What to know about variable heart rhythms and AFib
An Ohio State cardiac electrophysiologist shares what to know about heart rhythms and AFib.
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An arrhythmia, sometimes referred to as an irregular heartbeat, is an abnormal rhythm of the heart, which can cause the heart to pump less effectively. The heart may pump too fast, too slow or irregularly.
At least 2.7 million Americans have atrial fibrillation, the most common rhythm disorder, and the number is expected to double in the next 30 years.
As one of the top programs in the nation treating heart rhythm disorders, Ohio State offers cutting-edge care to treat arrhythmias:
We are the only hospital in central Ohio and one of the first heart and vascular centers in the world to do rotor mapping of atrial fibrillation for ablation of rotors in the heart, using focal impulse and rotor modulation (FIRM) guided therapy.
Physicians who treat heart rhythm disorders are known as electrophysiologists. The Electrophysiology team at Ohio State Richard M. Ross Heart Hospital consists of the largest group of electrophysiologists in central Ohio, as well as more than 100 nursing staff members dedicated to the care of patients with arrhythmias.
There are different kinds of arrhythmia or irregular heartbeats. When the heartbeat is too slow (fewer than 60 beats per minute), it’s called bradycardia or bradyarrhythmia. When the heartbeat is too fast (more than 100 beats a minute), it’s called tachycardia or tachyarrhythmia. Arrhythmias can occur in the upper chambers (atria) or the lower chambers (ventricles) of the heart.
Some heart rhythm disorders can be inherited arrhythmias, which are based on your genes.
The symptoms of arrhythmias may resemble other conditions, so it’s important to talk to your doctor for a diagnosis.
Certain health conditions can cause you to develop an irregular heartbeat. These conditions include:
Other factors that can cause an irregular heartbeat include:
Living a heart-healthy lifestyle can help reduce your chances of developing an arrhythmia. Lifestyle modifications you can make to reduce your risk include:
An electrophysiology (EP) study is an invasive test of the electrical system of the heart to help diagnose an abnormal heart rhythm. A heart rhythm expert (electrophysiologist) performs this test. The electrical system of the heart is the part of the heart that coordinates the beating of the heart muscle. Entering a leg vein, the electrophysiologist positions electrode catheters (long wires) inside your heart using X-ray guidance. The electrophysiologist uses these electrode catheters to evaluate the electrical system of the heart to see if there is a problem with the heart rate going too slow (bradyarrhythmia or bradycardia) or too fast (tachyarrhythmia or tachycardia).
If you’re experiencing symptoms such as fainting, episodes of almost fainting, sensations of rapid heartbeats or excessively slow heartbeats, your physician may recommend an electrophysiology study. Your electrophysiologist will make a diagnosis based on the results of your study. If you are found to have a heartbeat that is too fast, you may be a candidate for catheter ablation. Your physician will also be able to determine if you are a candidate for a pacemaker or implantable cardioverter defibrillator based on the results of your electrophysiology study.
You shouldn’t eat or drink anything other than water for a period of time before the test, often starting at midnight the night before your test. Your physician will give you specific instructions on which medicines, if any, you should stop taking before the test. If you’re not given specific instructions, please take your medicines as you normally would.
On the day of your EP study, a nurse will start an intravenous (IV) line. The IV line allows the doctor to give you medicine during the test, if needed. Your nurse will also shave an area over your groin. This is where your doctor will insert the tubes (catheters) and wires during your test.
Although you’ll receive a general time for your test, you may undergo the EP study at any time during the day. The time will depend on how many patients are scheduled, how long each test takes and if there are any emergencies.
You’ll undergo the EP study while you’re sedated to a comfortable state, but you will not be under general anesthesia unless ordered by your doctor. Members of your care team will help you onto the X-ray table, and the nurses will prepare you for the procedure by placing adhesive pads on your chest and legs. A nurse will place a large sterile sheet over your body, from your neck to your toes. Your electrophysiologist will then insert catheters (flexible tubes) or pacing wires into the blood vessel in the groin area. The anesthesiologist will inject local numbing medicine so that you don’t feel any discomfort when the electrophysiologist places the catheters.
Your electrophysiologist will position the pacing catheters into the heart using X-rays to guide positioning of the catheters. These catheters allow recording and testing of your heart’s electrical system.
Your test may be brief or may last a few hours. Your electrophysiologist will do the test as quickly and as safely as possible while obtaining all of the information needed.
When the test is over, your electrophysiologist removes the catheters and wires and places pressure over your blood vessels to stop any bleeding. To prevent bleeding, you’ll need to be in bed and have your leg straight for about three to four hours. Your nurse will tell you when you may get up. If you need to use the bathroom during this time, please ask the nurse for help.
Your nurse will check the areas where the catheters were placed, as well as your pulse and your blood pressure several times. You’ll be able to eat and drink after your procedure. Your doctor will decide when the IV will be stopped.
Right after the test, your doctor will talk with you and your family to review the results and the plan of care for you and will relay this information to your primary care doctor.
The results of the EP study may indicate a need to implant a pacemaker to treat a slow heart rhythm, or to implant a implantable cardioverter defibrillator to treat a rapid heart rhythm from the bottom chamber of the heart.
For some patients, the EP study may reveal a rapid heart rhythm problem from the top chamber of the heart, called paroxysmal supraventricular tachycardia. Your cardiologist may recommend radiofrequency catheter ablation to manage paroxysmal supraventricular tachycardia. In this treatment, the cardiologist uses a catheter that’s positioned at the site of origin of the paroxysmal supraventricular tachycardia to deliver radiofrequency energy. The radiofrequency energy creates an irreversible lesion (injury to the tissue) in the heart to permanently eliminate the paroxysmal supraventricular tachycardia.
The initial part of the radiofrequency catheter ablation procedure is to find and map the origin of the paroxysmal supraventricular tachycardia. This process may include the use of advanced technology that allows 3D mapping of multiple heart chambers. Once your cardiologist finds the site of origin of the paroxysmal supraventricular tachycardia, they can create the ablation lesion using radiofrequency energy. Ohio State Ross Heart Hospital offers advanced ablation technology that includes use of large-tip radiofrequency catheters, cooled-tip radiofrequency catheters, pulsed-energy radiofrequency ablation and cryo-ablation energy. Radiofrequency ablation is often quite successful, with a success rate of about 96 – 98%.
It's pretty unusual when a patient has a heart condition that doctors can't explain. It's even more unusual when the patient is a doctor himself. But that was the case for Dr. Walter Roehll, a respected cardiologist from Middletown, Ohio. Dr. Roehll had experienced some heart palpitations every now and then, but he didn't think much about it because they would always stop. Then one day, the active 81-year-old came home from his usual run and felt oddly lightheaded.
Dr. Roehll took his blood pressure and saw that it was low. Knowing that something was wrong, he told his wife they'd better go to the ER. As soon as they arrived, Dr. Roehll instructed the staff to run an electrocardiogram. The technician had just hooked him up to the ECG monitor when the next thing he heard was "Code 99!"
Dr. Walter Roehll talks about his rare heart rhythm problem and how Ohio State Wexner Medical Center effectively treated it.
Dr. Walter Roehll and Dr. William Abraham explain how Ohio State was able to locate and fix Dr. Roehll's highly unusual heart rhythm irregularity.
Dr. Raul Weiss talks about the amount of detail it took to find the cause of Dr. Roehll's abnormal heart rhythm.
John Hummel, MD, a heart rhythm specialist at Ohio State’s Heart and Vascular Center, explains the causes, symptoms and treatments of abnormal heart rhythms.
Ohio State was one of the first in the country to implant a tiny, high-tech pacemaker, only 24 millimeters long, directly into the heart of patients, without surgery.
The electrophysiology team at Ohio State Ross Heart Hospital consists of the largest group of electrophysiologists in central Ohio as well as more than 100 nursing staff members dedicated to the care of patients with heart rhythm problems. Ross Heart Hospital is also home to one of the highest volume programs in the nation.
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