Arrhythmia Care

To diagnose an arrhythmia, doctors will conduct an exam, and usually order an electrophysiology study. They may also use:

• Wearable heart monitors: These devices track your heartrate as you go about normal activities. They range from Holter monitors, which you wear for at least 24 hours, to devices that offer more long-term tracking. If your arrhythmia is infrequent, for example, we may recommend a 30-day monitor. We also have implantable monitors that are about the size of a wooden matchstick. They can remain in place for up to three years.
• Stress test: It monitors how your heart responds to physical activity. Usually, this test involves walking on a treadmill or using a stationary bike. Exercise may trigger your heart rhythm disorder.
• Echocardiogram: This test uses sound waves to create heart images [Services > Radiology & Imaging] while the organ is in motion.
• Tilt table test: It monitors your heart rhythm, heart rate and blood pressure while you are on a table that tilts to different positions. This test may be helpful if you have fainting spells.

Electrophysiology Lab

In our electrophysiology lab, we conduct tests to evaluate symptoms that may be related to cardiac arrhythmias. These tests determine where heart rhythm disorders originate. This helps us plan the best treatment.

During your study, doctors insert a thin tube called a catheter, into a blood vessel in the groin that leads to your heart. On the tip of the catheter are electrodes. They record the heart’s electrical activity. You may receive arrhythmia treatments in the electrophysiology lab, as well.

There are many treatments for arrhythmias. Depending on the type you have and its cause, we may recommend:

Lifestyle Changes

Such as weight loss, limitating alcohol consumption, avoiding tobacco and treating sleep apnea, if present

Medication

Including medicines that change your heart rhythm or heart rate. We may also use medicine to thin your blood and reduce the risk of clots.

Catheter Ablation

This procedure delivers energy to a small area of the heart via a thin tube that’s passed through a blood vessel. This causes scarring, which interferes with your heart’s abnormal electrical signals.

Left Atrial Appendage Occlusion

These procedures lower the risk of stroke if you have AFib. It’s estimated the number of AFib cases will more than double by 2050. With AFib, your risk of having a stroke is five times higher than that of someone without the condition.

Studies have shown that 90% of strokes in people with AFib that aren’t related to a heart valve problem, occur in a part of the heart called the left atrial appendage. Blood thinners may lower stroke risk but only about 60% of people who should get these medications do. Among those who do get them, 1 in 4 will stop the medicines within two years. Occlusion procedures block off the left atrial appendage.

Pacemakers or Implantable Cardioverter Defibrillators

Devices such as pacemakers or implantable cardioverter defibrillators (ICDs) treat a heart rate that’s too slow or irregular.

Some pacemakers go into your chest under your skin. They contain wires that we thread through a vein under your collarbone to your heart. Leadless pacemakers are similar devices that are placed through a vein in the leg and are implanted directly into the heart. 

Implantable defibrillators are for more serious arrythmias coming from the lower chambers of your heart. These devices monitor your heart rhythm. If necessary, they deliver a life-saving electrical shock.

Cardiac Resynchronization Therapy (CRT)

CRT treats a weakened heart muscle caused by abnormalities of your heart’s electrical system. Many times, a weakened heart leads to heart failure and symptoms such as shortness of breath and fatigue.

CRT involves placing a traditional pacemaker or defibrillator. But the device has an extra wire that we put onto the heart’s left ventricle. It helps improve the electrical and mechanical pumping function of your heart.

We routinely follow patients at Lahey who receive implanted cardiac devices through our Arrhythmia Device Clinic. Some people refer to the clinic as the “pacemaker clinic.”

At one time, simple pacemakers were the main type of implantable device. But over the years, these devices have evolved. In addition to pacemakers, there are devices that monitor your heart rhythm and intervene if there’s a problem. There are also some newer devices that we mainly use to detect arrhythmias.

If you receive an implantable device, you first visit our clinic about one month later. You then have in-person visits once or twice a year. We may use remote monitoring through your phone or internet access to follow you at home, as well.

We relay information we gather in these visits and through monitoring to your doctor. Usually this will be your cardiologist. But it’s common for people to form close relationships with our nurses and technicians. You can rely on us for support and education regarding your device and heart rhythm.

Currently, we work with more than 4,000 patients. There are more than 3,000 in-person visits at the clinic each year, and we perform more than 11,000 home checks annually.

If you have any questions, please call the Arrhythmia Device Clinic at 781-744-2404.