What is arrhythmia?
Arrhythmia is a condition in which the heart beats with an irregular rhythm. Electrophysiology studies are tests that record and monitor the electrical activity of your heart to determine what is causing the irregular rhythm, as well as help your doctor determine the treatment or medication that may be most effective.
The Clinical Cardiac Electrophysiology Program at UF Health Jacksonville is led by University of Florida cardiologists, as well as a team of skilled nurses trained and specialized in diagnostics, treatment and continuing care of patients with cardiac electrical problems.
Arrhythmia: Who may need testing?
There are a variety of situations in which a cardiologist may order an electrophysiology test or other heart monitoring studies. Diagnostic tests evaluate dizziness, palpitations, loss of consciousness resulting from insufficient blood flow to the brain, slow heart rate, fast heart rate, abnormal or irregular heart rhythm, atrial fibrillation and heart failure treatment.
Your doctor may order tests for a number of reasons, including:
- Suspicion that you have a condition affecting the electrical activity of your heart and causing an irregular heartbeat.
- Testing prior to receiving an implantable cardioverter/defibrillator, so your cardiologist knows what type of device is best suited for your condition.
- To better understand how effective your current medications are for an arrhythmia, or irregular heartbeat.
Upon completion of diagnostic evaluation, our specialists may perform the necessary intervention at the same time.
Arrhythmia: Evaluation and diagnosis
Diagnostic procedures may include:
- Electrophysiology study - An electrophysiology study is a test of the electrical conduction system of your heart. The study is done by threading catheters into a vein where the leg connects to the abdomen to measure the electrical signals generated by your heart.
- Holter monitoring - Holter monitoring continuously records a patient’s heart rhythm, usually for 24 hours, during typical daily activities. Small conducting patches called electrodes are placed on your chest and attached to a small digital recording monitor that you can carry in a pocket or in a small pouch worn around your neck.
- Event monitoring - Like holter monitoring, cardiac event monitoring is used to diagnose symptoms that are infrequent or sporadic; however, the monitor is worn for a longer period of time — about 30 days — to monitor heart rhythm and to record symptoms.
- Tilt table study - The tilt table test is used to determine the cause of your fainting spells. During a tilt table study, you’ll be connected to an EKG, an oxygen monitor and a blood pressure monitor and then strapped to a bed that’s tilted in different directions. Your blood pressure and pulse are measured and symptoms are recorded while you are in various positions. The test is designed to cause a fainting spell in a controlled environment and to show how your heart rate and blood respond to changing positions.
- Loop recorder implantation - An implantable loop recorder is used to determine the cause of fainting or near-fainting spells. The recorder is a small device put inside the body to record heart rhythm during fainting or near-fainting episodes. It is activated by a handheld device used during or after an event to store the event into the recorder’s memory. The device is removed after one or more episodes have been stored into memory.
Arrhythmia: Treatment options
Once your heart condition has been diagnosed, our specialists will design a personalized treatment plan, which may include medication, interventional procedures or surgical procedures. Often, an interventional procedure is performed at the time of an electrophysiology study.
Advanced treatment options provided include:
- Automatic implantable cardioverter-defibrillator insertion - The automatic implantable cardioverter-defibrillator (ICD) is a small, lightweight electronic device that is placed inside the body, constantly monitoring heart rhythm. If it detects a fast, abnormal rhythm, it delivers energy to the heart muscle. While the device is not a cure for a heart rhythm problem, it can save a life by quickly bringing a dangerously fast heart rhythm under control.
- Cardioversion - Cardioversion switches one cardiac rhythm or electrical pattern to another, almost always from an abnormal to a normal one. This conversion can be accomplished by using medications or by electrical cardioversion using a defibrillator, which delivers a low-energy shock at the same time as the heartbeat, to restore a normal heart rhythm.
- Catheter ablation - Cardiac catheter ablation is a nonsurgical treatment for people with an abnormal heart rhythm, or arrhythmia, in which a long, flexible wire is passed into the heart to eliminate the precise area of the heart causing the arrhythmia. Radiofrequency ablation scars or destroys heart tissue, which triggers abnormal rhythms, bringing the heart back to normal rhythm.
- Laser lead extraction - Laser lead extraction is a method of removing worn or infected pacemaker and defibrillator wires from patients’ hearts before implanting new ones. The lead, which passes through a major vein in the heart and attaches to the pacemaker or defibrillator, grows into the wall of the vein over time and becomes difficult to remove. Laser lead extraction involves sliding a sheath over the lead containing a laser light that removes the fibrous growth that holds the lead to the wall of the vein. The laser has very low tissue penetration, so it effectively detaches the fibrous tissue directly around the lead, sparing injury to the surrounding vein. Once the lead is no longer attached to the vein wall, it may be pulled out with less risk of damage to the vein.
- Maze procedure for atrial fibrillation - The maze procedure is offered for patients suffering from atrial fibrillation, a serious abnormality of the normal heart rhythm that affects a large population of patients. Often, a cardiothoracic surgeon will perform a modified maze procedure in which radio frequency applicators are used to eliminate the abnormal heart rhythm. While most maze procedures are performed in conjunction with heart valve surgery, it is also possible to treat atrial fibrillation in patients having no heart valve disease.
- Permanent pacemaker insertion - A permanent pacemaker is used to correct disturbances to the normal rhythm of your heart by analyzing the function of the heart’s own electrical system and, when necessary, sending tiny, precisely timed electrical signals to the heart to correct certain abnormalities in the heart’s electrical system.
- Resynchronization therapy through biventricular pacemaker insertion - A biventricular pacemaker is an artificial pacemaker or implantable cardioverter-defibrillator designed to treat congestive heart failure. In many heart failure patients, the walls of the left ventricle — the heart’s main pumping chamber — are no longer synchronized or pumping together as they normally would. A biventricular pacemaker is designed to resynchronize the pumping action of the left ventricle.
Why choose UF Health Jacksonville?
Our doctors are the region’s leaders in providing the most complete evaluation of the electrical needs of patients’ hearts and matching that with the most technologically advanced care of pacemakers, defibrillation therapy or ablation therapy. Our specialists are professors and researchers in one of the nation’s largest cardiovascular training programs — the University of Florida College of Medicine – Jacksonville. With more research-based and up-to-date treatment options than other facilities, we believe we can offer the best possible outcomes for our cardiovascular patients.
We also offer a comprehensive atrial fibrillation center, where electrophysiologists and cardiothoracic surgeons use innovative technology to improve the quality of life for our patients.