Posts Tagged ‘heart arrhythmias’

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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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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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.

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What Is Arrhythmia?

arrhythmiaAn arrhythmia refers to an abnormal pattern or rate of the heartbeat. Arrhythmias can include heartbeats that are too fast, too slow or irregular, as is the case with atrial fibrillation , the most common arrhythmia in the United States that requires medical attention.

The normal rhythm of the heart is a tightly regulated but dynamic electrical phenomenon that changes according to the needs of the body. The heart has built-in pacemakers and “wiring” that coordinate contractions in the organ’s upper chambers (the atria) and lower chambers (the ventricles). Glitches in this complicated electrical system can cause the heart to “misfire.”

Everyone has felt their heart “skip” a beat or two or speed up in times of fear or excitement or during exercise. Too much caffeine and certain medications can also cause heart palpitations (rapid thumping in the chest) in some people. These types of arrhythmias are generally harmless.

If irregular heartbeats are frequent or chronic, they can be serious. The consequences of having an arrhythmia usually depend not only on symptoms they can cause (such as faintness), but also on the presence of heart disease or structural abnormalities. In serious cases, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart and other organs.

Common symptoms of arrhythmia include:

  • Shortness of breath
  • Chest pain
  • Palpitations
  • Feeling tired or light-headed
  • Passing out

Call your doctor if you have any of these symptoms of arrhythmia, especially if you have heart disease or have had a heart attack.

If you have experienced an irregular heartbeat, palpitations, a racing heartbeat or other heart irregularities, we recommend that you schedule an appointment with a specialty-trained Emory Healthcare Nurse Practitioner who will begin a comprehensive screening evaluation to determine whether you need follow-up care with an Emory Electrophysiologist. Call 404-778-7777 to schedule your screening appointment. You can also learn more about the Emory Arrhythmia Center online .

About Dr. Lloyd

Michael Lloyd, MDMichael Lloyd, MD , began practicing medicine at Emory in 2007. He specializes in cardiology and cardiac electrophysiology. His areas of clinical interest and research include arrhythmias in athletes, arrhythmias in young adults with congenital heart disease, atrial fibrillation and implantable devices for the treatment of heart failure. Dr. Lloyd is the program director for the Cardiac Electrophysiology Fellowship Program at Emory and holds organizational leadership positions with the American College of Cardiology, the American Heart Association and the Heart Rhythm Society.

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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Emory Opens Heart Rhythm Clinics to Treat Growing Problem

arrhythmia screening centerEmory Healthcare is launching new screening centers across the Atlanta area to help diagnosis abnormal heart rhythms, or arrhythmias. An arrhythmia is a disorder of the heart that occurs when the body’s electrical impulses, which direct and regulate heartbeats, do not function properly and cause the heart to beat slowly (bradyarrhythmias), rapidly (tachyarrhythmias) or in an uncoordinated manner.

The new clinics will offer screening and, if needed, 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.

Emory has been a pioneer in shaping arrhythmia treatment options, serving as primary and principal investigators for many national clinical trials. We rank among the world’s leaders in cardiac resynchronization therapy and have performed more cardiac ablation procedures than anyone in the Southeast.

According to the American Heart Association, atrial fibrillation (A-fib) is the most common chronic cardiac dysrhythmia and affects nearly 2.3 million people in the United States. The prevalence of arrhythmias is age-related and is expected to rise substantially as the baby boomer population continues to age.

Emory has one of the most wide-ranging and innovative treatment programs for heart rhythm disorders in the United States. Anyone who is experiencing palpitations, heart racing or other rhythm symptoms can visit one of our new screening locations to determine if their condition is serious and requires treatment by a specialist.

To learn more about arrhythmia screening, treatment and heart rhythm management services at Emory, please visit emoryhealthcare.org/arrhythmia.

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?

Arrhythmia Web Chat with Dr. El-ChamiHave you ever experienced a skipped heart beat or a change in the regular beat of your heart? If so, you may have a rhythm disorder called an Arrhythmia. Arrhythmias are common in 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.

Join me on Wednesday, August 24, at 12:30 p.m. for an interactive web chat on the topic of Diagnosing, Managing and Living with Arrhythmias. I will be available to answer questions and discuss various topics about arrhythmias, including symptoms, diagnosis, prevention and treatment, as well as innovative new cardiovascular research on the horizon.

You can register online for the live chat! UPDATE CHAT TRANSCRIPT

Dr. El-Chami

About Mikhael El-Chami, MD

Dr. El-Chami completed his residency at Emory in 2003, and he 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 memberships with the American College of Cardiology and the Heart Rhythm Society. He speaks Arabic and French fluently.

Medication Treatments for Arrhythmia

In previous blog entries, we’ve covered medical procedures for heart arrhythmias. In this post, we’ll explore multiple drug treatment regimens we use to treat various cardiac arrhythmias.

There are several medications used in the treatment of cardiac arrhythmias. The choice of medicine depends on the type of arrhythmia and the presence of different comorbidities, such as heart, kidney or liver diseases.

Let’s explore the main categories of these medications:

Beta Blockers: Beta blockers block the effect of adrenaline on the heart and blood vessels. They are commonly used in the treatment of different arrhythmias. They are mainly used as blood pressure medication and also used in the treatment of coronary artery disease, congestive heart failure and angina. They are usually safe and well tolerated by patients.

Calcium Channel Blockers: Calcium channel blockers disrupt the process of calcium entering the heart and blood vessel tissues.  As with beta blockers, this blockage results in lower blood pressure, which is why this medication is also used to treat high blood pressure and angina. Calcium channel blockers are available in short and long acting forms.  This class of medication is also usually safe and well tolerated.

Antiarrhythmic Drugs: Antiarrhythmic drugs are often used in treating different arrhythmias, especially atrial fibrillation (A-fib). Different antiarrhytmic drugs are available, such as flecainide, propafenone, sotalol, and amiodarone. Each of these drugs has different side effects. A common side effect to all antiarrhythmic drugs is pro-arrhythmia, i.e. the occurrence of dangerous arrhythmias, which is why these medications should only be prescribed by a specialist. Patients taking these drugs should have an ECG done every 6 months to check for any evidence of medication toxicity.

Do you have any questions about any of these treatments or about cardiac arrhythmias in general? If so, I encourage you to leave a note in the comment section below.

About Mikhael El-Chami, MD: Dr. El-Chami completed his residency at Emory in 2003, he also was nominated for a chief residency year at Emory in 2004. His training in cardiology and electrophysiology was completed at Emory as well. His areas of clinical interest include: Cardiac arrhythmia ablation, cardiac resynchronization therapy and prevention of sudden cardiac death. Dr. El-Chami holds organizational leadership memberships with the American College of Cardiology and the Heart Rhythm society, and speaks Arabic and French fluently.

Defining Atrial Fibrillation

Atrial fibrillation, or A-fib, is the most common irregular heart rhythm, or cardiac arrhythmia in the United States. In fact, according to the American Heart Association, approximately two million Americans suffer from A-fib, which results when multiple circuits of disorganized electrical activity in the two upper chambers of the heart (the atria) take over the organized electrical activity normally generated by the heart’s sinus node. This produces a fibrillating, or quivering of the atria, as opposed to a regular heartbeat.

Although A-fib isn’t directly life threatening, it’s often debilitating, as it produces a fast, irregular pulse that can cause fatigue and contribute to additional heart problems over time, such as congestive heart failure. Other symptoms include palpitations, chest discomfort, shortness of breath, or dizziness. In many cases, A-fib greatly increases the risk of stroke; consequently, patients are often placed on blood thinners.

Just a few years ago, patients suffering from this condition were informed that they’d have to learn to live with it. However, increasing numbers of people suffering from A-fib can now be treated or even cured, thanks to innovative therapies and procedures available through The Emory Heart & Vascular Center.

Now that we’re able to successfully treat atrial fibrillation, we’re greatly improving the quality of life for our patients, reducing the number of medications they have to take, and limiting the amount of hospital trips they have to make.

Our next Heart & Vascular post will touch on the diagnosis of A-fib and arrhythmias in general.

Do you have any questions or thoughts about atrial fibrillation? If so, be sure to let me know in the comments.

About Jonathan Langberg, MD:

Dr. Langberg is the Director of Cardiac Electrophysiology at Emory University Hospital, as well as a professor of Internal Medicine. He is board certified in Internal Medicine, Cardiology, and Cardiac Electrophysiology. Dr. Langberg is a pioneer in the field of catheter ablation of arrhythmias and has published over 150 articles related to his field.