At The George Washington University Hospital, doctors can treat even the most difficult heart rhythm problems. Using resources available in the diagnostic center, doctors can determine the nature and severity of an abnormal heart rhythm. Many heart rhythm problems require no treatment, or may be well handled by correcting underlying conditions. Others need more advanced treatments.
Some patients may require more invasive treatments such as a radiofrequency catheter ablation in the electrophysiology laboratory. This treatment is used when a part of the heart tissue is responsible for the arrhythmia. Physicians place an ablation catheter on the affected heart tissue to deliver high frequency radio waves that ”zap” the tissue disrupting the irregular electrical signals and correcting the rhythm.
Some of the rhythms treated through ablation are life threatening and some are symptomatic causing significant disruption in day to day life. Following ablation, patients can return to a normal life style within days of the procedure. Some of the rhythms that are commonly treated by ablation include:
- Supraventricular tachycardia—one of several abnormal circuits that cause the heart to suddenly race at vary fast rates
- Atrial flutter—a rapid, fairly regular abnormal heart rhythm starting in the top chambers of the heart leading to severe symptoms such as shortness of breath, heart failure or stroke
- Atrial tachycardia—rapid heartbeat caused by a “run away” focus in the top chamber of the heart
- Ventricular tachycardia—an abnormal heart rhythm starting in the bottom chamber of the heart
During atrial fibrillation, the heart's two small upper chambers (the atria) quiver instead of beating effectively. Blood isn't pumped completely out of them, so it may pool and clot. If a piece of a blood clot in the atria leaves the heart and becomes lodged in an artery in the brain, a stroke may result.
Patients with more serious arrhythmias often need multifaceted therapy. Doctors will treat underlying conditions that can cause irregular heartbeats, like high blood pressure and heart disease. They also may prescribe anti-arrhythmic medications or recommend implantable devices that control heart rhythms.
In some cases, ablation of the atrial fibrillation may be the best option. To safely perform an atrial fibrillation ablation, doctors at The George Washington University Hospital use all the tools available including cardiac CT scans, intracardiac echo and three dimensional mapping.
Ongoing Research—The highly experienced team at GW Hospital continues to participate in ongoing research. For example, the National Institutes of Health (NIH)-sponsored CABANA (Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation) trial recently opened for recruitment. The primary purpose of this study is to determine if percutaneous left atrial catheter ablation for the purpose of eliminating AF is superior to current state-of-the-art therapy with either rate or rhythm control drugs for reducing total mortality in patients with untreated or under-treated AF.
- Pacemakers: are used to treat patients with slow heart rhythms or fainting spells. These devices implanted in the electrophysiology laboratory involve threading pacemaker wires (leads) through the veins, and into the heart. These devices send small electrical impulses to the heart muscle in order to maintain a suitable heart rate and are effective for most patients. They are easily monitored in an outpatient setting.
- Cardioverter defibrillator: Some patients with life threatening or potentially life threatening heart rhythm problems benefit from implantation of a special type of device called a defibrillator. Defibrillators come in several types. They all can function as pacemakers in the event of a slow heart rate, and they all can provide therapy in the event of a life threatening abnormal heart rhythm. Some of the devices called resynchronization devices have an extra lead that is placed in a vein on the left side of the heart. The resynchronization devices can help improve heart function and symptoms of heart failure in patients who have symptoms despite the best available drug therapy. Tests of heart function ahead of time such as echocardiogram with tissue doppler or MRI can help determine if a person is a good candidate for a resynchronization device.
Offsite Rhythm Monitoring
One challenge of an electrocardiogram (ECG) is that it is useful only if the symptoms occur during testing, which is quite rare. Therefore, some patients are provided a device to wear at home which automatically records the heart’s electrical activity at the time of their symptoms. The systems for monitoring can be used for a variable period of time. In some cases, 24-hours of monitoring is adequate to answer the clinical questions, while other patients require more extensive monitoring for up to 30 days. For those patients with extremely infrequent but concerning symptoms, a small monitor device can be implanted under the skin. This device can be “interrogated” or monitored in the physician’s office. These implantable recorders last up to several years and can be removed easily when no longer needed.