Cardiac Rhythm Management

Arrhythmias afflict millions each year. They can be difficult to assess and treat accurately because some sporadically present in generally healthy adults and do not pose a long-term threat to heart health — yet many others indicate more serious, potentially life-threatening problems. Allegheny General's Cardiovascular Institute approaches this often-elusive condition with the latest in comprehensive diagnostics; medical management; and surgical therapies.

Electrophysiology and Medical Management

John Chenarides, M.D., an electrophysiologist, analyzes information about the heart's conduction system.

Allegheny's Electrophysiology (EP) Laboratory remains one of the busiest in the region, with its clinicians performing more than 2,500 diagnostic and therapeutic procedures a year. Under the leadership of some of the nation's foremostelectrophysiologists, the lab has expanded dramatically — offering efficient, thorough diagnostic services as well as top-notch medical approaches to arrhythmia treatment, notably cuttingedge device therapy; radiofrequency ablation; and treatment combining the latest pharmacologic and device developments. The hospital offers stateof-the-art labs for services to its patients. Allegheny's EP professionals have the capability to work in concert with a patient's primary physician or general cardiologist, as needed.

Diagnostics

The hallmark of Allegheny's EP diagnostic effort is precision and accuracy in the assessment of the presence and causes of arrhythmias. The hospital offers:

Tilt-table testing to identify whether arrhythmias are the underlying cause of sudden blood pressure drops that lead to lightheadedness or syncope.
Holter monitoring to evaluate cardiac rhythm performance over a 24-hour period.
Electrocardiograms to record and reveal abnormalities in the heart's electrical system.
Electrophysiology studies and mapping procedures in which physicians trigger an arrhythmia in a controlled setting for the patient's safety in order to locate the specific structure within the heart that causes the arrhythmia. Mapping procedures allow physicians to see the architecture of an abnormal rhythm, and provide the foundation for future medical procedures to treat it.

Medical Management

Pharmacologic therapy.
Allegheny General's electrophysiology team makes available a complete spectrum of medications that restore normal heart rhythms for nearly half of patients experiencing these erratic heartbeats.

Allegheny General doctors also continue to evaluate the newest generation of drugs that chemically "remove" the heart from atrial fibrillation, as well as medications that work in conjunction with device therapy to maximize the effectiveness of devices that quiet abnormal rhythms.

Radiofrequency (RF) ablation.
Allegheny has offered RF ablation as an alternative to open-heat surgery to patients for nearly two decades, since the technique's inception. Physicians direct an electrode-tipped catheter to the region of the heart containing the faulty electrical pathway that sparks the arrhythmia — then deliver heat energy similar to microwaves to neutralize it and return the heart to a normal rhythm. For many patients, RF ablation has become the treatment of choice and is particularly effective at preventing recurrence of atrial-based tachycardia.

Atrial fibrillation ablation via pulmonary vein isolation.
Allegheny also offers this novel therapy, considered the latest, most innovative extension of RF ablation for the treatment of atrial fibrillation. Research has shown that atrial fibrillation starts where the atria connect to the pulmonary veins, with the abnormal rhythm originating from within the veins themselves. Using pulmonary vein isolation, Allegheny's EP specialists direct the heat waves of RF ablation where the atria join the pulmonary vein. The RF energy creates a scar that short-circuits impulses produced by the pulmonary vein — thus interrupting the potentially life-threatening cycle precisely where it starts.

Device therapy

Allegheny General offers many therapeutic options for treating life-threatening ventricular arrhythmias — from traditional pacemaker and defibrillation therapy to highly innovative approaches that build on these treatments.

AGH electrophysiologists implant the highest volume of pacemakers and implantable defibrillators in the region

AICDs.
National leaders in research and implementation of implantable cardioverter defibrillators since the 1980s, Allegheny electrophysiologists continue to expand the power of this technology by offering smaller, more efficient devices to rein in arrhythmias and restore normal heart rhythm.

Biventricular pacing/cardiac resynchronization therapy.
Allegheny General electrophysiologists were the first in the region to test an experimental implantable pacemaker that re-establishes the pumping rhythm of two of the heart's chambers, rather than just one — as is common with most pacemakers. By restoring synchronous contractions with the innovative biventricular pacemaker, Allegheny doctors increase the amount of blood pumped to the body, and, in turn, often improve the quality of life and survival of patients suffering from heart failure.

Allegheny cardiologists were the first in western Pennsylvania to utilize biventricular pacemakers with cutting edge diagnostic capabilities that allow monitoring of the device's effectiveness from the patient's home, providing physicians with information that helps to optimize the medical management of heart failure patients. These devices have the capability to reveal potential problems before the patient reports symptoms.

Christopher Bonnet, M.D., checking the status of a patient's implanted EP device.

Cardioversion (shock) therapy.
To halt the runaway, rapid beating of a heart in atrial fibrillation, Allegheny physicians also make available external and internal cardioversion therapy. In external shock therapy, doctors administer electrical currents to the heart through paddles placed on the patient's chest. Using internal shock therapy, electrophysiologists use catheters to more effectively target the specific area of the heart causing the abnormal rhythm with focused electrical impulses that require far less energy than external shock therapy.

Device Clinic.
Once the appropriate technology has been selected for patients, it is critical to monitor its effectiveness on heart health on a regular basis. Through Allegheny's Device Clinic, electrophysiology specialists can electronically monitor the device to make timely adjustments and better support a patient's heart.

Surgical management

Chronic AF can be debilitating and, for some patients, a life-threatening problem. Irregular cardiac rhythms can cause clots to form inside the heart and embolize to produce stroke. Heart failure may result from a persistently elevated heart rate.

The McGinnis Cardiovascular Institute provides surgical options for many patients whose AF does not respond to medical treatment. The MAZE technique for AF offers several approaches for redirecting the electrical impulses that produce AF rhythms, based on the concept of blocking AF pathways. Most patients can be offered a minimally-invasive procedure known as the "Mini-MAZE" operation, which has been shown to be effective in up to 85 percent of AF, depending upon the patient's AF history and concomitant medical conditions.