Heart Rhythm Disorders

Our Electrophysiology Team strives to provide state-of-the art arrhythmia care to patients within and outside our community. Our nationally-recognized EP team’s approach can be witnessed both in the hospital and in the office.

There is no field within cardiology that has undergone as much change in the last decade than the field of electrophysiology (EP). With advances in catheter-based ablation and implantable cardiac devices, we are able to tackle (and frequently cure) diseases previously considered untreatable.

We do this in many ways. First, we keep up with national trends and the newest procedures. The board-certified physicians and staff of Oklahoma Heart Institute attend national and regional meetings to make sure we are at the cutting edge of arrhythmia management. This allows us to perform not only simple ablation such as supraventricular tachycardia (SVT) and atrial flutter, but also complex ablations including atrial fibrillation and ventricular tachycardia.

Second, we educate our local community so that they can help us identify and treat patients in the most appropriate way. Our annual EP Symposium attracts over 300 healthcare providers from throughout the region. We also host quarterly Tulsa EP Society (TEPS) meetings which are aimed at local physicians, physicians-in-training and staffs of all Tulsa’s EP community.

Third, we participate in numerous research studies. This allows our patients to access medications and devices prior to market release. Examples of research studies we offered our patients include the ATHENA Trial and the Re-Ly Trial. These trials (both published in the New England Journal of Medicine) showcased dronedarone and dabigatran – medications which will change the way we treat atrial fibrillation for years to come.

Last, we collaborate extensively with our non-EP colleagues. We understand that patients often have complex medical issues that require thoughtful discussion with a variety of specialists. Because Oklahoma Heart Institute includes many subspecialists, including cardiovascular surgeons, interventional cardiologists and heart failure specialists, we are able to join forces to streamline your care like no one else.

If you or a loved one needs to see an arrhythmia specialist, the EP Team at Oklahoma Heart Institute will provide you with the best care available. We look forward to earning your trust and having you see what sets us apart.

Heart Rhythm Service

Oklahoma Heart Institute’s Heart Rhythm Service is the largest team of electrophysiology specialists in northeast Oklahoma offering state-of-the-art arrhythmia care. They provide a full array of advanced services to patients who need help regulating their heart rhythm including evaluation, diagnosis and therapy for conditions such as atrial fibrillation, ventricular arrhythmias and devices for congestive heart failure.

Our electrophysiology team specializes in catheter ablation for a variety of heart rhythm abnormalities. Also, every year they implant hundreds of pacemakers and defibrillators with cutting edge techniques to maintain or resynchronize the heart’s normal conduction system. Each device is carefully chosen to ensure its specific features are tailored to their patient’s needs. Our Heart Rhythm Service also provides the regular monitoring and adjustments needed to ensure all devices are performing effectively. Thousands of pacemaker evaluations are performed yearly by their electrophysiologists and specialized pacing nurses.

Types of Heart Arrhythmias

ATRIAL FIBRILLATION (AFib)

Atrial fibrillation is an irregular heartbeat, a rapid heartbeat or quivering of the upper chambers of the heart. AFib is due to a malfunction in the heart’s electrical system and is the most common sustained heart irregularity or cardiac arrhythmia. This disorder makes it difficult to efficiently pump blood throughout the body. Although AFib isn’t life threatening itself, it often causes fatigue, dizziness and breathing difficulties and can lead to more serious conditions including congestive heart failure and stoke. Damage or various abnormalities of the heart’s electrical structure can help cause AFib. Additional causes can include a previous heart surgery, abnormal heart valves, heart attack, high blood pressure, coronary artery disease, an overactive thyroid gland or other metabolic imbalances, exposure to stimulants (such as medications, caffeine, tobacco or alcohol), stress due to surgery, pneumonia or other illnesses and even in some cases sleep apnea.

ATRIAL FLUTTER

Atrial flutter is similar to Atrial Fibrillation (AFib) because it also occurs in the upper chambers of the heart and can result in a fast heartbeat. However, atrial flutter tends to be an organized rhythm that is caused by an electrical wave that circulates very rapidly in the atrium, about 300 times a minute. This can lead to a very fast, but regular, heartbeat. Like AFib, the upper heart chambers are not able to beat very well and thus results in an increased risk of stroke.

CONGESTIVE HEART FAILURE

Heart failure means the heart muscle is failing to pump blood normally because it is damaged and/or weak. Your heart can fail for different reasons, including problems with your valves, arteries, your heart’s electrical system or the heart muscle itself. With advanced heart failure, you may frequently experience symptoms such as shortness of breath and fluid overload, both of which affect your quality of life.

HEART CONDUCTION DISORDERS

Heart block occurs when electrical signals from the upper chambers of the heart (atria) cannot travel to the lower chambers (ventricles). The ventricles then beat too slowly, decreasing the amount of oxygen that gets to the body and brain. This causes a slow pulse and can result in a lack of energy, feeling lightheaded or fainting. Heart block can be a cause of syncope.

SICK SINUS SYNDROME

Also called bradycardia and sinus node dysfunction, sick sinus syndrome (SSS) is not a disease, but a group of signs or symptoms that show that the heart's natural electrical pacemaker, the sinus node, is not working properly. In SSS, the heart rate can alternate between slow (bradycardia) and fast (tachycardia), often in combination with atrial fibrillation or atrial flutter. SUPRAVENTRICULAR TACHYCARDIA Supraventricular tachycardia (SVT) is a rapid heartbeat that develops when the normal electrical impulses of the heart are disrupted. There may be heart palpitation type symptoms or there may be no symptoms at all. There are multiple different forms all with similar symptoms. The most common types of SVT are atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT) and atrial tachycardia (AT).

VENTRICULAR ARRHYTHMIAS

Ventricular arrhythmias are abnormal heartbeats that occur in the lower chambers of the heart. They include:

PREMATURE VENTRICULAR CONTRACTIONS (PVSs)

This can result when cells from the bottom chamber of the heart beat before the normal conducted impulse occurs. This often feels like the heart is “skipping a beat”. PVCs are usually not a significant impact to one’s health, but can be very bothersome. Rarely, PVCs can lead to congestive heart failure. Initial evaluation will likely address risk factor modification, such as avoiding stimulants (for example, caffeine and tobacco) and screening for sleep apnea.

VENTRICULAR FIBRILLATION

Sudden Cardiac Arrest (SCA) caused by ventricular fibrillation (VF) is the cause of half of all heart related deaths. VF is sudden, happens without warning and stops the heart from working. In VF, the heartbeat is fast and chaotic, causing the lower heart chambers (ventricles) to lose their ability to pump effectively. This results in a drop in blood pressure and loss of consciousness. If normal rhythm is not restored it will result in death. Sometimes, a heart attack (blockage of the heart pipes/arteries) can lead to VF. Bystander CPR can provide circulation and improve the survival rates in people with SCA until defibrillation is performed to restore the normal rhythm.

VENTRICULAR TACHYCARDIA

This is a rapid heart rhythm that occurs in the lower chambers or ventricles of the heart. It often occurs in people with underlying heart disease like coronary artery disease, heart failure, or history of a previous heart attack. In these situations, it can be a life-threatening arrhythmia, which can result in fainting or death if it persists and is untreated. Ventricular tachycardia (VT) can also happen in people with normal hearts and is called idiopathic VT. Because VT is often associated with symptoms and in many people can lead to ventricular fibrillation (a dangerously fast and disorganized heartbeat), it is a serious condition that needs aggressive treatment and follow-up.

Heart Screenings & Diagnostic Testing

Our experienced team of arrhythmia specialists often utilize various screenings and diagnostic tests to help uncover the true cause of arrhythmias. They will ask questions concerning medical and family history and do a thorough evaluation.

ELECTROCARDIOGRAM

This is a 10-second recording of one’s heartbeat. It can identify heart rhythm abnormalities as well as evidence of old heart attacks and some congenital abnormalities.

ELECTROPHYSIOLOGY STUDY

This study may be recommended to help induce heart rhythm abnormalities or detect conduction disease. In these procedures, soft flexible catheters are advanced through the vein in the leg and placed in the heart. Stimulation is then performed to help re-create the heart rhythm disturbance.

EVENT RECORDER

These monitors are often used to capture less frequent arrhythmias. A patient will usually wear this monitor up to 30 days and activate recording when symptoms are present.

HOLTER MONITORING

The Holter monitor records all heartbeats for extended periods of time. These usually will be worn from 1 day up to 14 days. An interpretation can be performed once the monitor has been returned and evaluated.

IMPLANTABLE LOOP RECORDERS

When even longer term monitoring is required, a patient may receive an implantable loop recorder. These recording devices are inserted just under the skin and have batteries that can last up to three years. They have advanced from an external, wired monitor to a small, insertable device that is nearly invisible to the naked eye. Benefits include being small in size, minimally invasive, technologically advanced, MRI accessible and the ability to continually collect data which improves efficiency.

MOBILE CARDIAC TELEMETRY MONITORING

Telemetry monitoring includes automatic recording of abnormal heart rhythms. These monitors can be used to detect arrhythmias that the patient may be unaware of, or unable to activate a recording device. These are often used to detect asymptomatic atrial fibrillation and passing out.

Treatments

Treatment options vary according to a patient’s health history, symptoms and preferences. Our arrhythmia specialists take these factors into account during the initial thorough evaluation.

CARDIAC RESYNCHRONIZATION THERAPY (CRT)

A CRT device is a special type of pacemaker for certain patients with heart failure. The implanted device paces both the left and right ventricles (lower chambers) of the heart at the same time. This helps to resynchronize muscle contractions and improve the efficiency of the weakened heart.

CARDIOVERSION

This is a brief procedure where an electrical shock is delivered to the heart to convert an abnormal heart rhythm back to a normal rhythm.

CATHETER ABLATION

During this procedure, flexible thin tubes (catheters) are guided into the blood vessels and to the heart muscle. A burst of energy heats to destroy very small areas of tissue that cause the abnormal electrical signals.

CRYOBALLOON ABLATION

While initial ablation procedures involved the delivery of a radiofrequency “burn” lesion at a single point, today’s cryoballoon ablation delivers a continuous circular lesion around the ostium of the vein with a single application of cryoablation. This simplified approach to pulmonary vein isolation results in a significant reduction in procedure duration and X-ray radiation exposure to the patient.

DEFIBRILLATOR

Implantable cardioverter-defibrillators (ICDs) continuously monitor the heart rhythm, automatically function as pacemakers for heart rates that are too slow and deliver life-saving shocks if a dangerously fast heart rhythm is detected. These devices are 99 percent effective in stopping life-threatening abnormal heart rhythms and are the most successful option to treat ventricular fibrillation (VF), the major cause of sudden cardiac arrest (SCA).

DEVICE EXTRACTION

In addition to implantation, Oklahoma Heart Institute’s electrophyiologists have experience with the removal of previously implanted pacemaker and defibrillator leads. At specialized centers such as Oklahoma Heart Institute, removal of pacing leads can be accomplished nearly 100 percent of the time without open heart surgery and with minimal risk to the patient.

FARAPULSE Pulsed Field Ablation (PFA) System

FARAPULSE™ is an FDA-approved alternative to thermal ablation that uses electrical signals to selectively treat heart cells, while reducing risks to nearby organs, in patients experience atrial fibrillation (AFib).

LEFT ATRIAL APPENDAGE CLOSURE (LAA)

It is estimated that 90 percent of heart clots that cause strokes come from the left atrial appendage closure (LAA). By closing off the LAA, the risk of stroke may be reduced and over time, patients may be able to stop taking warfarin. The highly successful implant offered to help close off the LAA:

WATCHMAN FLX™ DEVICE IMPLANT

This device offers a stroke risk reduction option for high-risk patients with non-valvular atrial fibrillation who are seeking an alternative to long-term warfarin therapy. This minimally invasive procedure usually takes one to two hours and is done under anesthesia. Usually this is a one-time procedure that offers significantly less pain than with open heart surgery. Most patients are normally able to stop taking their blood thinners around 45 days post-procedure.

MEDICATION

People with atrial fibrillation (AFib) are five times more likely to have a stroke than people without AFib. Stroke reduction therapy is usually directed at thinning the blood with anticoagulants (blood thinners). While blood thinners have been shown to significantly improve survival, it is important to assess each patient’s benefit to risk ratio.

Anticoagulants

Traditional: Warfarin (Coumadin & Jantoven)
Novel Oral Anticoagulation (NOAC)/Direct Oral Anticoagulant (DOAC): Apixaban (Eliquis), Dabigatran (Pradaxa), Edoxaban (Savaysa) and Rivaroxaban (Xarelto)

If appropriate, antiarrhythmic medications can be used to help manage arrhythmias. They are sometimes used as a first line therapy prior to undergoing an ablation procedure.

Antiarrhythmic Medications

Amiodarone (Cordarone & Pacerone)
Dofetilide (Tikosyn)
Dronedarone (Multaq)

Flecainide (Tambocor)
Propafenone (Rythmol & Rythmol SR)
Sotalol (Betapace & Betapace AF)

PACEMAKER

A pacemaker is a small, battery-operated device that helps control an abnormal heart rhythm which is sometimes called arrhythmia or dysrhythmia. Some pacemakers are permanent (internal) and are implanted under the skin of the chest or abdomen while others are temporary (external). This device uses electrical pulses to “pace” the heart or prompt it to beat at a normal rate which can relieve common symptoms such as fatigue and fainting. Most pacemakers are designed to detect the amount of activity a patient is doing and adjust the heart rate appropriately.

Oklahoma Heart Institute was the first center in northeast Oklahoma to offer a better pacemaker technique called his-bundle pacing. Traditionally, pacemaker wires are placed in the muscle at the bottom of the heart which leads to a more forced heart squeeze. This can sometimes cause weakening of the heart muscle (cardiomyopathy) over time and eventually congestive heart failure. His-bundle pacing places the pacemaker wires very close to the actual conduction system (nerves in the heart) for a more normal and natural heart squeeze.

Patient Story

RISK FACTOR MODIFICATION

Since other heart disorders increase the risk of developing abnormal heart rhythms, lifestyle changes often are recommended. Living a heart healthy lifestyle can ease the symptoms experienced with heart rhythm disorders and other heart disorders and can be beneficial to overall patient health.

While genetics and age play a significant role in atrial fibrillation (AFib), there are modifiable risk factors which can dramatically improve symptoms and frequency of this arrhythmia. Modifiable risk factors include weight, sleep apnea, alcohol consumption, tobacco usage, blood pressure control and diabetic management. Controlling these risk factors can drastically improve the ability to treat and prevent AFib.