Arrhythmia/Atrial Fibrillation

Takeaways from the Atrial Fibrillation (A-Fib) Live Chat

afib-email260x200Atrial fibrillation, or A-fib, is the most common irregular heart rhythm in the United States, affecting over two million Americans. We hosted a live chat on Tuesday, November 15th at 12pm EST about atrial fibrillation with Mikhael El-Chami, MD, of the Emory Heart and Vascular Center where we received a lot of great questions about symptoms, treatments, and more.

Dr. El-Chami was able to answer these questions and provide insight on this condition that affects so many people. Below are some highlights from this live chat.

 

Question: Are there different types of a-fib? Is one more serious than another?

Dr. El-Chami: There are typically two different types of a-fib. The first type is persistent a-fib (always in a state of a-fib) and the other type paroxysmal a-fib (a-fib that comes and goes). One type is not more dangerous than the other. The most devastating complication of a-fib is related to the predisposition to stroke. If that is treated appropriately with blood thinners, then the risk is reduced significantly. At times, a-fib is also associated with weakening of the heart muscle, and if that is the case physicians are usually very aggressive at trying to keep patients out of a-fib.

 

Question: What are some risk factors for a-fib?

Dr. El-Chami: That is a very good question. Common risk factors for a-fib include hypertension, obstructive sleep apnea, obesity, aging and structural heart disease (patients with valve problems, weak heart muscle or thick heart muscle). A-fib could occur in a younger patient without major health issues, but this is not the norm.

 

Question: Am I more likely to have a stroke if I have a-fib?

Dr. El-Chami: A-fib is typically associated with a 5 fold increase in the risk of stroke. There is a clinical scoring system (CHADSVaSC score) that will better determine the risk of stroke in patients that have a-fib.

 

Thank you to everyone who participated in our live chat! You can view the full chat transcript here.

Atrial Fibrillation Live Chat: November 15, 2016

afib-email260x200Atrial fibrillation, or A-fib, is the most common irregular heart rhythm in the United States, affecting over two million Americans. Are you one of them? Or do you know someone who’s affected by A-fib? We could help you find out the information you need.

Join us on Tuesday, November 15th at 12pm EST for a live chat about atrial fibrillation with Mikhael El-Chami, MD, of the Emory Heart and Vascular Center. We’ll answer your questions about A-fib and how it’s treated. Register today.

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Types of Cardiovascular Disease

heart-word-cloud 9-4Cardiovascular disease is the leading cause of death for both men and women in the United States. But did you know there are more than 50 types of heart disease? Heart disease is actually an umbrella term that includes a number of conditions affecting the structures or function of the heart, some of which are genetic, and many of which are the result of lifestyle choices.

Types of Cardiovascular Disease:

Coronary Heart Disease (CHD) is the most common form of heart disease. It occurs when the arteries supplying blood to the heart narrow or harden, which is known as atherosclerosis. CHD is usually the cause of heart attack, stroke, and peripheral vascular disease. Major risk factors include: high blood pressure, high blood cholesterol, tobacco use, unhealthy diet, physical inactivity, diabetes, advancing age, inherited (genetic) disposition.

Heart Attack – Also called “myocardial infarction,” a heart attack happens when blood flow to the heart is severely reduced or cut off, due to the hardening and narrowing of the coronary arteries from the build-up of fat, cholesterol, and other substances, known together as “plaque.” A blood clot forms around the plaque, blocking blood flow. This results in permanent damage or death of part of the heart muscle. The most common symptoms of a heart attack are:

  • Chest pressure or pain
  • Shortness of breath
  • Pain or discomfort in the jaw, neck, back, arms or shoulder
  • Feeling weak, lightheaded, or nauseous

Arrhythmia – “Arrhythmia” means your heartbeat is irregular. It doesn’t necessarily mean your heart is beating too fast or too slow. It just means it’s out of its normal rhythm. When the heart doesn’t beat normally, it can’t pump blood effectively to the lungs, brain, and other organs, causing them to potentially shut down or become damaged. You could have an arrhythmia even if your heart is healthy, as it can be a side effect of medicines that you are taking or a manifestation of an abnormality elsewhere in your body.

Heart failure is a serious condition that commonly develops slowly over time, and is the leading cause of hospitalization in people older than 65. Heart failure is a bit of a misnomer, since it does not actually mean the heart has stopped working; rather, the heart pumps weaker than normal, causing blood to move through the body at a slower rate and increases pressures in the heart. The weakened heart muscle has to work overtime to keep up with the body’s demands, which can leave a person tired. Some of the symptoms of heart failure:

  • Shortness of breath
  • Difficulty breathing when lying down
  • Swelling in the legs, ankles, and feet
  • General fatigue and weakness

Congenital Heart Disease is a category of heart disease in which congenital heart defects are present at birth. Defects occur when the fetus is developing and may produce symptoms at birth or during childhood, while others aren’t discovered until a person is an adult. Some causes of congenital heart defects are:

  • Chromosomal abnormalities, such as Down syndrome
  • Maternal viral infection in the first trimester of pregnancy
  • Maternal drug or alcohol abuse during pregnancy, and certain medications such as Warfarin

Heart Muscle Disease (Cardiomyopathy) is a progressive disease that causes the heart to be abnormally enlarged, thickened and/or stiffened. Cardiomyopathy limits the heart’s ability to pump blood effectively, and often leads to heart conditions like arrhythmias or heart failure.

While there is a wide range of heart and vascular conditions associated with cardiovascular disease, the good news is that many types of heart disease can be prevented with healthy habits. You can reduce your risk of certain types of heart disease, such as heart attack, coronary artery disease and peripheral artery disease by doing the following:

  • Eating a low sodium diet
  • Eating more fresh fruit and vegetables while limiting foods high in saturated fat
  • Exercising at least 3 – 5 times a week for 30 minutes a day
  • Stop smoking!
  • Controlling your diabetes and high blood pressure

If you suspect you have heart condition, talk with a trained Emory Healthcare doctor, who can recommend or administer screening or diagnostic tests.

About Dr. Danny Eapen, MD

eapen-dannyDanny Eapen, MD  is an Assistant Professor at Emory University School of Medicine. Dr. Eapen specializes in preventive cardiology and adult heart disease. He pursued a degree in medicine from the University of Miami, Miami FL, and his internship and residency in Internal Medicine at Emory University School of Medicine. He also completed his research and general cardiology fellowship at Emory University.

Takeaways from Dr. Hoskins’ Arrhythmia Live Chat

arryhthmia live chatThanks to everyone who joined us Tuesday, February 24 for the live online chat entitled “Irregular Heart Beat: Is it normal?,” hosted by Emory Arrhythmia Center physician Michael Hoskins, MD.

Because arrhythmias are common in young- and middle-aged adults, it is important to understand the symptoms. Some arrhythmias are relatively harmless, but others can be fatal if not treated. Dr. Hoskins provided answers to questions about the diagnosis and treatment of heart rhythm disorders, as well as tips of how to deal with an episode of irregular heart beats. Check out the conversation by viewing the chat transcript! Here are just a few highlights from the chat:

Question: I have observed that during some of these episodes my blood pressure is really low and it has been recognized that sometimes my oxygen level is low during the night. could this be causing my arrhythmias? I do have trouble breathing through a deviated nostril.

Michael Hoskins, MDDr. Hoskins: A common condition associated with arrhythmias is sleep apnea. This can be caused by a deviated septum and can cause difficulty breathing and low oxygen levels at night. It sounds like you may benefit from a sleep apnea evaluation.

 

Question: I have been advised that I am a candidate for ablation for my a-fib. What are the options offered by Emory and how do I become educated about the options?

Michael Hoskins, MDDr. Hoskins: Ablation and medications are both treatment options for atrial fibrillation. It’s important to tailor that therapy to each specific patient. I would encourage you to schedule a visit with one of our arrhythmia specialists.

 

Question: Most irregular heartbeats do resolve within a few beats. If they don’t resolve for a longer period of time, a person would go to the emergency room, right? Or should that person wait for other symptoms, (dizziness or something else).

Michael Hoskins, MDDr. Hoskins: Some arrhythmias are more dangerous than others. We often encourage patients to call their doctor before going to the ER if it has been determined that their particular arrhythmia isn’t life threatening. However, certain arrhythmias need immediate attention and are best handled in the ER. If your arrhythmia is accompanied by severe chest pain, shortness of breath or loss of consciousness, you should consider calling 9-1-1.

If you missed this chat, be sure to check out the full list of questions and answers on the web transcript. For more information or to request an appointment to be screened for a heart rhythm disorder, visit emoryhealthcare.org/arrhythmia.

If you have additional questions for Dr. Hoskins, feel free to leave a comment in our comments area below.

 

 

How an Irregular Heartbeat Can Increase Your Risk of Stroke

Irregular HeartbeatAtrial fibrillation (AF) is the most common arrhythmia seen by physicians. AF is a condition in which the two of the heart’s four chambers beat irregularly. According to the American Heart Association, the risk of stroke is 5 times higher in patients diagnosed with AF because of an increased risk for clots in the heart chambers.

Depending on a patient’s age and other clinical risk factors for stroke, a scoring system is typically generated that will help classify that patient’s stroke risk. Patients with one or more risk factors for stroke are usually advised to take blood thinners for stroke prevention. Warfarin (or Coumadin) and other newer agents Pradaxa®, Xarelto® or Eliquis®  are proven therapies for stroke prevention in AF patients. All of these medications have proven to be safe and effective. Nevertheless, some patients may not tolerate these medications or could develop bleeding complications. In that case, a new option for stroke prevention has been studied and is awaiting FDA approval.

This new therapy is called the “Watchman” device. This device is delivered via a minimally invasive procedure (entry via the femoral vein) into the left atrium. In the left atrium this device is used to cover the left atrial appendage. X-Ray and echocardiography are used to guide this procedure. The left atrial appendage is a structure in the left atrium, or left heart chamber, that has a “cul-de-sac” shape and is responsible for the majority of clot formation in patients with non-valvular AF.

Emory Electrophysiologists have participated in the original studies of the “Watchman” device, which may lead to FDA approval. To schedule an appointment with an Emory Electrophysiologist, please call 404-778-7777 or visit emoryhealthcare.org/arrhythmia.

About Dr. El-Chami

Mikhael El Chami, MDMikhael El-Chami, MD, is an Assistant Professor of Medicine at Emory University and is the director of the arrhythmia clinic at Emory University Hospital Midtown.

Dr. El-Chami received his undergraduate and doctorate of medicine degree at the American University of Beirut in Lebanon. Following his internship and residency at Emory University School of Medicine in Atlanta, he was selected to be a chief medical resident at Emory University Hospital Midtown. After completion of his Chief Residency he also finished a cardiology and cardiac electrophysiology fellowship at Emory. He has been an Emory Faculty member since 2008. He is a Fellow of the American College of Cardiology and the Heart Rhythm Society, as well as an Alpha Omega Alpha honor medical society member.

Dr. El-Chami’s professional interests involve the treatment of heart rhythm disorders and prevention of sudden cardiac death. He has had numerous publications in the field of electrophysiology and continues to be involved in research on a number of studies related to atrial fibrillation and management of heart failure through device therapy.

Irregular Heartbeat: Is it Normal? – Join Us for a Live Web Chat!

Arrhythmia live chatHave you ever felt like your heart skipped a beat? Do you experience palpitations or “fluttering?” This is a symptom of a very common rhythm disorder called an arrhythmia. Arrhythmias are common in young- and middle-aged adults. Some arrhythmias are relatively harmless, but others can be fatal if not treated. Nearly 1,000,000 people are hospitalized for an arrhythmia each year, and some arrhythmias, such as Atrial Fibrillation, are extremely common and affect over 2,500,000 million Americans.

Other symptoms of arrhythmia include:

  • Fatigue
  • Dizziness
  • Lightheadedness
  • Fainting (syncope) or near-fainting spells
  • Rapid heartbeat or pounding
  • Shortness of breath
  • Chest pain
  • In extreme cases, collapse and sudden cardiac arrest

Join me on Tuesday, February 24, at 12:00 p.m. for a live, interactive web chat on the topic of “Living With and Treating Arrhythmias.” Dr. Michael Hoskins will be available to answer questions and discuss various topics about arrhythmias, including symptoms, diagnosis, prevention and treatment.

During this interactive web chat, you’ll be able to ask questions and get real-time answers from our Emory Healthcare professional.

Register now for our February 24 chat at emoryhealthcare.org/mdchats.

About Dr. Hoskins

Michael Hoskins, MDMichael Hoskins, MD , is an assistant professor of medicine and electrophysiologist who practices primarily at Emory University Hospital. Dr. Hoskins received his medical degree from the Medical College of Wisconsin in Milwaukee, after which he completed his residency in internal medicine at Emory. He was chief resident in Internal Medicine from 2005 to 2006. He then completed fellowships in cardiology and electrophysiology, also at Emory, and has been practicing here since 2010. He specializes in treating cardiac arrhythmias, focusing on ablation of arrhythmias and implantation and management of pacemakers and defibrillators.

About Emory’s Arrhythmia Center

Emory’s Arrhythmia Center is one of the most comprehensive and innovative clinics for heart rhythm disorders in the country. Our electrophysiologists have been pioneers in shaping treatment options for patients with arrhythmias such as atrial fibrillation, as well as for those with congestive heart disease. Our specialized electrophysiology (EP) labs host state-of-the-art equipment, including computerized three-dimensional mapping systems to assist with the ablation of complex arrhythmias, and an excimer laser system to perform pacemaker and defibrillator lead extractions.

Patients with devices, whether implanted at Emory or elsewhere, have access to Emory’s comprehensive follow-up care. Patients benefit from remote monitoring, quarterly atrial fibrillation support groups and 24-hour implantable cardiac device (ICD) and pacemaker monitoring services. Inpatient telemetry and coronary care units, as well as outpatient care and educational support of patients with pacemakers and ICDs, complete Emory’s comprehensive range of arrhythmia treatments and services.

Emory Offers State-of-the-Art Therapies for Heart Rhythm Disorders

heart rhythm therapyHeart rhythm disorders (arrhythmias) are common medical problems that affect millions of Americans each year. Treatments for arrhythmias vary from simple medications to specialized procedures depending on the needs of a particular patient. Fortunately, due to rapidly advancing technology, available therapies are quickly changing.

As one of the premier medical research centers in the Southeast, Emory offers some of the most cutting-edge treatments available for a wide variety of heart rhythm disorders. Highlighted below are just a few of these new advances:

Wireless pacemakers

The world’s smallest pacemakers are being implanted at Emory as part of an ongoing clinical trial. The Micra leadless pacemaker is an investigational device that is about one-tenth the size of a standard pacemaker. This device is approximately the length of a paperclip and round, like a capsule. This capsule contains all of the components of the pacemaker including the battery, and eliminates the need for the wire that is part of a standard pacemaker system.

One of the key benefits of the Micra pacemaker is that fact that it is implanted using a catheter through a vein in the front of the leg. The device is inserted directly into the heart. This process is generally quicker than a standard pacemaker procedure, and avoids the need for a surgical incision. Patients who have slow heart rates with weakness, lightheadedness, or fainting may be candidates for the Micra pacemaker clinical trial. Emory is the only center in Georgia that is participating in this trial.

Subcutaneous defibrillators

Defibrillators are devices that are designed to detect and treat life-threatening heart rhythm abnormalities. They are traditionally inserted under the skin in the patient’s shoulder, with a wire (or “lead”) that travels through a vein into the heart. While these devices have proven very effective, the presence of a defibrillator lead within the bloodstream may be associated with certain long-term complications. These may include infection or scarring of the blood vessel.

The subcutaneous defibrillator is a new type of device that is placed under the skin just like a standard defibrillator. However, this new device has a lead that travels just under the skin without having to be inserted through a blood vessel. This reduces the risks associated with infection.

Cryoablation for atrial fibrillation

Atrial fibrillation is the most common heart rhythm disorder, and can be treated in a variety of ways depending on the needs of the patient. One treatment option for this arrhythmia is catheter ablation. Traditionally, ablation for atrial fibrillation involves heating, or cauterizing, certain cells involved in the generation of atrial fibrillation. One new technique that has become available in the past several years is cryoablation. This therapy involves freezing cells with a super-cooled balloon that is positioned inside the heart with the use of a catheter. Cryoablation has the potential to be quicker than standard ablation, while having similar safety and effectiveness.

Ongoing clinical trials

Emory offers several clinical trials for patients who suffer from heart rhythm disorders. These trials represent opportunities to participate in the use of cutting-edge treatments that may not be available elsewhere. To learn more about ongoing heart rhythm clinical trials at Emory, please contact:

Emory University Hospital: Janice Parrott, 404-712-5592, jparrot@emory.edu
Emory University Hospital Midtown: Paige Smith, 404-686-7992, pfsmith@emory.edu
Emory St. Joesph’s Hospital: Cindy Barnes, 678-843-6093, cynthia.barnes@emory.edu

About Dr. Hoskins

Michael Hoskins, MDMichael Hoskins, MD, is an assistant professor of medicine and electrophysiologist who practices primarily at Emory University Hospital. Dr. Hoskins received his medical degree from the Medical College of Wisconsin in Milwaukee, after which he completed his residency in internal medicine at Emory. He was chief resident in Internal Medicine from 2005 to 2006. He then completed fellowships in cardiology and electrophysiology, also at Emory, and has been practicing here since 2010. He specializes in treating cardiac arrhythmias, focusing on ablation of arrhythmias and implantation and management of pacemakers and defibrillators.

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Atrial Fibrillation and New Anticoagulation Medications

AnticoagulantsAtrial Fibrillation is a very common heart rhythm disorder that may affect patients of all ages. Typically, this type of heart arrhythmia causes symptoms including palpitations, chest pain, dizziness or shortness of breath. However, it is important to note that this disorder can sometimes (especially in the elderly) be present without any symptoms whatsoever. While this arrhythmia is often associated with other heart conditions (valve problems, hypertension, coronary artery disease, congestive heart failure), in many patients, there is nothing else wrong with the heart. Patients with atrial fibrillation or atrial flutter and 1 or more risk factors for stroke such as simply being older than 65, having diabetes or hypertension, having a history of heart failure or prior mini-strokes are often prescribed anticoagulant drugs to prevent a stroke. For decades, physicians have prescribed Coumadin (warfarin) to reduce the risk. Importantly, aspirin is not nearly as effective as Coumadin in reducing the risk of stroke in patients with atrial fibrillation and is not considered an anticoagulant.

Patients taking Coumadin require blood tests every 4-8 weeks to monitor the proper dose to be sure the drug is effective and to reduce the risk of bleeding. Certain foods can reduce the effectiveness of the drug (such as leafy greens or spinach) and often medications can interact with Coumadin that potentially increase the risk of bleeding (especially certain antibiotics). Despite these drawbacks, Coumadin has effectively been utilized for decades to reduce the risk of stroke in patients with atrial fibrillation.

In the past 5 years, newer anticoagulants have been approved by the FDA for reducing the risk of stroke in patients with atrial fibrillation. These include Pradaxa, Xaelto and Eliquis. Drugs such as Clopidogrel (Plavix) are not used for this purpose and like aspirin are antiplatelet drugs used for other purposes. These newer anticoagulants have the advantage of not requiring blood tests to monitor their efficacy and they have fewer interactions with foods and other medications. Large clinical trials have been performed for each of the above newer anticoagulants and 3 drugs have been tests in head to head comparisons with Coumadin for efficacy and bleeding complications. The trials have demonstrated that all of the newer agents are at least as effective as Coumadin without a significant increase in bleeding risk. Despite the fact that all the newer agents do not have an antidote (such as vitamin K or plasma) in patients who are bleeding, this has not translated into a significant increase in bleeding risk in the large trials, and therefore, is why they have been approved by the FDA.

That being said, all anticoagulants carry a risk of bleeding and the decision to use Coumadin or any of the newer drugs is a decision requiring close consultation and discussion with your physician. It is important to promptly notify your physicians if you have had atrial fibrillation, are not taking an anticoagulant and you have any symptoms of a mini-stroke, even if the symptoms resolve on their own.

It is also important to note that all of the above also applies to patients with atrial flutter, another arrhythmia similar to atrial fibrillation. The above does not apply to patients with palpitations and tachycardia unless atrial fibrillation or atrial flutter has been confirmed with an EKG.

If you have symptoms that suggest you might have episodes of atrial fibrillation or you have already been diagnosed with an arrhythmia and wish to discuss the use of Coumadin or any of the newer agents, you can contact your existing cardiologist, or call HealthConnection at 404-778-7777 to make an appointment with an Emory cardiologist near you.

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What Is Supraventricular Tachycardia (SVT) and Does It Require Treatment?

SVT heartSupraventricular tachycardia (SVT), also referred to as paroxysmal SVT or PSVT, is a type of abnormal heart rhythm (arrhythmia) in which the heart beats too fast. When the heart beats too fast, it may not function effectively, resulting in less oxygen-rich blood reaching the tissues throughout the body. SVT often starts and ends suddenly, and may not be associated with any symptoms. However, many people do experience symptoms as a result of SVT, including palpitations (rapid, noticeable heartbeats), dizziness, fainting, shortness of breath and chest pain (angina).

In most cases, SVT occurs because of a malfunction of the heart’s electrical system. The heart is made up of two upper chambers (atria) and two lower chambers (ventricles). In a normal heartbeat, an electrical impulse originates from an area in the right atrium called the sinus node. This impulse travels first to the atria, causing them to contract and pump blood into the ventricles. The electrical impulse then continues along its circuit to the atrioventricular (AV) node, where it pauses to allow the ventricles to fill with blood. Finally, the impulse reaches the ventricles, signaling them to contract and pump blood out to the lungs and the body. In SVT, the electrical malfunction occurs at some point before the electrical signal reaches the ventricles.

Common types of SVT include:

  • Atrial fibrillation (A-fib) is a type of tachycardia that occurs when multiple circuits of disorganized electrical activity in the atria replace the organized electrical activity that is normally generated by the heart. The result is fibrillation (quivering) of the atria instead of regular heartbeats.
  • Atrioventricular (AV) node re-entry tachycardia (AVNRT) is the most common form of SVT. Patients with this arrhythmia do not have structural problems with their heart, but have two pathways that can channel impulses to and from the AV node. Under certain conditions, usually following a premature beat, these pathways can form an electrical circuit, which starts a rapid heart rhythm.
  • Wolff-Parkinson-White syndrome (WPW) is an arrhythmia caused by an extra electrical pathway from the atria to the ventricles. Although some people with WPW do not have any symptoms, others experience palpitations, dizziness and angina. Rarely, WPW can be life threatening.

SVT often first occurs in children and young adults. Many controllable factors can increase the risk of SVT episodes, including stress and anxiety, certain medications, excessive alcohol or caffeine consumption, smoking and the use of illegal stimulants such as cocaine.

Otherwise healthy individuals experiencing SVT without significant symptoms may not require any treatment. However, if you have an underlying related health condition or significant symptoms, treatment may be necessary. This may take the form of medication therapy, pacemaker implantation or cardiac ablation, in which radiofrequency energy is used to destroy very tiny areas of tissue that give rise to abnormal electrical signals.

Emory’s Arrhythmia treatment program is one of the most comprehensive and innovative clinics for heart rhythm disorders in the country. In addition to offering state-of-the-art care for the full range of heart rhythm disorders, we also operate heart rhythm screening clinics at a number of locations throughout the Atlanta area. If you have experienced an irregular heartbeat, palpitations, a racing heartbeat or other troubling heart irregularities, we recommend that you schedule an appointment with one of our specialty-trained nurse practitioners, who will begin a comprehensive screening evaluation to determine whether you need follow-up care with an electrophysiologist.

About Dr. DeLurgio

David DeLurgio, MDDavid DeLurgio, MD , is a professor of medicine at Emory University School of Medicine and director of Electrophysiology at Emory Saint Joseph’s Hospital. Dr. DeLurgio earned his medical degree from the University of California Los Angeles School of Medicine, where he also completed his residency and fellowship training. He joined Emory Healthcare in 1996 and served as the director of the Arrhythmia Center and Electrophysiology Lab at Emory University Hospital Midtown before relocating to Emory Saint Joseph’s Hospital.

About Emory’s Arrhythmia Center

Emory’s Arrhythmia Center is one of the most comprehensive and innovative clinics for heart rhythm disorders in the country. Our electrophysiologists have been pioneers in shaping treatment options for patients with arrhythmias such as atrial fibrillation, as well as for those with congestive heart disease. Our specialized electrophysiology (EP) labs host state-of-the-art equipment, including computerized three-dimensional mapping systems to assist with the ablation of complex arrhythmias, and an excimer laser system to perform pacemaker and defibrillator lead extractions.

Patients with devices, whether implanted at Emory or elsewhere, have access to Emory’s comprehensive follow-up care. Patients benefit from remote monitoring, quarterly atrial fibrillation support groups and 24-hour implantable cardiac device (ICD) and pacemaker monitoring services. Inpatient telemetry and coronary care units, as well as outpatient care and educational support of patients with pacemakers and ICDs, complete Emory’s comprehensive range of arrhythmia treatments and services.

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What Is Bradycardia and Why Does It Occur?

bradycardiaBradycardia is the medical term for a heart rate that is too slow — specifically, a heart rate less than 60 beats per minute in adults. However, under some circumstances, a heart rate less than 60 beats per minute is perfectly healthy and not a cause for intervention. For instance, a resting heart rate below 60 beats per minute in a person who is physically fit may be normal, and it can be normal for the heart rate to dip below 60 beats per minute in some older adults and in anyone during sleep.

The heart consists of two upper chambers (atria) and two lower chambers (ventricles). In a normal heartbeat, an electrical impulse originates from an area in the right atrium called the sinus node. This impulse travels first to the atria, causing them to contract and pump blood into the ventricles. The electrical impulse then continues along its circuit to the ventricles, signaling them to contract and pump blood out to the lungs and the body.

In bradycardia, there is a problem with this electrical impulse. For instance, it may trigger the atria to contract, but not reach the ventricles to signal their contraction (heart block), or the signal may travel too slowly along its pathway through the heart. As a result, the heart may not pump enough blood out to the body, which can cause a range of symptoms, such as dizziness, fatigue, shortness of breath, chest pain (angina), lightheadedness and fainting. In severe cases, bradycardia can even lead to cardiac arrest.

Problems with the heart’s electrical system can have many causes, including damage to the heart muscle related to aging or heart disease, an imbalance of electrolytes in the body, the use of certain medications, hypothyroidism, sleep apnea, high blood pressure and underlying heart conditions, including congenital defects.

If your doctor determines that bradycardia occurs as a result of an underlying condition, such as high blood pressure, hypothyroidism or sleep apnea, the first step will generally be to treat the underlying condition to see if this corrects the slow heart rate. If medications you take may be causing your bradycardia, you doctor may adjust or change your medication regimen. If these approaches do not resolve your bradycardia, your doctor may recommend the implantation of a pacemaker to help the heart maintain a healthy rate.

If you experience symptoms of bradycardia or any other abnormal heart rhythm, you can visit one of Emory’s new heart rhythm screening clinics located throughout the Atlanta area to determine if your condition is serious.

About Dr. Patel

Anshul M. Patel, MDAnshul Patel, MD , is an assistant professor of medicine and electrophysiologist who practices primarily at Emory Saint Joseph’s Hospital. He graduated magna cum laude from Harvard College and received his medical degree from the Johns Hopkins University School of Medicine. Dr. Patel completed his internship, residency and cardiology training at Massachusetts General Hospital and Harvard Medical School, where he also completed a fellowship in cardiac electrophysiology. He specializes in pacemaker and defibrillator implantation, as well as catheter ablation, with a particular interest in atrial fibrillation and ventricular arrhythmias.

About Emory’s Arrhythmia Center

Emory’s Arrhythmia Center is one of the most comprehensive and innovative clinics for heart rhythm disorders in the country. Our electrophysiologists have been pioneers in shaping treatment options for patients with arrhythmias such as atrial fibrillation, as well as for those with congestive heart disease. Our specialized electrophysiology (EP) labs host state-of-the-art equipment, including computerized three-dimensional mapping systems to assist with the ablation of complex arrhythmias, and an excimer laser system to perform pacemaker and defibrillator lead extractions.

Patients with devices, whether implanted at Emory or elsewhere, have access to Emory’s comprehensive follow-up care. Patients benefit from remote monitoring, quarterly atrial fibrillation support groups and 24-hour implantable cardiac device (ICD) and pacemaker monitoring services. Inpatient telemetry and coronary care units, as well as outpatient care and educational support of patients with pacemakers and ICDs, complete Emory’s comprehensive range of arrhythmia treatments and services.

Related Links