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Question
and Answers with Dr. Hopson
Q. What is electrophysiology?
A. Electrophysiology (EP) is a subspecialty of Cardiology that deals with the evaluation and treatment of cardiac rhythm disturbances. EP specialists are typically board certified in Internal Medicine, Cardiology, and finally, EP.
Q. With regard to cardiac arrhythmias, who has more, men or women? And what is the average age to experience it?
A. There is not a strong gender predilection for rhythm disturbances as a whole, albeit some specific types of arrhythmias differ slightly in their frequency in men and women. The mix of arrhythmia types changes as folks get older, and in general the incidence increases with advancing age.
Q. My nephew had an ablation when he was only 14. Is this common and will he need to have another one in the future?
A. The most common arrhythmia in a healthy 14 year-old kid is SVT (supraventricular tachycardia). These rhythm disturbances are not rare, and if the ablation was successful he should not need another.
Q. What is EP mapping?
A. EP mapping is a technique, used in the EP lab typically during an ablation, whereby the site of arrhythmia origin within the heart is located, typically so as to target ablation properly.
Q. What are the symptoms of arrhythmias? Do symptoms differ between men and women?
A. Symptoms of arrhythmia vary widely, and might include palpitation, chest discomfort, lightheadedness, syncope (loss of consciousness), fatigue, and shortness of breath. Many arrhythmias are without symptoms.
Q. What are the risk associated with ablation?
A. Risks of an ablation include blood vessel injury, blood clot, injury to the heart lining/bleeding around the heart, or heart slowing requiring a pacemaker. The risk of a complication such as this is relatively small and depends on the type of procedure being done. Typically less than 1 percent. Risk of a catastrophic complication (stroke, heart attack, or death) is much smaller, but again depends on the type of procedure.
Q. If many arrhythmias are without symptoms, is it correct to say I could experience it over time, rather than as an event?
A. Indeed. Many arrhythmias are chronic conditions with symptoms that might be subtle, and manifest perhaps slowly or that evolve over time.
Q. Are there any alternatives to doing AF ablation?
A. Alternatives to ablation depend on the type of arrhythmia, but (speaking broadly) would include medication, certain types of surgery, and finally, pacemakers or an internal defibrillator. It should be pointed out that many arrhythmias do not require treatment. There are some types of rhythm disturbances which might also respond to diet, exercise, and other strategies which do not involve drugs, devices, or procedures.
Q. How dangerous are arrhythmias? Once treated, do they go away?
A. Some arrhythmias are quite dangerous, others are completely benign. Some are treated and cured, others are less amendable to a fix, and are managed in one fashion or another (and do not go away).
Q. A friend was told something about left bundle branches. Are there right bundles? I do not know her diagnosis or treatment but am curious about what these bundles are.
A. In brief, bundle branches are the wire or nerve-like connections in the heart that help pass the heart beat from the upper chambers smoothly to the bottom (ventricles). There are branches on each side, right and left. A disturbance in the operation of these branches is called "bundle branch block (BBB)". The health-implication of a BBB is variable, depending upon the situation.
Q. What does the patient experience during a cardiac ablation? How long does the procedure last? Does the patient stay over night in the hospital?
A. A typical ablation lasts several hours, although there are a few types which are more complex and last longer. The patient is typically lightly sedated but awake, and might be aware of the catheters being placed or of the alteration in heart beat associated with a normal study. A few patients with more complex ablation procedures are deeply sedated and sleep. Most pts go home the same day; a few are kept overnight.
Q. Who is the best candidate for a pacemaker that is suffering from heart failure?
A. Biventricular pacing is a technique whereby both of the bottom heart chambers are paced, with the goal being to improve the "synchrony" of contraction. The best candidates for cardiac resynchronization therapy (CRT) are those with heart failure and loss of normal synchrony of contraction. These latter patients are those with bundle branch block (esp. left BBB) with a QRS duration (an ECG measure) of >120 msec (best >150), or who have heart block being treated with a single-chamber pacemaker
Q. You mentioned diet earlier.....How can it affect heart rhythms? Are there certain foods that contribute to arrythmias?
A. Not many foods directly and immediately effect the heart rhythm, but examples might be alcohol and caffeine, both having the potential to aggravate certain rhythm disturbances. Diet is of course related to obesity, sleep apnea, diabetes, and general fitness and overall health, which in turn can effect the potential for arrythmia development.
Q. What is the success rate for cardiac ablations? And just how frequent or common is it?
A. Success for most ablations is well over 90%; there are few exceptions for rhythm disturbances of unusual complexity. By frequency I assume you mean of the procedure itself? Ablation is a very commonly performed cardiac procedure at hospitals with busy arrhythmia programs.
Q. How does the catheter ablation work?
A. Broadly speaking, it works like this: 1. the mechanism of the arrhythmia is defined. 2. A critical component of the arrhythmia (typically the "abnormal" component) is mapped and targeted. 3. Radio frequency (RF) or less commonly ice/cooling treatment is delivered to this site with a catheter. 4. The EP study is repeated to examine the effects of the ablation and to monitor success.
Q. There is no greater potential for arrhythmia in IDDM , is there?
A. There is potential for arrhythmia in IDDM (idiopathic dilated cardiomyopathy) of several types, the most feared being VF cardiac arrest.
Q. Once treated for atrial fibrilation, are you cured or do you still have it?
A. Depends on the treatment. Catheter ablation offers the potential for a cure, but most EP physicians are reluctant to say that AF will be permanently eliminated by ablation... the technique for AF is too new. Unless AF is triggered by a specific cause, which is itself treatable and curable (thyrotoxicosis for eg) AF is a condition which is medicated and managed rather than cured permanently.
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