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Electrical Malfunction

An EKG can be used to assess the electrical function of your heart.

The heart rhythm is controlled by an automatic pacemaker located in the heart tissue.  The pacing system receives input from the brain and hormonal systems of the body. In some patients, the heart rate is too slow requiring an artificial pacemaker. In others, the rhythm is too fast requiring medication to slow the heart to a normal rate. Yet, some patients have locations on the heart, which generate an abnormal beat in place of the normal rhythm. Often these abnormal rhythms are not effective in producing a good blood pressure and need medicines or surgical correction.

ATRIAL FIBRILLATION

Atrial fibrillation (Afib) is the most common heart rhythm problem in the United States. The upper chambers of the heartbeat so fast they can only quiver. Due to the heart's improper pumping function, blood is not completely emptied from the heart's chambers causing it to pool and sometimes clot. This clot can then dislodge and result in a stroke of the brain. Treatment may include drug therapy, percutaneous intervention or ablation, and surgery including the Maze procedure.

SURGERY FOR HEART RHYTHM

Pacemakers

For patients who have a slow heart rhythm or who require medication, which slows the heart down, a pacemaker is often employed. Most often, this is placed with the patient awake. Using a local anesthetic called lidocaine; the pacemaker is placed under the collar bone. A needle is used to find the vein, which runs under the collarbone and through this vein two leads are passed into the heart. These leads are then connected to a device, which acts as a computer to determine when you need pacing and as a battery to provide the stimulation for pacing.

The most common risk of surgery is a pneumothorax, an accumulation of air in the chest outside the lung. This requires placement of a chest tube for a few days. However, there is a small risk with manipulation of a wire in the heart. After placement of the pacemaker, we will monitor your heart in the hospital and at regular six-month intervals thereafter.

Defibrillator

Occasionally, patients will have life-threatening irregular heart rhythms. For these patients, the Automatic Implantable Cardioverter Defibrillator (AICD) administers an electric shock to restore the normal heart rhythm. The AICD has electrodes to monitor the heart rhythm and to deliver a shock when necessary. These are connected to a generator, which evaluates the rhythm and stores energy in large capacitors to administer the necessary shock.

Maze procedure

A new surgical therapy for atrial fibrillation has an excellent success rate for keeping patients in normal sinus rhythm. This minimally invasive procedure requires a very small  incision in the chest and the use of a camera. Two separate energy sources that are commonly used include ultrasound and radiofrequency energy. The atrial fibrillation is converted into sinus rhythm during this procedure. Patients are commonly placed on an antiarrhythmic or anticoagulant post-operatively. The Maze procedure is sometimes done at the same time as other procedures such as coronary artery bypass grafting and heart valve surgeries.