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Electrophysiology

Queen’s Heart at The Queen’s Medical Center is proud to offer state-of-the art care for patients with electrical heart disorders, providing highly specialized therapies for a variety of heart rhythm disorders. 

Ablation Therapy

Queen’s Heart offers Ablation Therapy, also called Cardiac Ablation, which is a generic term used to describe a procedure performed by an electrophysiologist. This invasive, nonsurgical procedure involves heating or freezing specific areas of the heart to make them inactive.

There are many heart rhythms that may respond to ablation therapy, including:

Diagram of the heart

By ablating select areas of the heart, it is possible to eliminate or reduce the burden of the heart rhythm disorder.

For all cardiac ablation procedures, the doctor will direct a specialized catheter (a long flexible wire) to the region of the heart that is responsible for the heart rhythm disturbance. Typically, an electrophysiologist will use veins and arteries in the groin (and sometimes neck) to access the heart.

It is not uncommon for patients to stay overnight after an ablation procedure, but in some cases, the patient may be able to leave on the same day.

Atrial Fibrillation Management

The team at Queen’s Heart at The Queen’s Medical Center takes a multidisciplinary, patient-centered approach to provide patients with the specialized atrial fibrillation care they require. We believe this is essential for optimal management of Atrial Fibrillation. We tailor therapy to each individual patient and utilize the latest technologies.

AF Management may include:

Your multidisciplinary care team may include:

Not everyone who is referred to our center for AF ablation undergoes the procedure. For some patients, weight loss or management of sleep apnea is the best treatment strategy. Even if ablation is warranted, we will routinely screen for sleep apnea and work closely with our weight management colleagues to maximize the likelihood of successful ablation. We also encourage practices such as yoga and meditation, which we believe may be useful in the management of this disease.

What is Atrial Fibrillation?

Atrial fibrillation, also called AF or A-fib, is an abnormal rhythm of the heart. It is relatively common, affecting more than 2 million people in the United States.

A highly organized electrical system causes the human heart to beat.

When the body’s natural pacemaker, known as the SA node, is functioning, an individual is said to be in “normal sinus rhythm” with a heart rate between 60 and 80 beats times each minute. 

When AF occurs, the electrical activity of the heart is disorganized, causing an irregular heartbeat.

When someone is in AF, the top chambers of heart (the atria) beat at approximately 300-600 times per minute. Under certain circumstances, the bottom chambers of the heart (the ventricles) beat at a very fast pace as well. This condition is known as “atrial fibrillation with rapid ventricular response.”

Frequently Asked Questions

It is estimated that one out of every four individuals will develop AF in their lifetime. Certain risk factors are associated with a greater likelihood of developing AF including:

  • Advancing age
  • Congenital Heart Disease
  • Coronary Artery Disease
  • Diabetes
  • Excessive alcohol or stimulant use
  • Heart Failure
  • High Blood Pressure
  • Lung disease
  • Obesity
  • Serious illness or infection
  • Sleep apnea
  • Surgery (particularly open-heart surgery)
  • Thyroid disease
  • Valvular Heart Disease

Symptoms of AF can range from almost non-existent to disabling.

Mild symptoms include:

  • Unpleasant palpitations or irregularity of the heart beat
  • Mild chest discomfort (sensation of tightness) or pain
  • A sense of the heart racing
  • Lightheadedness
  • Mild shortness of breath and fatigue that limits the ability to exercise

Severe symptoms include:

  • Difficulty breathing
  • Fainting or near fainting
  • Chest discomfort
  • Any symptom associated with stroke – weakness, slurred speech, numbness, confusion

Some of the consequences of AF include heart failure and stroke.

AF is usually diagnosed with an electrocardiogram (ECG or EKG), which records the heart’s electrical activity.

Other tests that may be performed:

  • Ultrasounds to look for heart failure or heart valve problems
  • Blood tests to screen for thyroid disorders
  • Sleep studies to look for sleep apnea
  • Lung function tests to detect underlying lung disease

Fortunately, there are many treatment options for AF, focused around two strategies:

  • A “rate control” strategy focuses on reducing the symptoms of AF by controlling a patient’s heart rate.
  • A “rhythm control” strategy focuses on keeping patients in a normal sinus rhythm.

You should discuss with your doctor which treatment plan makes sense for you.

The goals of AF treatment may include:

  • Returning the heart to a normal rhythm, often via a procedure known as AF ablation, through the use of medications, or a combination of the two options.
  • Reducing symptoms related to AF and improving quality of life.
  • Controlling the heart rate.
  • Preventing blood clots from forming in the heart.

Patients with AF are 5 to 7 times more likely to have a stroke.

Strokes in AF patients occur when a blood clot, caused by blood pooling when the top chambers of the heart (atria) beat rapidly, is dislodged from the heart and travels to the brain. Approximately 90% of these clots are formed within the area of the heart known as the left atrial appendage.

An individual’s risk of stroke due to AF is dependent on many factors, such as:

  • Age
  • Coronary Artery Disease
  • Diabetes
  • Heart Failure
  • High Blood Pressure
  • Prior History of Stroke

To assist with stroke prevention in AF patients for medium- to high-risk individuals: 

Medium-risk patients may be required to take blood thinners to help prevent blood clots from forming in the heart
High-risk patients who cannot tolerate anticoagulants may be eligible to have a non-surgical procedure, called a Left Atrial Appendage Occlusion, designed to reduce the risk of stroke related to AF.

Device Management

The team at Queen’s Heart believes in continuity of care from the time that your doctor recommends implantation of a cardiac device.  There are many different kind of cardiac devices that we implant including

Once you have had your device implanted, our specialists will continue to care for you to ensure that your device is functioning properly and that that you are adjusting well to the new device. In addition to regularly scheduled clinic visits, you may be enrolled in our remote monitoring program, which allows our physicians and other device clinic staff to be alerted quickly if there is a problem with your device or with your heath rhythm.

Left Atrial Appendage Occlusion

Left Atrial Appendage Occlusion (LAAO) is a procedure that Queen’s Heart may recommend for patients with atrial fibrillation (AF) who are at high risk for stroke, but are unable to take blood thinners. Because approximately 90% of blood clots in AF form in the left atrial appendage, occluding (or blocking) it may reduce stroke risk. 

We currently utilize the WATCHMAN™, an FDA approved device designed for LAAO. It is inserted through a vein in the upper leg using a catheter, and guided up into the heart. The device is threaded through the catheter, and plugs the left atrial appendage. Over time, tissue grows over the device and occludes (or blocks) that area.

Diagram explaining left atrial appendage.

See the animation below for a brief overview of the procedure.

What to Expect

Before having the device implanted, you will undergo a Transesophageal Echocardiogram (TEE) which will help to assess the heart’s anatomy and to ensure a clot is not present.

You will be under general anesthesia during the procedure. A cardiologist will implant the device while under the guidance of a Transesophageal Echocardiogram and fluoroscopy.

You will need to stay in the hospital overnight.

Patients will need to take a blood thinner for at least 45 days following the procedure.

Repeat Transesophageal Echocardiograms are performed at 45 days and one year after the procedure.

Who is a Candidate for LAAO?

You are a good candidate for LAAO if you have AF with a high risk for stroke and:

  • Are unable to tolerate long-term use of blood thinners
  • Are at an increased risk of bleeding
  • Have frequent falls

To learn more, call the Queen’s Heart Institute Center for Heart Rhythm Disorders at 808-691-8512.