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Electrophysiology

Electrophysiology

Cardiac electrophysiology is a branch of cardiology that deals with abnormal heart rhythms – when the heartbeat is too fast, too slow or irregular.

Over two million Americans have abnormal heartbeats, the most common of which is atrial fibrillation. While the symptoms may be severe or barely noticeable, cardiac arrhythmias significantly increase the risk of stroke, heart attack and sudden cardiac arrest. Fortunately, there are many effective medical and interventional cardiology treatments for this common cardiac problem.

Until now, most Seacoast patients with abnormal heart rhythms were referred to Boston- area electrophysiology labs, staffed by cardiologists with advanced training in the treatment of abnormal heart rhythms. But thanks to a collaboration of Seacoast area cardiologists and our continuing investment in new technology, advanced electrophysiology services are now available at the Heart & Lung Center at Portsmouth Regional Hospital.

Our Board Certified Electrophysiologists, Dr. Bruce Hook and Dr. David Martin and Dr. David Cunningham, have decades of experience and training in the latest diagnostic and treatment approaches. To learn more about their credentials, please visit our Doctors page.

This Web page presents general information about cardiac arrhythmias and some of the most common treatment options:

Symptoms of Cardiac Arrhythmia

  • Arrhythmias may cause a variety of symptoms including
  • Chest palpitations
  • Lack of energy
  • Dizziness
  • Chest discomfort
  • Shortness of breath
  • Fainting spells

Even if these symptoms are mild, they should always be discussed with your doctor. Untreated, arrhythmias greatly increase the risk of heart disease and stroke.

Treatment Approaches

The cardiologists at the Heart & Lung Center use a variety of approaches for treating cardiac arrhythmias, choosing the least invasive options first. Medications are often effective in slowing down rapid heart rate, and “cardioversion” may be used to restore normal heart rhythm with an electric shock if medications alone don’t work.

Radiofrequency ablation, pacemakers and implantable defibrillators are effective interventional cardiology treatments performed by our electrophysiologists in the Heart & Lung Center’s cardiac catheterization laboratories.

Diagnostic Electrophysiology Studies

In patients with an abnormal heart rhythm, an electrocardiogram (E.C.G. recording), performed during symptoms, often leads to a diagnosis. In many cases, however, a routine E.C.G. does not give a complete diagnosis, and an E.P. study (Intracardiac Electrophysiologic Procedure) may be needed.

In an E.P. study, narrow catheters are advanced through the veins of the leg or the shoulder into the heart and E.C.G. signals from inside the heart are recorded. The heart is then stimulated to produce the abnormal rhythm, and the signals are recorded. These recordings enable the electrophysiologist to diagnosis the problem and determine the best course of treatment, which may involve medicines, implantable devices or ablation.

Radiofrequency Ablation

Radiofrequency ablation is the preferred treatment for many types of rapid heartbeats. It has a success rate of over 90 percent and a low risk of complications. It causes little or no discomfort and patients can resume normal activities in a few days.

Radiofrequency ablation involves the use of mild, painless radiofrequency energy (similar to microwave heat) to permanently cure arrhythmias. The cardiac electrophysiologist guides a catheter with an electrode at its tip to the exact site inside the heart where cells give off the electrical signals stimulating the abnormal heart rhythm. Then a mild, painless radiofrequency energy (similar to microwave heat) is transmitted to the heart muscle cells in a very small area (about 1/5 of an inch). That stops the area from conducting the extra impulses that caused the rapid heartbeats.

Radiofrequency Ablation During Cardiac Surgery

Patients with serious heart disease requiring open-heart surgery frequently have cardiac arrhythmias as well. Dr. Donato Sisto, our Chief of Cardiac Surgery, is internationally renowned for pioneering the use of radiofrequency ablation during cardiac surgery. By treating the patient’s arrhythmia along with his or her arterial blockage or valve problem, the surgical outcome can be significantly improved.

Pacemaker Implantation

As explained by the American Heart Association, an "artificial pacemaker" is a small, battery-operated device that helps the heart beat in a regular rhythm. Some are permanent (internal) and some are temporary (external). For some patients whose arrhythmias cannot be treated adequately with medication or ablation, a pacemaker can be a lifesaving tool.

A pacemaker uses batteries to send electrical impulses to the heart to help it pump properly. An electrode is placed next to the heart wall and small electrical charges travel through the wire to the heart.

ICD Implantation

We’re all familiar with external defibrillators; devices used by EMT's, physicians and even lay people to deliver an electric shock to restart the heart during cardiac arrest. Defibrillators are also used to stop life-threatening tachycardias (very rapid heart beats). Implantable defibrillators can provide automatic electrical therapy on a chronic basis for patients with recurrent tachycardias. The greatest advance in this area is the implantable cardioverter defibrillator (ICD), used in patients at risk for recurrent, sustained ventricular tachycardia or fibrillation.

For More Information

For more information about the Electrophysiology Service at the Heart & Lung Center, please call 603-433-4032. To learn more about cardiac arrhythmias and their treatment, we invite you to visit the following excellent Web sites.

The American Heart Association Web site:
www.americanheart.org

Medline Plus – A Service of the US National Library of Medicine and the National Institutes of Health
http://www.nlm.nih.gov/medlineplus/arrhythmia.html

The American Academy of Family Physicians Web site:
www.familydoctor.org

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Locations

  • Seacoast Cardiology Associates, PA<br>

    Seacoast Cardiology Associates, PA
    2064 Woodbury Avenue
    Newington Park, Building 1, Ste 103
    Newington, NH 3801

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  • Lahey Clinic<br>

    Lahey Clinic
    41 Mall Road
    Burlington, MA 1805

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  • Clipper Cardiovascular Associates<br>

    Clipper Cardiovascular Associates
    333 Borthwick Avenue
    Suite 402
    Portsmouth, NH 03801

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  • Coastal Cardiothoracic Associates<br>

    Coastal Cardiothoracic Associates
    333 Borthwick Avenue
    Suite 402
    Portsmouth, NH 3801

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