heart conditions

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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Understanding Peripheral Vascular Disease

PVDDo you experience painful muscle cramps in your hips, thighs or calves when moving around? You may be surprised to learn that this is the primary symptom of peripheral vascular disease (PVD). PVD is defined as diseases of the arteries outside of the heart and brain. PVD is a term used interchangeably with peripheral artery disease, or PAD, but PVD encompasses diseases of the arteries AND veins.

Arteries move blood away from the heart, and PAD typically involves the narrowing of the arteries that transport blood to the arms and legs. Veins take the blood back to the heart and generally don’t get narrowed with cholesterol, but rather develop another very common condition called chronic venous insufficiency (varicose veins).

PAD – Arteries

Many patients go undiagnosed because the symptoms can be attributed to something else, such as arthritis, a neuropathy or normal stiffness that occurs with aging. Patients with PAD may also experience numbness, weakness or coldness in one or both legs. Often the symptoms come on slowly and the patient starts altering their life style and become more sedentary.

On the other hand, at least half of people who suffer from PAD have no signs or indications at all. Risk factors for PAD include aging, personal or family history, cardiovascular disease or stroke. Controllable risk factors include:

  • Cigarette smoking
  • Obesity
  • Diabetes mellitus
  • Physical inactivity
  • High blood cholesterol
  • High blood pressure Renal failure

Chronic Venous Insufficiency

This is more common than PAD and may start at an early age. The symptoms of this may include any one or more of the following: legs feeling heavy or tired especially at the end of the day, mild swelling of ankles, severe cramps at night time, restless legs, itching of legs, or formation of visible veins on the leg. In severe cases the skin around the ankle area may get darker in color and sores may form, generally above the ankle, which are slow to heal.

Some of the risk factors include age, family history of varicose veins, obesity, standing for long periods on hard surfaces and history of blood clots or phlebitis in the leg.

If you have any of the above symptoms or would like to discuss your risk factors, talk to your healthcare provider. PVD diagnosis begins with a physical examination.

At Emory, treatment of PVD is a combined effort within the Emory Heart & Vascular Center, the Division of Vascular Surgery and Endovascular Therapy and Interventional Radiology. To make an appointment, call 404-778-7777.

About Khusrow Niazi, MD

Khusrow Niazi, MDDr. Niazi specializes in interventional cardiology, carotid artery disease, peripheral artery disease and venous disease of the legs. He has been practicing at Emory since 2003. He has been involved in many trials in treating blockages in the carotid arteries and leg arteries with less invasive options. Dr. Niazi is involved in trials focused on the removal of plaque from the leg arteries with less invasive methods. He also has treated many patients with chronic venous insufficiency and varicose veins.

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.

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Is a Fast Heart Rate Dangerous?

TachycardiaTachycardia is a general term used to describe a rapid heartbeat. In some instances, tachycardia is the body’s normal reaction to situations that cause increased levels of adrenaline and generally poses little or no health risk. However, other types of tachycardia can be more serious.

When the heart beats significantly faster than normal, it can be less effective in providing oxygen-rich blood to tissues throughout the body. Though tachycardia sometimes goes unnoticed, it many cases the reduction in oxygen supply is associated with a range of symptoms, including shortness of breath, fatigue, dizziness, lightheadedness and chest pain. Some types of tachycardia can even lead to a heart attack or stroke.

Tachycardia can sometimes be reversed with lifestyle changes such as reducing alcohol or caffeine consumption, controlling stress or making adjustments to your medication regimen. In other cases, tachycardia can be controlled by treating an underlying medical condition, such as anemia, heart disease or hyperthyroidism.

However, some types of tachycardia occur due to an extra electrical circuit in the heart or structural damage to the heart muscle (e.g., from illness or a heart attack) that causes the heart’s electrical system to malfunction. In these cases, direct treatment may be necessary. This might 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 Center 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, the Center also offers 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. El-Chami

Mikhael El Chami, MDMikhael El-Chami, MD , completed his residency at Emory in 2003 and was nominated for a chief-residency year at Emory in 2004. His training in cardiology and electrophysiology also was completed at Emory. His areas of clinical interest include cardiac arrhythmia ablation, cardiac resynchronization therapy and prevention of sudden cardiac death. Dr. El-Chami holds organizational leadership positions with the American College of Cardiology and the Heart Rhythm Society. He speaks fluent Arabic and French.

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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Are Heart Palpitations Cause for Concern?

Heart BeatPalpitations are rapid, noticeable heartbeats that may be felt in the chest, back or throat. Often, they are associated with a fluttering sensation in the chest or that of the heart skipping a beat. They can occur following exertion or while you are at rest.

Most of the time, palpitations are not a sign of a serious health condition. For instance, caffeine and nicotine consumption can cause palpitations. They can also occur as a result of stress or anxiety, vigorous exercise, a fever, hormonal changes associated with pregnancy or menopause, taking certain medications or the use of illicit drugs such as cocaine. In these cases, palpitations will generally resolve on their own or with changes in behavior — such as drinking less coffee, learning to control anxiety or making adjustments to the medications you take. But palpitations can also be an indication of underlying health issues, including hyperthyroidism (an overactive thyroid gland) and any number of underlying cardiovascular conditions.

In general, if palpitations only last a few seconds and do not occur often, medical evaluation may not be necessary. However, if they occur frequently, the episodes are longer or you have already been diagnosed with a related health condition such as heart disease, diabetes, high cholesterol or high blood pressure, it is important to seek prompt medical attention. Regardless of your medical history, if other symptoms occur with the palpitations, including dizziness, confusion, shortness of breath and chest discomfort, you should seek emergency medical care.

Heart conditions that may be associated with palpitations include valve disorders, congenital defects and arrhythmias. An arrhythmia refers to an abnormal pattern or rate of the heartbeat. Palpitations can be a symptom of a number of arrhythmias, including the most common one, atrial fibrillation.

If you have experienced prolonged or frequent palpitations, you can visit one of Emory’s new heart rhythm screening clinics located throughout the Atlanta area to determine if your condition is serious. The Emory Arrhythmia Center also provides comprehensive, state-of-the-art care for the full range of heart rhythm disorders.

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.

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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Has Your Heart Ever “Skipped a Beat”? It Was Probably a Premature Contraction

Heart AtriumThe 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 ventricles, signaling them to contract and pump blood out to the lungs and the body.

Sometimes, abnormal electrical signals originate from areas of the heart other than the sinus node. These extra impulses may target the atria or the ventricles, causing them to contract out of rhythm with the regular heartbeat. This type of arrhythmia is called a premature contraction.

Premature contractions are common and may even go unnoticed. However, some people report a feeling of the heart skipping a beat, often followed by a stronger-than-usual beat. The pause is actually the heart waiting for the regular rhythm to resume. Following the pause, the normal contraction is often stronger than usual due to the presence of a greater volume of blood in the chambers.

Premature contractions may occur for a number of reasons, including an imbalance of electrolytes in the body, certain medications, alcohol or drug use, or increased adrenaline, for instance from exercise or anxiety or the consumption of caffeine or tobacco. Rarely, premature contractions are an indication of an underlying heart condition, such as congenital heart disease, heart failure or scarring of the heart muscle.

In most cases, premature contractions do not require treatment. However, if the symptoms are bothersome or the contractions may exacerbate underlying heart conditions, premature contractions may be treated with medications such as beta-blockers, calcium channel blockers or antiarrhythmics. Your doctor may also instruct you to avoid things that can trigger the contractions, such as caffeine, alcohol or stressful situations.

If lifestyle changes and medications are not effective in reducing or eliminating the premature contractions, your doctor may use cardiac ablation to treat them instead. During an ablation procedure, one or more thin, flexible tubes are guided with X-rays into blood vessels and directed to the heart muscle. Then radiofrequency energy is delivered to destroy very tiny areas of tissue that give rise to abnormal electrical signals.

Emory Healthcare recently launched new screening centers across the Atlanta area to help diagnosis abnormal heart rhythms. If you experience symptoms of premature contractions or any other abnormal heart rhythm, you can visit one of our new screening locations to determine if your condition is serious. In addition to screenings, the new clinics offer state-of-the-art care by some of the country’s leading arrhythmia experts. Clinics in Villa Rica, Conyers and Johns Creek are already operating, and a fourth location in Decatur will open later this summer.

About Dr. Merchant

Faisal Merchant, MDFaisal Merchant, MD , is an assistant professor of medicine who practices primarily at Emory University Hospital Midtown. He received his medical degree from Duke University, completed internal medicine and general cardiology training at Massachusetts General Hospital in Boston and a cardiac electrophysiology fellowship at Emory. He specializes in cardiac electrophysiology and treats all forms of arrhythmias, including pacemaker and defibrillator implantation and catheter ablation.

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 Atrial Flutter?

Atrial FlutterAtrial flutter, also called “heart flutter,” is a type of arrhythmia that occurs when the upper two chambers of the heart (the atria) contract too rapidly. The first contraction in a normal heartbeat occurs in the atria. This contraction pumps the blood into the lower chambers of the heart, called the ventricles. The second contraction occurs in the ventricles and serves to pump blood out of the heart.

In atrial flutter, the atria contract at an abnormally fast rate, but only about half of these contractions are followed by the second ventricular contraction. This causes the heart to work inefficiently and may result in poor blood supply to the body, including the brain and the heart muscle itself. If the heart and brain do not receive enough blood, organ failure can occur in the form of congestive heart disease, heart attack or stroke.

Atrial flutter can occur on its own, but often occurs in people with other conditions, including atrial fibrillation , heart failure, congenital heart defects, high blood pressure, diabetes, thyroid conditions, heart valve conditions and chronic lung disease. The risk of atrial flutter also increases following serious illness, an episode of heavy drinking, surgery or a heart attack. Symptoms may include heart palpitations (rapid, noticeable heartbeats), dizziness, shortness of breath, lightheadedness and chest pain (angina).

A simple, non-invasive test called an electrocardiogram (ECG) that measures the electrical impulses in the heart can be used to diagnose atrial flutter and other arrhythmias. Upon diagnosis, the doctor will determine the best way to control the rapid heartbeat. If there are serious symptoms, this might be accomplished with IV medications or cardioversion (electrical shock to interrupt the arrhythmia and restore a normal heartbeat). Oral medication is more common if there are not serious symptoms. Because atrial flutter can increase the risk of stroke, many people are also prescribed a blood thinner.

If you believe you are experiencing atrial flutter, it is important to seek emergency care. In addition, follow-up care with a physician that specializes in arrhythmias is also important. Emory’s arrhythmia treatment program is one of the most comprehensive and innovative clinics for heart rhythm disorders in the country. Our physicians have been pioneers in shaping treatment options for patients with arrhythmias. Our Arrhythmia Center offers screening, treatment and heart rhythm management services at locations across Atlanta .

About Dr. Merchant

Faisal Merchant, MDFaisal Merchant, MD , is an assistant professor of medicine who practices primarily at Emory University Hospital Midtown. He received his medical degree from Duke University, completed internal medicine and general cardiology training at Massachusetts General Hospital in Boston and a cardiac electrophysiology fellowship at Emory. He specializes in cardiac electrophysiology and treats all forms of arrhythmias, including pacemaker and defibrillator implantation and catheter ablation.

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

What Causes Congenital Heart Disease?

Congenital heartCongenital heart defects (CHDs) are the most common type of birth defect, affecting about 1% of infants born in the United States. While doctors can sometimes pinpoint the likely cause of a particular defect, most of the time the cause is uncertain.

Most CHDs are the isolated type, meaning that they occur alone without other birth defects. In most isolated CHDs, the cause cannot be determined and is generally assumed to be a combination of genetic (inherited) and environmental factors.

There are a number of genetic birth defects that often occur together with CHDs, including Down syndrome, Turner syndrome, Marfan syndrome and Williams syndrome. In these cases, a defect in the infant’s DNA causes the heart to develop improperly. For instance, about half of babies born with Down syndrome also have a CHD, most often a defect in the wall between the left and right sides of the heart (atrioventricular septal defect).

A mother’s exposure to certain substances during pregnancy can increase the risk for CHDs. Some medications increase risk, including certain acne and seizure medications. Environmental exposures can be more difficult to pinpoint but may contribute as well. A mother ingesting too much alcohol during pregnancy can also increase the risk of her infant being born with a heart defect.

In addition to environmental exposures, some health issues in pregnant women can play a role in increasing the risk for CHDs. These include infections such as rubella, as well as chronic conditions that are not under control, such as diabetes and lupus.

The Congenital Heart Center of Georgia was created to bridge the gap between pediatric and adult care for people with CHDs. If you were born with a CHD and haven’t been evaluated regularly by a cardiologist, you were recently diagnosed with a CHD or you have a child who will be transitioning into adult care in the near future, learn more about the Congenital Heart Center of Georgia and make an appointment today.

About Dr. Rodriguez

Fred Rodriguez, MDFred Rodriguez, MD, is a pediatric cardiologist who practices pediatric cardiology at the Children’s Healthcare of Atlanta Sibley Heart Center and adult congenital heart disease at the Emory Clinic and Emory University Hospital. Dr. Rodriguez earned his medical degree from the Louisiana State University at New Orleans School of Medicine, where he also completed his combined residency in both internal medicine and pediatrics. Following his residency, he completed a cardiology fellowship at Texas Children’s Hospital in Houston, with additional training in adult congenital heart disease. He is board certified in pediatrics, pediatric cardiology and internal medicine.

About the Congenital Heart Center of Georgia

The Congenital Heart Center of Georgia is a collaboration between Children’s Healthcare of Atlanta and Emory Healthcare. The Congenital Heart Center of Georgia is a comprehensive program for children and adults with congenital heart disease (CHD) that provides a continuum of lifesaving care from before birth through adulthood. It is the first comprehensive CHD program in the South and one of the largest in the country. The program is led by Emory Healthcare cardiologist Wendy Book, MD, along with Robert Campbell, MD, chief of cardiac services and director of cardiology at Children’s Sibley Heart Center. To schedule an appointment, please call 404-778-7777.

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