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.
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 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 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 (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.
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.
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