Electrophysiology

Pacemaker

A pacemaker is a small device implanted in the chest. It sends electrical signals to start or regulate a slow heartbeat. It's most often placed in the chest just under the collarbone. A pacemaker may be used if the heart's natural pacemaker (the SA node) is not working properly causing a slow heart rate or rhythm, or if the electrical pathways are blocked.

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Implantable Cardioverter Defibrillator (ICD)

An implantable cardioverter defibrillator (ICD) looks similar to a pacemaker, though slightly larger. It works very much like a pacemaker. But the ICD can send a low-energy shock that resets an abnormal heartbeat back to a normal. It can also send a high-energy shock if an arrhythmia becomes so severe that the heart can't pump at all.

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Cardiac Resynchronization Therapy (CRT)

Cardiac resynchronization therapy (CRT) is treatment to help restore the normal rhythm (timing pattern) of the heartbeat.

A dual chamber pacemaker can help coordinate the timing of the upper heart chambers (atria) and the lower heart chambers (ventricles). A CRT pacemaker (CRT-P) is a specific type of pacemaker with an additional wire that goes to the left side of the heart. This allows it to coordinate the timing between the left and right sides of the heart.

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Atrial Fibrillation Ablation

Ablation is a procedure to treat atrial fibrillation. It uses small burns or freezes to cause some scarring on the inside of the heart to help break up and or insulate the electrical signals that cause irregular heartbeats. This can help the heart maintain a normal heart rhythm.

The heart has four chambers. There are two upper chambers called atria and two lower chambers called ventricles. Normally, a special group of cells begin the signal to start your heartbeat. These cells are in the sinoatrial (SA) node in the upper right atrium of the heart. During atrial fibrillation (AFib), the signal to start the heartbeat doesn’t begin in the sinoatrial node the way it should. Instead, the signal begins somewhere else within the tissue of the atria. This abnormal signalling most commonly occurs near the connection between the pulmonary veins and the left atrium. These veins are what bring blood back from the lungs to the left atrium. When in AFib the atria can’t contract normally to move blood to the ventricles. This causes the atria to quiver or “fibrillate.” The disorganized signal spreads to the ventricles, causing them to contract irregularly and sometimes more quickly than they normally would. The contraction of the atria and the ventricles is no longer coordinated, and ventricles may not be able to pump blood as effectively to the body.

For ablation, a doctor puts thin, hollow tubes (catheters) into a blood vessel in the groin (or both groins) and threads it up to the heart giving access to the inside of the heart. Once the catheter is inside the heart, software mapping systems are used to allow the doctor to study the electrical signals as they occur in the heart as well as navigate where to position the catheter. The doctor then uses the catheters to create organized scar in a small area of the heart by making small burns or small freezes. In the burning process, a type of energy called radiofrequency energy uses heat to scar the tissue. The freezing process involves a technique called cryoablation. Scar does not conduct electrical signals inside the heart. Thus, by creating scar with the ablation, it helps prevent the heart from conducting the abnormal electrical signals that cause AFib.

Sometimes doctors use a surgical approach instead. This is most common when you are already having heart surgery for another reason.

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Ablation

Catheter ablation is a nonsurgical procedure used to treat an abnormal heartbeat (arrhythmia). An arrhythmia can make your heart beat too fast or in an irregular pattern. During the procedure a healthcare provider guides a flexible tube (catheter) into your heart. The catheter is placed near the small area of heart tissue that may be causing your abnormal heartbeat. Once there, heat (radiofrequency) or cold energy (cryoablation) is used to destroy the tissue.

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