Conditions We Treat

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Cardiac Electrophysiology

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Atrial Fibrillation
Atrial Flutter
Bradycardia
Heart Block
Palpitations
Supraventricular Tachycardia (SVT)
Ventricular Tachycardia (VT)

Atrial Flutter

Atrial flutter is a condition in which the upper chambers of the heart, known as the atria, beat fast but somewhat regularly.

Symptoms

Some people with atrial flutter have no symptoms. Others may have:
• Shortness of breath
• Chest pain
• Dizziness
• Palpitations, or pounding

Causes

Atrial flutter is associated with:
• Advancing age
• High blood pressure
• Heart disease due to other causes such as heart attack, diabetes, congestive heart failure or valve disease
• Aftermath of heart surgery

Sometimes atrial flutter occurs in people with no other heart problems.

Diagnosis

Like most arrhythmias, atrial flutter is diagnosed by recording the abnormal rhythm in progress. It can also be induced, or triggered, in Swedish’s Electrophysiology Laboratory.

Treatments

Not everyone with atrial flutter requires treatment. Those who do may need medication, including blood thinners to reduce the chance of a stroke. Other treatments such as electrical cardioversion or ablation may be necessary.

Watch a 3D animation that explains electrical cardioversion and how it restores a normal heart rhythm.

Bradycardia

Bradycardia is a slow heart rate.

Symptoms

Bradycardia is not necessarily abnormal. Some people, especially trained athletes, have normally slow heart rates and no symptoms.

The most common symptoms for abnormal bradycardia are:
• Dizziness
• Fainting
• Fatigue
• Tiring easily during exercise

Causes

Bradycardia can be caused by:
• Medications
• Heart surgery
• Thyroid problems
• Age-related degeneration of the heart’s electrical system

Diagnosis

As with all heart rhythm problems, the key to diagnosis is recording the abnormal rhythm with a monitor or an electrocardiogram, known as an ECG.

Treatments

If treatment is required, it could include:
• Stopping medications that are slowing your heart rate
• Treating underlying conditions that may be responsible for a low thyroid
• Inserting a pacemaker to regulate your heart rate

Watch a 3D animation about pacemakers and how they are implanted.

Heart Block

Heart block is a condition in which the electrical system of the heart weakens or fails. Not all of the impulses from the upper heart chambers, or atria, reach the lower chambers, known as ventricles, resulting in bradycardia, which is a slow heartbeat.

Symptoms

The most common symptoms for heart block are:
• Dizziness
• Fainting
• Fatigue
• Tiring easily during exercise

Causes

Heart block can be present from birth, and it can be caused by medications. But it is most often due to:
• Age-related degeneration of the electrical system
• Heart attack
Cardiomyopathy
• Heart surgery

Unusual causes include Lyme disease, an inflammation of the heart called sarcoidosis and amyloidosis, a condition involving abnormal protein deposits in heart tissue.

Diagnosis

As with all heart rhythm problems, the key to diagnosis is recording the abnormal rhythm with a monitor or electrocardiogram, known as an ECG.

Treatments

Sometimes heart block goes away. For instance, if a medicine is responsible, changing the dose or discontinuing the medicine altogether could solve the problem. Otherwise, heart block is almost always treated with a pacemaker.
Watch a 3D animation about pacemakers and how they are inserted.

Palpitations

Palpitations are a symptom, not a disease.
They are usually described as a “pounding,” “fluttering” or “skipping” sensation in the heart.

Causes

Most arrhythmias can cause the sensation of palpitations, but some people will feel palpitations even if their heart rhythm is normal. This may occur when they are scared, sick or even just exercising.

Diagnosis

To diagnose the cause of palpitations, an electrocardiogram – or ECG -- or other heart monitor test is done while the symptoms are occurring. Because palpitations are a symptom, however, the heart rhythm may be completely normal. Equally important, no test can “show” a palpitation.

Treatments

Treatment depends on the cause of the palpitations. It can include reassuring the patient, medication or medical procedures, which would depend on the severity of the symptoms and the specific diagnosis.
Watch a 3D animation that explains cardiac conduction and how the heart’s electrical system works.

Supraventricular Tachycardia (SVT)

Supraventricular tachycardia is a rapid heart rhythm originating in the upper chambers, or atria, of the heart.
There are several kinds of SVT, including:
• Atrial fibrillation
• Atrial flutter
• AV node re-entry
• Accessory pathway tachycardia, including Wolff-Parkinson-White syndrome
• Atrial tachycardia

Symptoms

The most common symptoms for supraventricular tachycardia are palpitations, dizziness or fainting. Only under very rare circumstances is SVT life-threatening.

Causes

SVT is caused by an abnormal electrical circuit in the heart. Sometimes it is present at birth, as is usually the case with accessory pathway tachycardia or AV node re-entry. It may also occur as a consequence of heart surgery. Atrial fibrillation has multiple causes.

Diagnosis

SVT is diagnosed by making a recording of the abnormal rhythm on a monitor or electrocardiogram, known as an ECG, or by inducing it in the Electrophysiology Laboratory.

Treatments

If episodes of supraventricular tachycardia are infrequent or the symptoms are mild, no treatment may be necessary. If treatment is needed, it could include medication or ablation. In some cases, patients can be taught to stop supraventricular tachycardia by what are known as “vagal maneuvers.”

Video

Dr. Adam Zivin explains Supraventricular Tachycardia:

Watch a 3D animation that explains cardiac conduction and how the heart’s electrical system works.

Ventricular Tachycardia (VT)

Ventricular tachycardia is a rapid heart rhythm originating in the lower chambers, or ventricles, of the heart.

Symptoms

The most common symptoms of VT are:
• Palpitations
• Dizziness
• Fainting

Ventricular tachycardia can cause cardiac arrest or death, but this is not always the case.

Causes

VT is most commonly a consequence of:
• A heart attack
• Inadequate blood flow to the heart
Cardiomyopathy

It also can occur following heart surgery, especially with congenital heart disease. Other causes include some medications and congenital abnormalities in the heart. These abnormalities occur with Long QT syndrome, Brugada syndrome, catecholaminergic polymorphic VT, arrhythmogenic right ventricular dysplasia and hypertrophic cardiomyopathy.

Diagnosis

VT can be diagnosed by:
• Doing an electrocardiogram, or ECG
• Attaching a portable monitoring device to a person who then does normal activities
• Inducing arrhythmia in the Electrophysiology Laboratory

The key is to try to determine the underlying cause of ventricular tachycardia. This will determine the appropriate treatment.

Treatments

As with all cardiac arrhythmias, even some VT doesn’t require treatment. When treatment is needed, options include:

Video

Dr. Eric Williams explains ventricular tachycardia:

Watch a 3D animation that shows how ICDs are implanted in the chest.