FV Electrophysiology Unit

Syncope (fainting) can be a symptom of an arrhythmia – when the heart is not beating regularly or may not be pumping blood as efficiently as normal. Fainting often occurs suddenly without warning, particularly during exercise, and requires immediate medical evaluation to determine if it is due to a dangerous abnormal heart rhythm.

Atrial Fibrillation is the most common form of arrhythmia and occurs more frequently as we age. It happens when the upper chambers quiver rather than beating regularly and effectively. People with AFib often experience palpitations, fatigue, chest discomfort or shortness of breath. However, some people may not feel any symptoms, and we often discover it during a routine check-up.

Left untreated, Atrial Fibrillation is a leading cause of stroke and can weaken the heart and cause heart failure. Treatments include medications, cardiac surgery, ablation, and implantable devices. Women may respond differently or have different side effects from the drugs that are used to treat arrhythmias.

Episodes of atrial fibrillation may come and go (called paroxysmal atrial fibrillation) or they may continue for longer periods of time (persistent atrial fibrillation). Typically, atrial fibrillation lasts for up to 24 hours; when an episode lasts more than 7 days, we call the condition persistent atrial fibrillation.

Atrial flutter is similar to atrial fibrillation, though the fast heartbeat can be more regular. Many people with atrial flutter develop atrial fibrillation over time. Atrial flutter can also make it harder for your heart to push blood into your ventricles, which are the lower chambers of your heart. That, in turn, means your heart sends less blood throughout your body. Symptoms include a fluttering feeling in the chest, palpitations, pressure in the chest, shortness of breath, anxiety, lightheadedness, and fainting. This condition increases the risk of stroke and heart failure.

Atrial flutter can be chronic or it can come and go. We treat it by slowing down the electrical impulses that go from the top chambers of the heart to the bottom ones. To do this, we prescribe medications and use an external defibrillator to administer electrical shocks. More of the time we perform catheter ablation therapy, a non-surgical catheter procedure that can cure a patient of this rhythm.

Also known as a slow heartbeat, bradycardia may stem from problems with the heart’s electrical system. It can be caused by aging, electrolyte abnormalities, medications, and abnormal thyroid function. Sometimes this condition occurs in athletic individuals or those taking medications. A slow heart rate can cause fatigue, dizziness, and fainting. We typically treat symptomatic bradycardias with the implantation of a pacemaker.

Tachycardia, or a fast heartbeat, can have many causes. The heart normally beats faster with physical activity or emotional stress, but if the heart races at other times or for a prolonged period, you should have it evaluated. Tachycardias are grouped by the chamber from which they originate.  Supraventricular arrhythmias, for instance, start in the upper chambers of the heart (the atria) and include atrial fibrillation, atrial flutter, supraventricular tachycardia, and Wolff-Parkinson-White syndrome.

Supraventricular Tachycardia, also called SVT, is usually caused by either an abnormal electrical circuit or rapidly firing cells in the upper chambers of the heart. SVT can last anywhere from a few seconds to several hours. Symptoms can include palpitations, lightheadedness, pounding of the chest, and shortness of breath – especially while exercising. Episodes generally are not life threatening but can be bothersome and debilitating. We often treat SVT with an ablation procedure.

A ventricular arrhythmia is a condition which originates in the lower chambers of the heart (ventricles). We usually find the problem when we hear three or more beats in succession coming from one of the ventricles. We consider the arrhythmia to be sustained if it lasts more than 30 seconds. Sustained ventricular arrhythmia keeps the lower heart chambers from being able to maintain proper blood flow throughout your body. The condition can lower your blood pressure and cause heart failure.

Ventricular arrhythmia can cause heart palpitations, shortness of breath, fainting, lightheadedness, chest discomfort, and pale skin. It can be tricky to diagnose this condition as it often occurs in emergency situations. Treatment options include cardiopulmonary resuscitation, defibrillators, medicines, catheter ablation procedures, and open heart surgery. Sometimes we install an automatic defibrillator into your heart to deliver shocks as needed, to keep your heart beating steadily.

Some people are born with an extra electrical pathway between the top and bottom chambers of the heart, which we call Wolff-Parkinson-White Syndrome (WPW). This condition causes abnormal circuits to form and leads to a fast heart rhythm. We usually find this syndrome during a routine electrocardiogram. It can be dangerous even if you experience no symptoms. We often treat WPW with an ablation procedure.

There are two types of ventricular arrhythmias, which are abnormal heartbeats in the lower chambers of the heart (called ventricles). The first type, ventricular tachycardia, is a fast heart rhythm that can cause dizziness, palpitations, and fainting. Ventricular tachycardia is often associated with coronary artery disease and other heart problems and requires prompt medical attention.

The second type of ventricular arrhythmia, called ventricular fibrillation (VF) is a medical emergency. The electrical signals in the lower chambers become erratic and the heart stops beating. If not treated immediately, VF can result in sudden death.

Premature beats are early, extra heartbeats, often called “skipped beats.” Premature beats can arise from the upper or the lower chambers of the heart. While normally not dangerous, they can be associated with other heart diseases or predict future cardiac problems or arrhythmias. The condition can be aggravated by smoking or an excess amount of caffeine. Treatment may be necessary if you frequently experience premature beats, or if they cause symptoms.

Ventricular premature complexes (VPCs) are single beats that disrupt the usual sequence of heart beats. The frequency of VPCs may occur very infrequently or thousands of times a day. Regardless of the trigger, VPCs can indicate possible heart dysfunction and you should have the condition evaluated. While most people don’t feel VPCs, some do experience palpitations or fluttering in the chest, especially when at rest and when lying on their backs.

Similar to VPCs, atrial premature complexes involve extra heart beats that occur alone or in series. Symptoms, also, are similar to ventricular premature complexes.

Holter monitoring (or ambulatory electrocardiogram) is a test where the electrocardiogram (ECG) is continuously monitored for 24 hours to 7 days and the signals are simultaneously recorded onto a special recorder worn by the patient. This test is useful for detecting transient rhythm disorders of the heart, which are not detected at the time when an ECG is done. This test is indicated for patients with palpitations, giddiness or fainting spells.

The upright tilt test is used to detect recurrent syncope (fainting) of unknown origin. A common form of syncope is called a simple faint or vasovagal syncope, i.e. fainting due to abnormally sensitive reflexes in the cardiovascular system during prolonged standing or when subjected to unpleasant stimuli. 

Although this form of faints may appear alarming, they are rarely life-threatening. The test requires you to be tilted in an upright position to simulate a situation of prolonged standing and you will be continuously monitored to see if this will reproduce the symptoms of recurrent fainting.

An electrophysiology (EP) study is a test performed to assess your heart’s electrical system or activity and is used to diagnose abnormal heartbeats or arrhythmia.The test is performed by inserting catheters and then wire electrodes, which measure electrical activity, through blood vessels that enter the heart, to find out where abnormal heartbeats are coming from.

Ablation is a general term for a procedure to destroy abnormal tissue. In the treatment of arrhythmias, tiny patches of heart cells that are causing the irregular heartbeat are destroyed, effectively short circuiting the disruptive electrical circuit. Ablation treatment for arrhythmias is a catheter-based procedure in which the catheter has a device at its tip that can freeze the targeted heart cells through cryoablation or burn them using radio frequency energy. This procedure is performed in FV cath-lab.

Pacemakers are commonly used to treat several forms of arrhythmia, they monitor the heartbeat. If the heart rate is normal it stays off; however, if the beat is too slow, fast or erratic, the pacemaker sends a mild electrical signal to the heart that causes it to beat at a more beneficial pace.

A pacemaker is a battery-powered device that is inserted under the skin (or sometimes under the muscle), usually near the collarbone. It is attached to the heart via one or more wires (leads) that extend from the pacemaker through the veins to the right side of the heart. It typically takes 45-60 minutes, using local anaesthetic and conscious sedation. Wires (leads) are guided through veins to the heart using imaging, and patients are often discharged on the same day or within 24 hours.

FV Hospital offers leadless pacemaker implantation, a minimally invasive, 30–90 minute procedure where a miniaturised device (roughly the size of a large vitamin capsule) is delivered via catheter through the femoral vein in the groin directly into your heart. There’s no separate battery. And it doesn’t need leads (wires) because the whole device sits in your heart’s right ventricle.

An ICD is a small, battery-powered device, similar to a pacemaker that can be implanted under the skin near the collarbone. Wires (leads) run from the ICD to the heart through a large vein. The ICD monitors the heartbeat, and, if it senses an arrhythmia, sends an electrical shock to “reset” the heartbeat, stopping the fast or erratic rhythm.

This device is usually implanted under the skin by an electrophysiologist during a minor surgical procedure. The device is carefully monitored, usually remotely, and the generator (or battery) can last as long as ten years.

An arrhythmia is a problem with the heartbeat rhythm arising from issues with the heart’s electrical impulses. Sometimes a mild, well-timed electrical shock to the chest (electrical cardioversion) can reset those electrical impulses and stop arrhythmias. This is often a second step after drug therapy for atrial fibrillation or flutter—fast or irregular heartbeats that start in the heart’s upper chambers (atria). 

Cardioversion is normally a scheduled, outpatient procedure for people whose arrhythmias put them at risk for serious heart problems in the future. It is performed under sedation, and the patient is completely asleep. Patches and paddles are placed on the patient’s chest to monitor the heartbeat, and then used to deliver an electrical shock synchronized to the heartbeat, and delivered at a precise juncture; this “resets” the heartbeat back to a regular rhythm. The electrical current used for cardioversion is much milder than that used for emergency defibrillation and is not painful.