If you suffer from an arrhythmia like Afib and specifically a fast heartbeat known as tachycardia, you may have seen information on two very different ways to get the heart back into sinus or normal rhythm. First, we’d like to give you an overview of each procedure; then, we will discuss when these procedures can be used to maximize effectiveness.
Cardioversion involves shocking the heart back into its normal rhythm. It’s a straightforward procedure that EMTs can perform during an emergency but is more often scheduled with your electrophysiologist. Pads are placed on the chest, and an electric shock is delivered to the heart to reset its electrical signals.
While electrical cardioversion uses shocks to bring the heart back into normal rhythm, there are also medications that, in theory, can do the same thing. While some patients may benefit from chemical cardioversion (thus avoiding sedation and electric shock), electrical cardioversion is typically much more successful.
How Does Cardioversion Differ from Defibrillation?
While the principle of shocking the heart is the same, cardioversion delivers a milder shock. Defibrillation is always used during emergencies where the patient is at significant risk for sudden cardiac death. Cardioversion is used to shock the heart out of an arrhythmia.
Cardiac Catheter Ablation
On the other hand, cardiac catheter ablation is a much more involved procedure that requires anywhere from 2 to 4 hours. During this procedure, a catheter is threaded up a vein in the groin to the heart. The heat generated by RF waves or cold generated by cryo-ablation is delivered to the specific areas of the heart, neutralizing the heart tissue causing the arrhythmia.
When Would Either Be Used?
Cardioversion may be used as a first step intervention to shock the heart back into normal rhythm. This is typically performed early in the continuum of patient care with the hope that an arrhythmia is a one-off event. However, if the patient begins to experience more frequent arrhythmia episodes or if it is clear that the arrhythmia is here to stay, cardiac catheter ablation is often a more suitable option. Why? If there is an underlying cause of the arrhythmia, cardioversions do not address it. It simply brings the heart back to normal. On the other hand, cardiac catheter ablation targets the errant electrical signals of the heart by destroying the tissue that creates them. While an ablation is more involved, it can significantly reduce the likelihood of future Afib or other arrhythmia episodes.
Most importantly, if you are experiencing occasional or persistent atrial fibrillation, it is important to visit an electrophysiologist like Dr. Banker to understand the next steps in the treatment process. For some, lifestyle changes and medication may be sufficient to control arrhythmia. For others, however, cardiac catheter ablation may be a good option for controlling the arrhythmic events and reducing dependence on medication.
Dr. Banker is the principal investigator or PI of a groundbreaking first-ever study of a dual-chamber leadless pacemaker. If this device is ultimately FDA approved, it would be the world’s first and significant step forward in pacemaker technology and miniaturization. To understand how significant this is, it’s essential to discuss existing pacemaker technology and its limitations.
Fascinating new research shows the benefits of walking-related to our biological age. Most of us may have commented on how we feel so much younger or older than we were at one time or another. This phenomenon and feeling arise due to the often-underappreciated differences between biological and chronological age.
For most of us, feeling young or old is very subjective. They may revolve around stressful or happy times in our lives. They are strongly influenced by how we think of ourselves emotionally and the aches or pains we may be experiencing. However, it’s essential to realize that we may also “feel younger” on a cellular level. Research is starting to show possible connections between one’s biological age and telomere length as an objective measurement within the body.
If you’ve ever seen an EP lab, you will notice that it is one of the most advanced operating theaters of any medical specialty – humming with technology. And there is a good reason for this. Accurately mapping the structures and electrical signals of the heart requires incredibly advanced and robust technology. Not only must we ensure precise treatment of the areas of the heart producing the errant electrical signals, but we must also verify that our treatment has indeed worked. While one distinct benefit of cardiac catheter ablations that it can be performed more than once, we want to minimize the number of procedures performed, for the sake of our patients’ comfort and convenience.
Cardiac catheter ablations, like any treatment, are not 100% effective for all patients. A minority of patients may not experience the full benefit of the ablation or may have to return for a second procedure. Advanced artificial intelligence technology has begun to address this issue by using computing power to monitor the electrical firings of the heart in real-time, during the ablation, and processing the data on the spot. Using algorithms based on our knowledge of cardiac arrhythmias, these computer programs can often help the electrophysiologist pinpoint areas of concern that would otherwise not have been apparent.
We have long known that lifestyle choices play a big part in the risk factors associated with atrial fibrillation or Afib. There are other components to the risk of developing heart arrhythmias, but a number of these are modifiable – meaning we can change them.
One risk factor that is less understood but confirmed in a recent study is the role of alcohol in Afib. The study sought to find out whether alcohol triggered an episode in those who were currently suffering from paroxysmal or occasional Afib. A relatively small study of 100 patients with an average age of 64 showed that even one drink can increase the risk of an Afib episode by two times, and two drinks can triple the risk of an Afib episode. This was true regardless of the type of alcohol consumed and was noticed very shortly after consuming the drink(s).1
Virtually everyone will experience chest pain at some point in their lives. This could represent minor discomfort and nothing to be worried about, or it can be a sign of serious cardiovascular issues. Unfortunately, while our understanding of the heart has improved dramatically over the past several decades, it is still impossible to tell (with 100% certainty) the severity of chest pain without comprehensive testing. As a result, it is crucial to say early on that if you believe you have a cardiovascular emergency, you should dial 911 immediately.
Technology in cardiology and electrophysiology, in particular, have made incredible leaps and bounds over the past several decades. We now treat many conditions that once required open-heart surgery with minimally invasive tools that offer similar results with far reduced risk. One of the tools in an electrophysiologist’s armamentarium is the electrophysiology or EP study.
An EP study is where a minimally invasive catheter is threaded through a small incision in the groin and up to the heart via the femoral vein. However, you may be wondering when and how we get to the need for an electrophysiology study.
When patients come to our office complaining of symptoms from their atrial fibrillation or Afib, they are often desperate for relief and a solution. At best, a rapid heartbeat is concerning, but for some, episodes can be downright scary, putting them in the emergency room worried about a heart attack. Medication management is the first line of treatment for most, but only about 50% of patients tolerate these medications well. For the other 50%, drugs may become less effective over time, or the side effects of the medication may be unacceptable. These patients often look to have a cardiac catheter ablation to eliminate these side effects while benefiting from their arrhythmia’s potential improvement or resolution.
If you have been diagnosed with atrial fibrillation / Afib or any other tachycardia, you may have been told that cardiac catheter ablation may be the appropriate option for you. During your research, you may have found two strikingly similar ablation options to choose from. Dr. Banker performs both procedures – RF ablations using heat and cryoablations using cold to achieve the same goal of eliminating errant electrical heart signals.
Before we get into the similarities and differences of these two procedures, it is important to understand why you have been referred to Dr. Banker for an ablation. Even if your arrhythmia is relatively mild and doesn’t cause significant lifestyle issues, you are at a much greater risk of a stroke, heart attack, and long-term heart failure. Arrhythmias, especially Afib, the most common type, may increase the likelihood of blood pooling and clotting in the heart. If a clot breaks off and travels to the brain, it can cause a stroke. Cardiac catheter ablation is an excellent, effective, and safe minimally invasive procedure to identify the problematic electrical signals and destroy the heart tissue causing them. All of this, without the need for open-heart surgery, significant downtime, or large incisions.
Significant research has been performed on the potential causes of Atrial Fibrillation or AFib. Lifestyle choices, including a lack of exercise and poor diet, most certainly contribute to the incidence and severity of Afib. It is also important to note that one of the most significant consequences of this poor lifestyle is high blood pressure or hypertension. As the arteries narrow due to plaque buildup known as atherosclerosis, the heart must pump ever harder to get the same amount of blood through the body. While the heart is a formidable muscle, even the strongest of muscles can begin to weaken when overworked. As such, high blood pressure can begin to cause various arrhythmias or irregular heartbeats, including Afib.