Electrophysiology

Electrophysiology services at The New England Heart & Vascular Institute offers several options to help manage arrhythmias:

If you have symptoms of an arrhythmia, you may be referred for outpatient testing in Non-Invasive Cardiology. This includes electrocardiograms, echocardiograms, Holter monitoring, event recorder, and exercise test (stress test or treadmill test). 
 
In certain cases you may have an event monitor implanted under the skin to keep track of the heart for long periods of time and automatically transmit data to the physician’s office. You could also be referred for a diagnostic cardiac electrophysiology study. This is when catheters are placed in the heart to record electrical signals inside the heart.

Some arrhythmias are caused by abnormal cells and circuits in the heart tissue that alter the conduction of the electrical signals which control the heartbeat. Ablation can improve heart arrhythmias by destroying those abnormal cells and circuits that can cause an irregular heartbeat. 

During the procedure, catheters are placed in the heart. Radiofrequency energy is delivered through one of the catheters and ablates the cells and circuits responsible for the arrhythmia.

After receiving an implanted device, your provider will continue to monitor your care. It is important to check the battery and the leads on a regular basis to make sure the device is working properly. Using advanced technology, this can be done from home, eliminating the need of an office visit.

Most pacemakers and implantable cardioverter defibrillators (ICD) include small wires or coils, called leads, which run from the device into the heart.  Over time, fibrous tissue forms over these leads.  A lead extraction may be necessary if the leads stop working or if an infection forms on this tissue. 

Leads that have been in place for less than a year can usually be removed in a short procedure performed in CMC’s electrophysiology lab.  Laser extractions are conducted in our hybrid operating room to remove leads that have been in place longer than a year that are infected, malfunctioning, or had previously been abandoned inside the body.  The laser procedure carefully removes the lead from the tissue that has grown around it, minimizing the damage to blood vessels in the heart. 

Lead extraction is only recommended in patients who have an infection or complication related to their leads, or for those with abandoned leads.
 

Implantable cardioverter defibrillators (ICDs) and pacemakers are devices that can help maintain a normal heart rhythm. A pacemaker uses electrical pulses to help the heart beat normally when it is too slow. An ICD senses a dangerously abnormal rhythm and delivers therapy to stop the dangerous rhythm. ICDs also act as pacemakers. A biventricular ICD or pacemaker, known as a CRT (Cardiac Resynchronization Therapy) device, is for heart failure patients who may have an arrhythmia. This device helps the chambers of the heart to beat in a way that relieves symptoms of heart failure.

These devices are generally placed under the skin near the shoulder and have wire leads placed into the heart.  The New England Heart & Vascular Institute now offers Micra the world’s smallest, leadless pacemaker.  The device is inserted directly into the heart via a catheter and is about the size of an adult vitamin.