Electrophysiology

Cardiac Electrophysiology

Cardiac electrophysiology is the science dealing with the mechanisms, functions, and performance of the electrical responses of different regions of the heart. This term is typically used to describe studies of such phenomena by invasive recording of activity in addition to cardiac responses to programmed electrical stimulation. These studies are performed to evaluate complex arrhythmias, study abnormal electrocardiograms, quantify risk of developing arrhythmias in the future, and design treatment. More and more these procedures include therapeutic methods in addition to diagnostic and prognostic procedures. Other therapeutic methods employed in this field of study include anti-arrhythmic drug therapy and insertion of pacemakers and implantable cardioverter-defibrillators.

A specialist in cardiac electrophysiology is known as a cardiac electrophysiologist. Cardiac electrophysiology is a subspecialty of cardiology and in most countries requires one or more years of fellowship training beyond a general cardiology fellowship.

invasive and noninvasive procedures including:

Invasive Procedures & Tests:

Electrophysiology (EP) Study and the mapping of the heart - An EP Study is conducted in order to measure exactly how the electrical impulses flow through your heart during a heart beat. A small catheter is placed inside your heart to record electrical impulses and to determine areas of abnormal electrical conduction information.
Radiofrequency Arrhythmia Ablation - This is a non-surgical procedure used to treat certain types of rapid heart irregularities or cardiac arrhythmias.
Permanent Pacemaker Implantation - This procedure is recommended to correct some types of bradycardia (slower than normal heart beat) or heart blocks. A pulse generator is implanted under the skin in the upper chest area and lead wires are also attached.
Implantable Cardioverter Defibrillator (ICD) - This is a small device implanted into the upper chest area to accurately analyze and treat cardiac rhythm and arythmias. The ICD monitor senses the abnormal rhythm and sends one or more electrical impulses or shocks to the heart restoring normal rhythm.

Non-Invasive Tests:

Tilt table test - Determines the appropriate treatment for patients who experience fainting or near fainting (syncope or presyncope) symptoms.
NIPS (Non-Invasive Programmed Stimulation) - Tests the implanted defibrillator and/or treats certain types of cardiac arrhythmias such as atrial fibrillation or atrial flutter.

Implantable Defibrillator
An implantable defibrillator is a device that monitors your heart rate. It is used in patients at risk for recurrent, sustained ventricular tachycardia or fibrillation. The defibrillator uses batteries to send electric signals to a heart that’s beating too slow, similar to a pacemaker.

Prior to Surgery

Any necessary precautions prior to surgery will be outlined for you in the treatment plan. If you require pre-op therapy, you will receive the proper instructions. If you are a smoker, you may be asked to stop for a time prior to your surgery. You might also be asked to refrain from using vitamin E (in large does), aspirin or anti-inflammatory medicines since they can lead to increased bleeding during surgery.

The Procedure

You surgeon will place a defibrillator inside your chest and its leads will be connected inside the heart or on its surface. These leads produce electrical shocks, read the cardiac rhythm and if necessary pace the heart. The various leads are channeled to a pulse generator, which is placed in a pocket of skin of the chest or abdomen. These generators are usually larger than a wallet and have electronic monitoring in order to treat heart rhythms recognized as abnormal. Some of the newer devices are smaller and have less complicated lead systems. They can be installed through blood vessels, eliminating the need for open chest surgery

After your surgery

Recovery from a defibrillator implantation is dependant on the method used to install the device. The recovery time is rapid if a microscopic device is installed and longer in cases where an incision is made.

Risks

Aside from common risks of infection, this discussion becomes more about the risks of not having the surgery. While an implantable defibrillator does not guarantee 100% protection against abnormal heart rhythms, its presence more than offsets any risks having the device me cause.

Surgery always has an element of risk. We have attempted to minimize that risk by having an American-trained surgeon, a professional staff and a world-class hospital ready for your Panama defibrillator implantation. At Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, we want your visit to be a safe and rewarding procedure.

Cardiac Radio Frequency Ablation
Cardiac Radio Frequency Ablation is a procedure that is performed to regulate heart rhythm; it is a technique that can cure many types of tachycardia. Using catheters that are threaded into the heart, radiofrequency energy is targeted toward the area causing the abnormal heart rhythm, permanently damaging small areas of tissue. The damaged tissue is no longer able to generate electrical impulses. If the procedure is successful, the arrhythmia is no longer able to be generated, curing the patient.

The Procedure

Small catheters will be moved into the heart; many times these catheters are placed into the vein or artery in both the right and left groin and are positioned within the chambers of the heart using fluoroscopy. The exact location for these catheters is found by measuring the electrical impulses from the heart's muscle. The surgeon will use these impulses trying to recreate the arrhythmia.

Utilizing one of several methods for identifying the electrical system, the various sections of the heart that are causing your arrhythmia can be identified. After identification, the surgeon will then use the radiofrequency energy to treat the problem area. Throughout this procedure, a patient's heart rate and rhythm and blood pressure are closely monitored to watch for problems.

When the procedure is completed, the doctor will again attempt to start the arrhythmia. If it cannot be recreated, the procedure is considered to be complete; however, if the arrhythmia can still be started, additional radiofrequency energy is used. The length of the procedure varies from patient to patient, depending upon the type of arrhythmia being treated and how many times the procedure is repeated. Typically, the procedure lasts three hours or more.

After your surgery

You will be taken to a recovery area while the effects of the sedative subside. The catheter insertion sites will be monitored for bleeding and the heart rhythm is observed closely during this time. You will stay in bed for several hours to reduce the risk of bleeding from the catheter incisions.

Some patients are admitted to the hospital following the procedure, but many go home later the same day. Certain activities are limited for a brief period in order to avoid problems with the catheter incision sites. You will likely be asked to take aspirin every day for several weeks to prevent blood clots. The surgeon will give you more detailed information about medications needed after the procedure. Pain medication after the surgery is usually needed for only a short time, if at all.

Risks

Like any invasive procedure, cardiac radio frequency ablation carries some risk. Complications can include:

Problems from threading the catheters through the blood vessels including bleeding, infection, blood clots, bruising, and injury to the vessels.
Injury to the heart due to the catheters. This can include a perforation through the muscle or damage to one of the valves within the heart.
Blood clots.
Heart block or failure of any electrical impulse to travel from the top parts of the heart to the bottom. If this occurs, a pacemaker is required.
New arrhythmias
Radiation exposure.
Death (occurs in approximately 0.1 to 0.3 percent of cases)

While there is always an element of risk, having an American-trained surgeon, a professional staff and a world-class hospital make your Panama cardiac radio frequency ablation at Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, a safe and rewarding procedure.


Cardiac Electrophysiology Cardiac electrophysiology is the science dealing with the mechanisms, functions, and performance of the electrical responses of different regions of the heart. This term is typically used to describe studies of such phenomena by invasive recording of activity in addition to cardiac responses to programmed electrical stimulation. These studies are performed to evaluate complex arrhythmias, study abnormal electrocardiograms, quantify risk of developing arrhythmias in the future, and design treatment. More and more these procedures include therapeutic methods in addition to diagnostic and prognostic procedures. Other therapeutic methods employed in this field of study include anti-arrhythmic drug therapy and insertion of pacemakers and implantable cardioverter-defibrillators. A specialist in cardiac electrophysiology is known as a cardiac electrophysiologist. Cardiac electrophysiology is a subspecialty of cardiology and in most countries requires one or more years of fellowship training beyond a general cardiology fellowship. invasive and noninvasive procedures including: Invasive Procedures & Tests: Electrophysiology (EP) Study and the mapping of the heart - An EP Study is conducted in order to measure exactly how the electrical impulses flow through your heart during a heart beat. A small catheter is placed inside your heart to record electrical impulses and to determine areas of abnormal electrical conduction information. Radiofrequency Arrhythmia Ablation - This is a non-surgical procedure used to treat certain types of rapid heart irregularities or cardiac arrhythmias. Permanent Pacemaker Implantation - This procedure is recommended to correct some types of bradycardia (slower than normal heart beat) or heart blocks. A pulse generator is implanted under the skin in the upper chest area and lead wires are also attached. Implantable Cardioverter Defibrillator (ICD) - This is a small device implanted into the upper chest area to accurately analyze and treat cardiac rhythm and arythmias. The ICD monitor senses the abnormal rhythm and sends one or more electrical impulses or shocks to the heart restoring normal rhythm. Non-Invasive Tests: Tilt table test - Determines the appropriate treatment for patients who experience fainting or near fainting (syncope or presyncope) symptoms. NIPS (Non-Invasive Programmed Stimulation) - Tests the implanted defibrillator and/or treats certain types of cardiac arrhythmias such as atrial fibrillation or atrial flutter. Implantable Defibrillator An implantable defibrillator is a device that monitors your heart rate. It is used in patients at risk for recurrent, sustained ventricular tachycardia or fibrillation. The defibrillator uses batteries to send electric signals to a heart that’s beating too slow, similar to a pacemaker. Prior to Surgery Any necessary precautions prior to surgery will be outlined for you in the treatment plan. If you require pre-op therapy, you will receive the proper instructions. If you are a smoker, you may be asked to stop for a time prior to your surgery. You might also be asked to refrain from using vitamin E (in large does), aspirin or anti-inflammatory medicines since they can lead to increased bleeding during surgery. The Procedure You surgeon will place a defibrillator inside your chest and its leads will be connected inside the heart or on its surface. These leads produce electrical shocks, read the cardiac rhythm and if necessary pace the heart. The various leads are channeled to a pulse generator, which is placed in a pocket of skin of the chest or abdomen. These generators are usually larger than a wallet and have electronic monitoring in order to treat heart rhythms recognized as abnormal. Some of the newer devices are smaller and have less complicated lead systems. They can be installed through blood vessels, eliminating the need for open chest surgery After your surgery Recovery from a defibrillator implantation is dependant on the method used to install the device. The recovery time is rapid if a microscopic device is installed and longer in cases where an incision is made. Risks Aside from common risks of infection, this discussion becomes more about the risks of not having the surgery. While an implantable defibrillator does not guarantee 100% protection against abnormal heart rhythms, its presence more than offsets any risks having the device me cause. Surgery always has an element of risk. We have attempted to minimize that risk by having an American-trained surgeon, a professional staff and a world-class hospital ready for your Panama defibrillator implantation. At Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, we want your visit to be a safe and rewarding procedure. Cardiac Radio Frequency Ablation Cardiac Radio Frequency Ablation is a procedure that is performed to regulate heart rhythm; it is a technique that can cure many types of tachycardia. Using catheters that are threaded into the heart, radiofrequency energy is targeted toward the area causing the abnormal heart rhythm, permanently damaging small areas of tissue. The damaged tissue is no longer able to generate electrical impulses. If the procedure is successful, the arrhythmia is no longer able to be generated, curing the patient. The Procedure Small catheters will be moved into the heart; many times these catheters are placed into the vein or artery in both the right and left groin and are positioned within the chambers of the heart using fluoroscopy. The exact location for these catheters is found by measuring the electrical impulses from the heart's muscle. The surgeon will use these impulses trying to recreate the arrhythmia. Utilizing one of several methods for identifying the electrical system, the various sections of the heart that are causing your arrhythmia can be identified. After identification, the surgeon will then use the radiofrequency energy to treat the problem area. Throughout this procedure, a patient's heart rate and rhythm and blood pressure are closely monitored to watch for problems. When the procedure is completed, the doctor will again attempt to start the arrhythmia. If it cannot be recreated, the procedure is considered to be complete; however, if the arrhythmia can still be started, additional radiofrequency energy is used. The length of the procedure varies from patient to patient, depending upon the type of arrhythmia being treated and how many times the procedure is repeated. Typically, the procedure lasts three hours or more. After your surgery You will be taken to a recovery area while the effects of the sedative subside. The catheter insertion sites will be monitored for bleeding and the heart rhythm is observed closely during this time. You will stay in bed for several hours to reduce the risk of bleeding from the catheter incisions. Some patients are admitted to the hospital following the procedure, but many go home later the same day. Certain activities are limited for a brief period in order to avoid problems with the catheter incision sites. You will likely be asked to take aspirin every day for several weeks to prevent blood clots. The surgeon will give you more detailed information about medications needed after the procedure. Pain medication after the surgery is usually needed for only a short time, if at all. Risks Like any invasive procedure, cardiac radio frequency ablation carries some risk. Complications can include: Problems from threading the catheters through the blood vessels including bleeding, infection, blood clots, bruising, and injury to the vessels. Injury to the heart due to the catheters. This can include a perforation through the muscle or damage to one of the valves within the heart. Blood clots. Heart block or failure of any electrical impulse to travel from the top parts of the heart to the bottom. If this occurs, a pacemaker is required. New arrhythmias Radiation exposure. Death (occurs in approximately 0.1 to 0.3 percent of cases) While there is always an element of risk, having an American-trained surgeon, a professional staff and a world-class hospital make your Panama cardiac radio frequency ablation at Hospital Punta Pacifica, Affiliated with Johns Hopkins Medicine International, a safe and rewarding procedure.