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Innovative Treatment Options

Jeffrey M. Carlton Heart & Vascular Institute provides a full array of advanced treatment options for arrhythmia. Many of these innovative procedures are being performed in the new Allan and Sandy Fainbarg Electrophysiology Cath Lab Suite, the first EP suite of its kind in Orange County. The new state-of-the-art suite offers the latest in EP technology coupled with a comfortable patient-centered environment.

As a recognized leader in state-of-the-art arrhythmia management, Hoag's multidisciplinary team of arrhythmia experts perform some of the most complex heart rhythm procedures available in the nation with clinical outcomes that rival national figures.

Learn more about Jeffrey M. Carlton Heart & Vascular Institute's top rated arrhythmia management program:

Treatment for cardiac arrhythmia varies according to the type and severity of the heart rhythm disorder. In some cases, no treatment is necessary. When treatment is recommended, the most common options include: medication therapy, invasive therapies, electrical devices or surgery.

Medication Therapy

There are many effective anti-arrhythmic medications available today. Though medication therapy doesn’t cure the problem, it can help to reduce episodes of tachycardia (rapid heartbeat) or slow down the heart when an episode does occur. In fact, some of these medications may slow the heart so much that a pacemaker is required. If your physician prescribes medication therapy, it’s vital to take these medications exactly as directed in order to avoid complications.

Ablation Procedures

Ablation refers to a group of procedures used to treat abnormal heart rhythms when medication therapy is not effective or convenient. The type of arrhythmia and the presence of other heart disease will determine whether ablation can be performed surgically or non-surgically. At the Jeffrey M. Carlton Heart & Vascular Institute, our expert team of electrophysiologists and cardiothoracic surgeons are recognized leaders in the successful treatment of arrhythmia, performing the highest volume of ablations in the county, including ground-breaking procedures that are not readily available at other centers.

Catheter ablation

Catheter ablation is a minimally invasive procedure that is performed in Hoag’s new state-of-the-art Allan and Sandy Fainbarg Electrophysiology Cath Lab Suite. During the procedure, an electrophysiologist (a cardiologist who has completed extensive fellowship training in heart rhythm disorders) threads thin, flexible catheters through a vein or artery in the upper thigh, arm or neck. He/she guides these catheters to the heart, placing the tip of the catheter at the precise location where the arrhythmia begins. The catheter emits an energy source that the physician uses to destroy (ablate) a small area of heart tissue that is causing rapid and irregular heartbeats. Destroying this tissue helps restore the heart’s regular rhythm. In catheter ablation, different energy sources may be used to block the abnormal electrical signals, such as radiofrequency energy or cryotherapy.

Surgical ablation

Surgical ablation (also called the Maze procedure) is performed by highly-skilled cardiothoracic surgeons in the Jeffrey M. Carlton Heart & Vascular Institute’s newly renovated and expanded surgical suites. Surgical ablation is usually performed in patients who have both an arrhythmia as well as another heart issue, such as coronary artery disease or valve disease. During this open-heart procedure, the surgeon uses a device with an energy source to destroy (ablate) problematic heart tissue where the arrhythmia occurs. This process creates scar tissue, which is extremely beneficial since scar tissue cannot conduct electricity. Therefore, the scar tissue helps to block the random electrical signals that cause arrhythmia. Because the scars are made in a specific pattern, like a maze, they helps to redirect the heart’s electrical impulses back to their normal pathway. Other areas where the abnormal heart rhythm begins can also be treated during this advanced surgical procedure. These additional areas cannot be treated using the catheter ablation method.

Mini Maze Procedure

Hoag cardiothoracic surgeons specialize in the Mini Maze procedure. This state-of-the-art minimally invasive ablation procedure is performed in the Jeffrey M. Carlton Heart & Vascular Institute’s newly renovated and expanded surgical suites. Mini Maze allows patients a faster recovery and less pain compared to traditional surgery because its performed through small incisions, or ports, without opening the chest. During the ablation procedure, a highly trained cardiothoracic surgeon uses specialized instruments to carefully destroy (ablate) the problematic heart tissue in the area where the arrhythmia begins. This process creates an electrical block along the pathway that's causing your arrhythmia, thereby stopping the abnormal heart rhythm. This ablation method is often utilized for treatment of atrial fibrillation, a common type of arrhythmia.

State-of-the-Art Hybrid Ablation

A highly innovative procedure that requires sophisticated technology and an expert clinical team. This ground-breaking procedure combines catheter ablation and the Mini Maze procedure, allowing physicians to successfully treat problematic areas in the heart that cannot be treated by catheter ablation alone. At Hoag, both an electrophysiologist and a cardiothoracic surgeon​ work together during this highly advanced procedure. The surgeon destroys (ablates) the problematic tissue on the outside of the heart, while the electrophysiologist ablates the problematic tissue on the inside of the heart. This tandem surgical approach helps ensure that all layers of heart tissue that are causing abnormal electrical signals are destroyed in order to successfully treat atrial fibrillation. This state-of-the-art hybrid procedure is performed in Hoag’s specially designed Hybrid Cardiac Surgery Operating Room (CVOR). The hybrid CVOR has the most advanced robotic imaging and communications technology available to support both minimally-invasive surgery and catheter-based procedures, which has resulted in improved patient care and outcomes.

Topera RhythmView – 3D Mapping

Topera RhythmView is a 3D graphical display that pinpoints the exact “starting point” of a heart arrhythmia, better identifying where in the heart therapy would be most needed. It is like a GPS of the heart’s electrical activity, and its ability to target treatment for atrial fibrillation (AF) has been significant for patients.

At Hoag, the new system has accurately identified rotors or focal beats in a high percentage of AF patients who used RhythmView, leading to better treatment and outcomes.

Hoag is one of only 17 hospitals in the country and second on the West Coast to use the FDA-cleared Topera RhythmView system.

Electrical Cardioversion

Patients with persistent arrhythmias, such as atrial fibrillation, may not be able to achieve a normal heart rhythm with medication therapy alone. Electrical cardioversion delivers an electrical shock to the chest wall, which synchronizes the heart allowing the normal rhythm to restart. This procedure is performed in a monitored setting, and patients are given medication to relax them during the procedure, so there's no pain involved.

Permanent Pacemaker Implantation

A pacemaker is a small electronic machine that regulates the heart’s rhythm. It may be used to manage certain heart rhythm disorders. The pacemaker is implanted under the skin near the collarbone. It is connected to the heart through small wires. When the pacemaker senses an abnormal heartbeat, it sends electrical signals to the heart to return it to a normal rhythm.

View an animation of a pacemaker implantation from the American Heart Association.

Implantable Cardioverter Defibrillator (ICD)

An implantable cardioverter-defibrillator (ICD) is a pager-sized device that is implanted in the chest and may reduce the risk of dying if the heart goes into a dangerous rhythm and stops beating (cardiac arrest). An ICD may be recommended for individuals who have a dangerously fast heartbeat (ventricular tachycardia), or a chaotic heartbeat that impedes the heart from supplying enough blood to the rest of your body (ventricular fibrillation). Implantable cardioverter-defibrillators work by detecting and stopping dangerous, abnormal heartbeats (arrhythmias) by delivering electrical shocks to restore a normal heart rhythm when necessary.

View an animation of an implantable cardioverter defibrillator from the American Heart Association.

Bi-ventricular Implantable Cardioverter Defibrillator

For patients with severe left ventricular heart failure, a biventricular ICD may be used to provide a more balanced method of controlling rapid heart beat (arrhythmia). The biventricular ICD leads are attached in the right atrium, the right ventricle and the left ventricle. The biventricular ICD detects when the heart is beating at a faster than normal rate, and shocks it back to normal.

Follow-up Care

After treatment, your physician will implement a follow-up care plan in order to monitor your heart rhythm and rate. Your physician may also recommend cardiac rehabilitation, if necessary, and discuss important lifestyle changes that will help control your heart rhythm and improve your overall heart health.