The Rhythm of the Beat

New service line broadens care for arrhythmia patients.

Every heart has a rhythm, and that rhythm is measured by the heart’s electrical system.

That’s what happens when special cells create electrical signals that travel along pathways to the heart’s upper and lower chambers. The signals prompt the chambers to fill up with blood, then eject it in a precise sequence. A completed sequence constitutes a heartbeat.

But sometimes, abnormal cells in the heart create abnormal electrical signals that cause irregular heartbeats called arrhythmias. There are different types of arrhythmias. Some are harmless, but others are life-threatening.

“People may have slow heart rhythms, which include bradycardia, complete heart block and pauses in heart rhythm,” notes Jared Collins, DO, a board-certified internist and fellowship-trained cardiac electrophysiologist at Lakewood Ranch Medical Center.

“There are fast arrhythmias as well, such as atrial fibrillation, atrial flutter and supraventricular tachycardia. There are heart rhythm disorders that come from the bottom of the heart, including ventricular tachycardia and ventricular fibrillation, which can be deadly.”

In some cases, people are born with excess conduction tissue in their heart that creates extra electrical signals, causing an arrhythmia. Most times, however, arrhythmias develop over time.

Many factors can contribute to arrhythmia development, including scarring of the heart from a heart attack, high blood pressure, hyperthyroidism, coronary artery disease, diabetes, smoking, drug abuse, excessive caffeine intake, stress and certain medications. Symptoms vary depending on the arrhythmia.

“Sometimes, arrhythmias have no symptoms, and the patient’s doctor discovers the condition on a routine examination,” Dr. Collins informs. “In other cases, there are noticeable symptoms. But having symptoms doesn’t necessarily mean there’s a serious heart problem. That’s determined through a thorough physical exam and testing.”

Noticeable arrhythmia symptoms include a feeling that the heart is racing or skipping beats, which is common with tachycardia; a slow heartbeat, which is a symptom of bradycardia; or shortness of breath, chest discomfort, dizziness, sudden weakness, sweating, fainting and sudden cardiac arrest, which can occur with ventricular fibrillation.

Identifying the source of the arrhythmia is necessary to determine the most appropriate treatment, Dr. Collins stresses.

“Everyone’s heart has its own native pacemaker system,” the doctor relates. “But over time, abnormalities in the normal heart rhythm can arise, and oftentimes, those abnormalities must be clearly defined.

“In those cases, invasive tests may be the best way to localize the abnormalities and determine where in the heart they’re coming from. We may need to study people’s electrical system in detail to determine treatment for their arrhythmia. We do that by stimulating the heart in various regions via catheters and evaluating how the heart reacts.”

The tests used are called electrophysiology, or EP, studies, and they’re among the services offered through Lakewood Ranch Medical Center’s new electrophysiology service line. The service line was introduced in July following the installation of new equipment in Lakewood Ranch Medical Center’s expansion of the cardiac catheterization/electrophysiology lab.

“This service line is a great benefit for our community,” Dr. Collins asserts. “It gives us the opportunity to treat patients at Lakewood Ranch Medical Center who previously had to be transferred to other facilities to receive those services. It further localizes specialty care.”

Abnormalities Ablated

“There are noninvasive methods for monitoring patients’ heart rhythms, including EKGs and Holter monitors, but those methods give us incomplete information,” Dr. Collins reports. “To get more in-depth data about a patient’s heart rhythm and electrical system so we can determine the best treatment, we often have to perform EP studies.

“Once those studies are completed and we have the information we need, we can more effectively treat the patient’s arrhythmia with medication, an implanted device or a procedure called radiofrequency ablation.”

Medications may be used to treat tachycardia, a fast heart rhythm. Medications will not cure the arrhythmia but are typically effective at reducing its symptoms and reestablishing proper electrical conductivity in the heart.

“Patients diagnosed with slow heart rhythms, or bradycardia, may benefit from an implanted cardiac device, such as a pacemaker,” Dr. Collins observes. “A pacemaker uses electrical pulses to prompt the heart to beat at a normal minimum rate.

“An implantable cardioverter defibrillator, or ICD, is a device that detects dangerously fast or chaotic heartbeats and delivers a shock to the heart to restore normal rhythm. We implant pacemakers and ICDs at Lakewood Ranch Medical Center.”

During radiofrequency ablation, catheters are inserted, typically through a vein in the leg, and worked up through the venous system into the heart. Through the catheters, the electrophysiologist stimulates the heart and localizes the areas where the abnormal signals are originating.

“We use radiofrequency energy to wipe out those areas and eliminate the abnormal signals they’re creating,” Dr. Collins explains. “We deliver heat energy to very localized regions of the heart to destroy the abnormal tissue without damaging the rest of the heart.

“Using radiofrequency energy, we’re able to cause controlled areas of scarring in the heart to ablate the abnormalities and leave the rest of the heart in healthy condition.”

The Sooner, the Better

To reduce the risk of developing arrhythmias, people should live a heart-healthy lifestyle. That includes exercising regularly, maintaining a healthy weight and eating a low-fat diet with plenty of fruits, vegetables and other vitamin-rich foods.

“If people smoke, they should quit,” Dr. Collins adds. “And they should limit their intake of alcohol and caffeine. Some people will notice an increase in symptoms when using products high in caffeine such as tea, coffee, soda and certain over-the-counter medications.

“They should avoid stimulants as well, which can be found in certain cough and cold medicines, and some herbal and nutritional supplements. Some of those products can lead to irregular heart rhythms. I recommend people consult their doctor or pharmacist to determine which products are best for them. They should also avoid illegal drugs.”

There are other factors that put people at risk for arrhythmias. These include stress because severe stress, anxiety or fear can cause the heart to beat out of rhythm, as can intense physical activity. People must find healthy ways to manage stress, and if certain physical activities lead to abnormal heart rhythms, those activities should be avoided.

“People should talk with their doctor about treating conditions that may contribute to the development of arrhythmias, such as coronary artery disease, hyperthyroidism, high blood pressure and diabetes,” Dr. Collins says. “Keeping these conditions under control can help reduce the risk for heart rhythm disorders.

“It’s important that people get regular physical exams and tell their doctor about any unusual symptoms they’re experiencing. Most arrhythmias are harmless, but others can be deadly. In any case, the sooner they’re discovered and treated, the better.”

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    • Jared Collins, DO

      Jared Collins, DO, is board-certified in cardiovascular disease and internal medicine by the American Board of Internal Medicine. He is also certified in echocardiography by the National Board of Echocardiography and in nuclear cardiology by t... Read More