Your provider will do a complete medical evaluation to diagnose arrhythmia. He/she will ask about your medical history and complete a physical exam. Diagnostic tests may be ordered, including:
- Blood tests
- Chest x-ray
- Electrocardiogram (EKG)
- Holter monitor or event monitor (portable EKG/ECG)
- Stress test
There are many different types of arrhythmia. The most common type is atrial fibrillation, or AFib. AFib is an irregular heart rhythm that is often very fast. People with atrial fibrillation are at higher risk of stroke.
• Atrial fibrillation (AFib)
• Atrial flutter
• Paroxysmal atrial tachycardia (PAT)
• Premature supraventricular or atrial contractions (PACs)
• Premature ventricular complexes (PVCs)
• Sick sinus syndrome
• Sinus arrhythmia
• Sinus tachycardia
• Sudden cardiac death syndrome
• Supraventricular tachycardia (SVT)
• Ventricular fibrillation
• Ventricular tachycardia
• Wolff-Parkinson-White syndrome
Arrhythmias are most often treated with lifestyle changes, medications, medical devices, or minimally invasive procedures to regulate the rhythm of the heart. MaineHealth offers a full array of the most advanced treatment services, provided by one of the most experienced EP teams in New England.
- Left atrial appendage occlusion/closure (LAAC) device – This device is implanted in the left atrial appendage of the heart to permanently close off this small pouch and keep harmful blood clots from entering the bloodstream. By closing off the left atrial appendage, the source of more than 90% of stroke-causing blood clots in people with non-valvular a-fib, the risk of stroke may be reduced.
- Pacemaker implantation – A pacemaker is a small device, surgically implanted under the skin, which sends electrical impulses to the heart muscle to maintain an appropriate heart rate and rhythm.
- Cardiac resynchronization therapy (CRT) or biventricular pacing – This is a special pacemaker used to treat the delay in heart contractions that can occur in advanced heart failure. In about 30% of patients with heart failure, an abnormality in the heart's electrical conduction system (called an intraventricular conduction delay or bundle branch block) causes the heart’s two ventricles to beat out of synch, reducing the efficiency of an already-damaged heart. CRT re-coordinates the beating of the two ventricles so they beat simultaneously.
- Implantable cardioverter defibrillator (ICD) placement – Also surgically implanted under the skin, an ICD is an electronic device that constantly monitors the heart’s rhythm. When it detects an abnormal heart rhythm, it delivers energy to shock the heart back into beating regularly.
- Catheter ablation – The most effective treatment for some arrhythmias is to destroy the heart tissue that is causing the short circuit. This non-surgical procedure is called ablation, and it involves threading a catheter through a blood vessel to locate the problem using fluoroscopy (a type of x-ray). Through the catheter, the EP specialist then delivers either radiofrequency energy to cauterize (burn), or intense cold (cryotherapy) to freeze, and destroy a small amount of tissue, which helps restore a healthy heart rhythm. Catheter ablation is successful in a high percentage of cases, eliminating the need for open-heart surgeries or long-term drug therapies in many patients.
- AV node ablation – The AV node is the electrical pathway that connects the atria (upper chambers of the heart) to the ventricles (lower chambers). Disrupting this pathway with a catheter ablation procedure prevents the upper chambers from controlling the rate of the lower chambers (which determines the heart and pulse rate), and can reduce symptoms of atrial fibrillation. Patients who receive AV node ablation will require a permanent pacemaker to activate the ventricles.
- Cardioversion – When the heart beats too quickly, blood can no longer circulate effectively in the body. Cardioversion restores the heart's normal rhythm and efficient pumping action by applying a controlled electric shock to the exterior of the chest.
- Medical management – For certain patients, antiarrhythmic and other cardiac medications such as beta blockers are used to control abnormal heart rhythms. Some patients may also have to take anticoagulant medications to reduce the risk of blood clots.
- Device management – Patients with implanted devices must be regularly monitored. MaineHealth specialists see cardiac patients at local hospitals across Maine and parts of NH to monitor and manage their pacemakers and ICDs.
- Laser lead extraction – A lead is a special wire that delivers energy from a pacemaker or ICD to the heart muscle. Extraction is needed when the leads are not working properly due to damage, the build-up of scar tissue or infection. This is a technically-challenging procedure requiring considerable expertise.
- Open-heart surgery – There also are surgical approaches to treating atrial fibrillation and/or atrial flutter in appropriately selected patients. The traditional procedure, in which a number of incisions are made in the heart’s atria (upper chambers), produces scar tissue that acts as insulation and forces the heart’s electrical impulses to travel in a more normal direction. The operation requires opening the chest and stopping the heart temporarily with use of the heart-lung machine.
- Convergent procedure – Performed by both a cardiothoracic surgeon and a cardiologist trained in electrophysiology, this approach is less invasive than open-heart surgery and can be highly effective in restoring normal heart rhythm in appropriate patients. The convergent procedure uses radio frequency (focused heat) to produce lesions (scar tissue) on the heart to block abnormal electrical signals. The procedure is performed on both the inside and outside of the heart.
Paul’s atrial fibrillation, or AFib, meant his heart was out of tune. When blood thinners were no longer an option, his doctor told him about a new procedure at MMC. Now healthy, and with plans to travel, Paul found the key to living retired life on his terms.
Podcast: New Hope for Patients with Chronic ArrhythmiaAndrew Corsello, MD discusses convergent maze, a new procedure for chronic atrial fibrillation. Performed in Maine only at Maine Medical Center, convergent maze is less invasive than standard surgical treatment and gets patients home sooner. Listen Now
Provider ReferralsIf you are a provider who would like to refer a patient for MaineHealth cardiac arrhythmia services, please review our clinical guidelines and call 207-885-9905. Clinical Guidelines
MaineHealth Cardiovascular Programs:
WATCHMAN is for people with atrial fibrillation not caused by a heart valve problem who need an alternative to warfarin. Talk with your doctor to understand all of the risks and benefits associated with the implantation of the WATCHMAN Device. Image provided courtesy of Boston Scientific. © 2018 Boston Scientific Corporation or its affiliates. All rights reserved. For more information, visit www.WATCHMAN.com.