Heat energy is transmitted via the catheters to destroy the pathway.
After the procedure, the patient spends several hours in bed before being allowed to move around. The patient may be required to stay in the hospital overnight for observation.
A successful ablation will provide a cure for the
patient and allow discontinuation of antiarrhythmic
medications, which may be causing undesirable side effects.
If you would like to make an appointment or need assistance
to find an appropriate physician, please call us at
(888) LUHS-888.
Related Links
Electrophysiology tests
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