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The Cardiac Arrhythmia Service
Please visit our site at EPMCG.net for more information.
The Cardiac Arrhythmia Service at MCG is a team of doctors, nurses and technicians who have an expertise in caring for problems of the heart’s electrical system, or arrhythmias (abnormal heart rhythms). Patients with this type of difficulty may present with a sensation of inappropriate heart racing, skipping heartbeats, fluttering, heart pounding or even a sensation of heart slowing. Sometimes patients may have fainting spells or even have suffered a cardiac arrest. The job of the Arrhythmia Service is to evaluate, manage and treat patients with these problems.
The physicians who perform this service are General Internists who are fully trained Cardiologists with additional training and Board Certification in Cardiac Electrophysiology, also known as EP.
The Normal Heart Beat
The heart’s electrical system controls the rhythmic contractions that keep the heart pumping and circulating blood throughout your body. These electrical impulses start at the sinus node, a group of specialized heart cells that are the heart’s natural pacemaker. The impulse then travels to the atrioventricular node, where it is then distributed to the main pumping chambers of the heart over a network of nerve-like fibers.
The Slow Heart Beat
If the natural pacemaker or any part of the electrical network fails, even briefly, this could cause the heart to go too slowly or stop. This may be called Bradycardia, Sick Sinus Syndrome or Heart Block. The treatment of slow heart beating is to implant an artificial pacemaker (see below description).
The Fast Heart Beat
If your heart goes inappropriately too fast, it is called tachycardia. There are many types of tachycardia, some of which are relatively benign and others that have more serious implications. The Cardiac Electrophysiologist is responsible for evaluating these patients to assess their risk of major complications from tachycardia and to formulate a treatment plan. The treatment of tachycardia depends on the specific type of heart rhythm problem. Some tachycardias are treated with medicines, while others particularly the tachycardias that originate from the top chamber of the heart (the SVTs) may be treated with a catheter procedure, also known as a catheter ablation. The more dangerous types of arrhythmia frequently require implantation of a cardioverter defibrillator - ICD (see below description). Catheter ablation, when feasible, is particularly attractive as it often replaces the need for medical treatment of the heart rhythm problem.
Fainting
Fainting is a symptom where the patient has a brief loss of consciousness
and falls due to a lack of muscular tone. There are many synonyms for
fainting: falling out, blackout, pass-out, and collapse to mention a few.
The medical term for a faint is syncope (also known as neuro-cardiogenic or
neurally-mediated syncope). Fainting can be due to many different causes,
from slow heart beating to fast heart beating, or even low blood pressure.
Although less common, fainting could be due to problems unrelated to the
heart. The Cardiac EP is specialized in performing this evaluation and
determining the best treatment for recurrent fainting spells.
Sudden Cardiac
Arrest
A sudden cardiac arrest most commonly
occurs in patients with known heart disease, particularly those patients
with weakened hearts. Those patients with reduced heart function (ejection
fraction
less than or equal to
35%) are particularly prone to a cardiac arrest. The EP physician is
frequently called upon to assist the primary care physician or general
cardiologist to perform a risk assessment for patients with known heart
disease to determine a patient’s risk for a sudden cardiac arrest. Once
this risk assessment is done the EP’s job is to find the best type of
preventative treatment, usually implantation of a cardioverter
defibrillator. It is alarming to know that 90-95% of cardiac arrest victims
do not survive these events unless they have an implantable defibrillator.
Pacemakers, Defibrillators and Biventricular Defibrillators
EP physicians are experts in the implantation and follow-up of pacemakers and implantable defibrillators.
A pacemaker is a device about the size of two stacked half dollars. Within the pacer is a computer and battery. The pacemaker is surgically implanted under the skin, with one or two wires (or leads), threaded through veins and into the heart. The job of the pacemaker is to prevent the heart from going too slowly. The pacer can detect your normal rhythm and works “on demand”, that is, only as much as needed. The EP doctor’s clinic has a small computer that communicates with the pacemaker through the skin and allows your device to be adjusted and personalized for an individual patient’s needs. The pacemaker battery has a 7-10 year life span.
An implantable defibrillator (ICD) is a device that is similar to a pacemaker, but in addition to treating slow heart rhythms, it is designed to treat life-threatening fast heart rhythms by overdrive suppression of the tachycardia, or delivering a life saving shock to the heart. The ICD is implanted in a manner similar to a pacemaker. Because of the higher energy needed to shock the heart, the device is about the size of a small pager (2”x2”x1/2”) and its battery life is about 5-7 years.
More recent developments in device technology have given us biventricular ICDs. The biventricular ICD is designed for those patients who in addition to the having a high risk for a cardiac arrest also have severe symptoms of congestive heart failure (a weak heart). It, too, is implanted like a pacemaker or ICD, except there is an additional wire placed into a vein on the backside of the heart. This extra wire allows your doctor to adjust the timing sequence of the contraction of the heart to optimize the heart function, similar to what a mechanic does to adjust the timing of the spark plugs in a car to improve the horsepower. The biventricular ICDs are implanted in addition to the usual heart medicines your doctors use to treat heart failure. These devices are very successful in helping heart failure patient’s breathe easier, have more energy and better endurance. They also save lives because they are defibrillators.
The
Cardiac Arrhythmia Service at MCG
Dr. Sorrentino is the director of Arrhythmia Services at the Medical College
of Georgia. He is a Board Certified Electrophysiologist with 16 years of
experience in the field. He attended medical school at Albany Medical
College in Albany, New York. He went on to do his internship and residency
in Internal Medicine at Duke University Medical Center. He did his
subspecialty training in Cardiology and Cardiac Electrophysiology at Duke.
Once completing his training, he remained on faculty at Duke for 13 years
where he was the Director of the Pacemaker service and later Clinical
Director of the Electrophysiology Service. Dr. Sorrentino joined the
faculty of the Medical College of Georgia in January, 2005. Dr. Sorrentino
has additional board certification in Internal Medicine, and Cardiovascular
Diseases and is a Testamur in pacing and defibrillation (NASPExam). Dr.
Sorrentino and his EP staff manage patients with any type of heart rhythm
problem, catheter ablation, device implantation and follow-up and lead
extraction. MCG completed construction of a new Electrophysiology lab in 2006, and offers the latest state-of-the-art equipment for the
diagnosis and treatment of patients with heart rhythm problems.
You may call (706) 721-2426 to arrange a consultation or second opinion.
For additional information from the internet go to:
The
Heart Rhythm Society
or
The American Heart Association
