Arrhythmia and Device Clinic
What Is an Arrhythmia?
When there is an irregularity in the electrical system of the heart, whether the heart is going too slow or too fast, or just beating erratically, an arrhythmia may have occurred. An arrhythmia is any disturbance in the rhythm of the heart beat, either from the upper (atrial) or lower (ventricular) chambers. Arrhythmias can slow down blood flow, which the body requires either in the heart itself or throughout the body’s organs. When this occurs, it can cause dizziness, palpitations, shortness of breath, fatigue, fainting, or in some cases, may suggest a serious condition.
What Are the Different Types of Arrhythmias?
Bradycardia: an abnormally slow heart rhythm. This generally results from the failure of either the heart’s own natural pacemaker (sinoatrial node) to start a signal or the junction box of the heart (AV node) to transmit the signal to the ventricles. This condition will slow the heart’s rhythm and can cause many of the symptoms noted above. An example of a slow heart rhythm is heart block.
Tachycardia: an abnormally fast heart rhythm. This can start either in the atria or in the ventricles. With either, symptoms occur because the heart is beating too fast and cannot pump efficiently. Many symptoms mentioned above may occur from these heart rhythms. Some examples of fast heart rhythms are atrial fibrillation, atrial flutter, or ventricular tachycardia.
How Are Arrhythmias Diagnosed?
There are several diagnostic tests that physicians may use to determine the exact cause of an arrhythmia. Non-invasive testing may include EKGs, Holter monitors, event recorders, treadmill testing, echocardiogram, and tilt table testing. Also, physicians at NHI can help “map out” the heart’s electrical system and identify where the abnormal electrical signal is coming from. This is done in the electrophysiology laboratory, using x-rays and catheters placed in the heart.
How Are Arrhythmias Treated?
Treatment options vary on the type of arrhythmia and symptoms. Some arrhythmias do not require treatment. Other treatments can include medications, cardiac ablation, or implanted devices. Your physician can help you decide which type of treatment would be best for you.
What Are the Treatments for Arrhythmia?
Electrical Cardioversion: an electrical shock is delivered to the heart to stop the fast heart rhythm.
Pacemakers: small electronic devices implanted in the upper chest for slow heart rhythms—those rhythms that occur when the natural pacemaker of the heart or the wires of the heart carry the electrical impulses too slowly.
Implantable Defibrillators (ICDs): protects against fast heart rhythms that can cause sudden cardiac death. This is also implanted in the upper chest and constantly monitors your heart rhythm. When it detects a very fast and dangerous heart rhythm, it delivers a shock to the heart. This causes the heart to beat in a normal rhythm again.
Ablation: a special catheter is used to destroy the electrical pathway of the heart that is causing the abnormally fast rhythm.
Pulmonary Vein Isolation Ablation (PVI): A type of ablation designed specifically to treat atrial fibrillation. Again, catheters are used to prevent signals from creating a fast heart beat.
Examples of Cardiac Arrhythmia Monitors:
Holter Monitoring (24 or 48 Hours)
- Records every heart beat for 24 or 48 hours (Patients do not come back 24 hours later to get the second 24 hour Holter hook up)
- Holters can be applied in the NHI clinics, CHI Hospitals within Nebraska and contracted outreach sites
- If a follow-up is needed, please schedule at least one week from the date the monitor is applied
- Best use: immediate arrhythmia analysis for daily/continuous symptoms
- Disadvantages: the monitors are bulky, and one is less likely to determine etiology of infrequent rhythms
- Order in one-week increments up to three weeks – “real time” analysis
- Medi-Lynx can be applied in the NHI clinics and the CHI Hospital within Nebraska
- Monitors can be mailed to the patient directly from the company
- If patients are to return to the clinic for results, please schedule their follow-up at least one week after post-completion of the monitoring
- Monitors can be worn up to 30 days
- Best use: infrequent arrhythmia symptoms, evaluation for unexplained syncope, weakness, and follow-up for paroxysmal atrial fibrillation (PAF) frequency
- Disadvantage: the electrodes and batteries need to be changed daily
- Zio monitors are like a Holter or provide continuous recording, and can be typically worn 7 to 14 days
- This does not provide “real-time” monitoring
- The patch must be sent back to the company and scanned before any results are known
- The monitor is one adhesive rectangle patch worn continuously
- At completion of the monitoring, the patch is mailed into lrhythm for scanning
- The ordering cardiologist will receive results one week AFTER the Zio has been mailed back to the company, so follow-up should be scheduled accordingly (example: a seven-day monitor should follow up two weeks out)
- The Zio patch is ideally used for athletes as well as cognitively impaired patients
- Zio does not monitor in real-time, therefore is not recommended for patients with suspected life-threatening arrhythmias
- Reimbursement for Zio is not completely supported, which requires the patient to sign a “Waiver for Non-covered services”
Implanted Loop Recorder
- Requires consult with EP prior to implant
- Implanted monitor by EP that has a battery life up to three years
- Records and stores arrhythmias
- Recordings are downloaded (similar to a pacemaker download) in the office
- Useful for patients with syncope