Why see an EP?
Electrophysiologists (EPs) are cardiologists who have undergone extensive cardiology education and training. They are able to perform procedures like ablations and treat people who are specifically connected to arrhythmias like Afib. An EP can help you take steps toward determining the most effective treatment for you, and restoring normal rhythm.
How Treatment Works
Many options are available to treat Afib, including lifestyle changes, medications, catheter-based procedures and surgery. The type of treatment that is recommended for you is based on your particular heart rhythm and symptoms. The goals of treatment for Atrial fibrillation include regaining a normal heart rhythm (sinus rhythm), controlling your heart rate, preventing blood clots and reducing the risk of stroke. Most often, the timing of when to do a specific treatment is just as important as what to do.
There are, generally, three types of medications to help manage Afib:
These medications are used to reduce blood clotting and prevent stroke in Afib patients. They can range from aspirin, which causes platelets to become less adhesive, to prescription medications like warfarin, which thins the blood to prevent coagulation.
Rate control medications, such as beta blockers, calcium channel blockers and cardiac glycosides, can be used to bring the heart rate down in order to reduce Afib symptoms.
Antiarrhythmics are rhythm control medications. From sodium channel blockers to potassium channel blockers, they can impede the electrical signals that cause Afib, thereby keeping it suppressed in order to maintain normal rhythm.
When medications do not work to control Afib, or when they are not well tolerated, a procedure may be needed to treat your abnormal rhythm.
This is an outpatient procedure performed under short- acting sedation that electrically “resets” the heart. A low dose of energy reactivates normal rhythm, although its effect may not be permanent.
Catheter ablation is a minimally invasive procedure that typically applies radiofrequency energy to eliminate the small areas of heart tissue that are causing your Afib. Catheter ablation is designed to restore the heart’s normal rhythm on a long-term basis.
An electrophysiologist (EP) performs the procedure, guiding catheters to the heart usually through a vein in the groin or neck. The procedure can take up to several hours and is performed under sedation with
an anesthesiologist. Patients typically go home the following day and return to normal life and activities in one to two weeks. Medications for controlling the arrhythmia may be reduced or even eliminated following successful catheter ablation.
There are a few primary devices available Baptist Health that can be implanted in the body in order to regulate a normal heartbeat and reduce frequency/severity of arrhythmias.
These are small electrical devices, implanted under the skin close to the collarbone, that transmit an electrical signal to control proper contracting of the heart’s rhythm.
Baptist Health offers the latest MRI-compatible pacemakers and is one of only 25 research centers in the nation, and one of only two in Florida, to offer the new leadless pacemaker. This advancement allows the world’s smallest pacemaker — the size of a vitamin — to be placed directly into the heart without any attached wires and offers numerous benefits.
ICDs (implantable caridoverter-defibrillators) are implanted devices used to perform cardioversions and restore and correct pacing of the heart. Unlike pacemakers, they are also able to treat unexpected, life- threatening arrhythmias such as Ventricular Tachycardia and Ventricular Fibrillation.
Baptist Health offers the most advanced defibrillator technologies. The new subcutaneous defibrillator has wires placed under the skin instead of directly into the heart to decrease chances of infection. The new ICD Mini is the world’s smallest heart defibrillator. New biventricular defibrillator implants now utilize the latest biventricular leads for patients whose hearts are both weak and out of sync to improve symptoms and quality of life.
Maze surgery is conducted during open-heart surgery, and is generally recommended for patients who are undergoing cardiac surgery for another reason. Small incisions are made in the upper part of the heart and then stitched back together to form scar tissue. Scar tissue does not carry electric currents and, therefore, it blocks the rogue impulses that contribute to Afib.
Which Procedure is Right for Me?
Medications, like those mentioned above, are the typical first line of defense against Afib. However, the success of medication alone is indefinite and often, alternative treatments can provide more successful results over long periods of time. Baptist’s EPs advocate for the following treatments when medication alone is no longer an option:
Success at ablating increases when targeting the arrhythmia at earlier stages. For people with paroxysmal Afib, Baptist offers pressure sensing ThermoCool SmartTouch® Catheter to burn the sources of Atrial fibrillation in the heart, or the new Cryoballoon Catheter that uses miniature balloons at subzero temperatures to freeze them. Both have an 80% overall success rate.
Persistent & Longstanding Persistent Patients
For people with longstanding and persistent Atrial fibrillation cases, the ThermoCool SmartTouch® Catheter can be used to target the problem sources within the heart. The catheter is beneficial in that it allows higher energy transference into the heart tissue in order to create more effective lesions. The pressure sensor on the catheter tip allows better tissue contact for effective lesions and to avoid perforations.
Combining these capabilities with the three dimensional virtual, real time map, allows Baptist’s EPs to use their experience and training toward the goal of obtaining the best outcomes for each patient.
Patient wellness is priority number one. Since Baptist’s heart specialists are always aware of the small but real possibility of serious complications with all procedures, we take precautions to reduce these risks. We use anticoagulation protocols to reduce risk of stroke, safer, pressure sensing catheters, and intracardiac ultrasound devices that reduce risk of perforations. Our board certified anesthesiologists are able to achieve adequate patient sedation and allow constant monitoring of blood pressure and other vital signs during the case. We put safety first, and are sure to take necessary precautions in order to maintain the integrity of our procedures and wellbeing of our patients.