Heart rhythm problems can often cause fainting or dizzy spells. OHSU's Heart Rhythm and Arrhythmia experts work as a team to determine the best treatment option for you, including but not limited to pacemakers, defibrillators and medications as well as innovative treatments such as radiofrequency ablation as a way to eliminate rhythm problems and avoid long-term drug treatment.
Ablation (also known as cardiac ablation or radiofrequency ablation) is a procedure that uses catheters placed through the blood vessels in the groin up to the heart to find and eliminate sources of arrhythmias. Electrodes at the end of the catheter are used to stimulate your heart and locate the problem areas that are causing the abnormal heartbeat. Then, radiofrequency energy is used to destroy or "ablate" the problem area. This area is usually quite small and once destroyed, the abnormal electrical signals that created the arrhythmia can no longer be sent.
Epicardial ablation – or ablation of cells on the outside the heart muscle – is used for patients whose arrhythmias originate in tissue on the outside of the heart and cannot be treated effectively with standard catheter ablation from inside the heart.During epicardial ablation, a special catheter is passed through the chest wall into the pericardial space around the heart. Using a cooled-tip catheter, radiofrequency energy is then used to cauterize the heart tissue causing the abnormal heart rhythm.
Pacemaker (PPM) Placement
A permanent pacemaker (PPM) is a small device that is implanted under the skin (most often in the shoulder area just under the collarbone) that sends electrical signals to start or regulate a heartbeat. A permanent pacemaker may be used to make the heart beat if the heart's natural pacemaker (the SA node) is not functioning properly or if the electrical pathways are blocked.
Biventricular (BiV) Pacemaker Placement
A new type of pacemaker, called a biventricular pacemaker, is currently used in the treatment of heart failure. Sometimes in heart failure, the two ventricles (lower heart chambers) do not pump together in a normal manner. When this happens, less blood is pumped by the heart. A biventricular pacemaker paces both ventricles at the same time, increasing the amount of blood pumped by the heart. This type of treatment is called cardiac resynchronization therapy.
Implantable Cardioverter Defibrillator (ICD) Placement
An implantable cardioverter defibrillator (ICD) looks very similar to a pacemaker, except that it is slightly larger. It has a generator, one or more leads, and an electrode for each lead. These components work very much like a pacemaker. However, the ICD is designed to deliver an electrical shock to the heart when the heart rate becomes dangerously fast, or "fibrillates."An ICD senses when the heart is beating too fast and delivers an electrical shock to convert the fast rhythm to a normal rhythm. Some devices combine a pacemaker and ICD in one unit for persons who need both functions. After the shock is delivered, a "back-up" pacing mode is available if needed for a short while.The ICD has another type of treatment for certain fast rhythms called anti-tachycardia pacing (ATP). When ATP is used, a fast pacing impulse is sent to correct the rhythm.
Laser Lead Extraction
Use of the excimer laser to remove PPM and ICD wires from the body
Lead extraction is a technically challenging procedure that must be performed when a permanent pacemaker or implantable cardiac defibrillator (ICD) is removed or replaced. Leads are the wires attached to the devices that conduct electrical signals to the heart. After a pacemaker or ICD is implanted, the body forms scar tissue around the leads. The longer the device is in the body, the more scar tissue there is, making removal difficult. In fact, the most challenging part of removing a pacemaker or defibrillator system is removal of the leads, which cannot be left in the body as they would interfere with the new device or cause damage to blood vessels.
OHSU's Electrophysiology physicians are experienced lead extraction experts. In especially difficult cases, they can use an excimer laser to help break up scar tissue, making removal safer and easier.
Some arrhythmias are best treated by medications that can help suppress the areas of arrhythmia. The decision of which medication to use is determined by the type of arrhythmia, other conditions which may be present, and other medications already being taken by the patient.