Electrophysiology and Cardiac Arrhythmia

Electrophysiology (EP) is the study of electrical activity—beats and rhythms—in the heart. Cardiac arrhythmia means abnormal heart rhythm. The cardiac electrophysiologists at Harrison are board-certified cardiologists who use minimally invasive procedures to help hearts beat as they should.

Our skilled team of doctors, nurses, and technicians work in our newly opened Heart & Vascular Center with brand-new equipment. Electrophysiology care is considered an advanced subspecialty of cardiac care, most often available in major cities and at academic medical centers. We offer these services right here in Kitsap County. The lab in our Heart & Vascular Center is specifically dedicated to patients needing electrophysiology procedures and treatments.

Arrhythmia diagnosis and treatment with EP

Arrhythmia can occur independent of heart disease, and heart disease can exist without rhythm abnormalities—in any range from benign to life threatening, from fleeting and episodic to persistent. That’s why having an expert electrophysiology team on your side for diagnosis and treatment is so important.

• Tachycardia: This fast heart rhythm causes palpitations (a sense of the heart pounding rapidly in the chest), and can be associated with shortness of breath, chest pain, dizziness, or even passing out.
• Fibrillation or fluttering: These fluctuating heart rhythms may manifest as extreme fatigue.
• Bradycardia: These slow heart rhythms can cause fatigue, as well, but in their most severe form, can cause unconsciousness.
• Other: Some conditions have a combination of dysfunctional rhythms. Electrophysiology assessments can discover and treat them.

EP and Ablation

Sometimes, the heart’s electrical flow gets blocked or travels the same pathways repeatedly—creating a “short circuit” that disturbs heart rhythms. Medicine often helps. In some cases, the most effective treatment is to destroy, also called ablate, the tissue housing the short circuit.

Ablation is a minimally invasive procedure: catheters (thin, flexible tubes) are threaded through the patient's blood vessels to reach the heart. Energy applied through the catheter tip destroys the abnormal heart tissue causing the heart rhythm disorder. This energy may take the form of radiofrequency energy (heat) or cryoblation (freezing).

Radiofrequency ablation to treat and actually cure atrial fibrillation (quivering of the heart muscles of the atria, instead of a coordinated contraction) is only available at the most advanced cardiac centers—including Harrison—and is a common procedure for us.

EP and Implanted Devices: Implantable Cardiac Defibrillators (ICDs) and Pacemakers

Our highly competent and experienced EP team implants hundreds of devices each year. Patients who have a cardiac device implanted must receive follow-up care for many years. Harrison offers you comfort and peace of mind there is even more comfort in having both the procedure and aftercare close to home.

The latest advances in life-saving device technology are available at Harrison—smaller devices, more sophisticated device drivers, wireless communication abilities so the pacemaker can be ‘tested’ daily while the patient sleeps, and home monitoring that alerts your doctor if something is amiss. This allows you to live your life with fewer disruptions to your normal routine.

Implantation is a minimally invasive procedure: devices are connected to leads positioned inside the heart. These leads are used to deliver electrical shocks, sense the cardiac rhythm and pace the heart as needed. The leads are tunneled to a pulse generator, which is implanted in a pouch beneath the skin of the chest or abdomen. These generators are typically a little larger than a pack of saltine crackers and have electronics that automatically monitor and treat heart rhythms recognized as abnormal. Newer devices are smaller and have simpler lead systems. 

• Pacemakers are used when the heart rhythm is slow and not treatable with medication alone. Pacemaker leads can stimulate either the atria (top chamber of the heart) or ventricle (bottom chamber of the heart) or both to cause them to contract. 
• Defibrillators are slightly larger than a pacemaker and prevent cardiac arrest. The device shocks the heart if it detects a life-threatening rhythm disturbance. A defibrillator also can stimulate the heart like a pacemaker, help stop fast rhythms, and at times, prevent the heart from beating too slowly.

What you can expect during procedures

Major risks of EP studies and ablation such as death, stroke, and heart attack are very uncommon (less than one percent).

With liberal use of numbing injections and moderate sedation, the procedures used to diagnose, correct problems, or implant a device are well tolerated. Sometimes general anesthesia is administered during electrophysiology procedures.

Life after ablation or device implantation

Ablations are usually same-day procedures. After a period of rest, recovery, and observation in our Heart & Vascular Center care unit, there are few after-effects from the procedure itself.

With device implantation, recovery may take slightly longer, but it will be possible to get back to normal activities within a few weeks or months. Some patients hope that having a new implanted device means they can stop their cardiac medications, but this is not the case. Devices usually work better when coupled with medications than without.

How dramatically you feel a change after the procedure depends on the condition of your heart before treatment. Some patients have had an asymptomatic condition, and even if a pacemaker is implanted, it provides undetectable protection from dangerous heart rhythms. In other cases, patients who have been impaired by slow heart rates can feel instantly better and more energetic living with a pacemaker.

More than 150,000 pacemakers are implanted each year in the U.S. with great results. Most often, patients are concerned about restrictions to their daily lives. Contrary to common misconception, patients can use cell phones, portable electronic devices, microwave ovens, etc., with minimal restrictions. We discuss simple instructions regarding metal detectors and the use of electronics. Patients rarely have to adapt their lifestyles much after having a pacemaker implanted.

Device aftercare includes close follow up with your primary cardiologist immediately after the procedure followed by checkups every 3-6 months to ensure device efficacy. To help you understand and manage, Kitsap Cardiology Consultants (KCC) offers a support group for ICD patients. Often intimidated by their condition and the notion of having regular shocks, we conduct free monthly ‘ICD Support Group’ meetings in conjunction with St. Jude Medical. Patients receive education about living with an ICD and answer to their specific questions—and enjoy a new lease on life.