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:

  • Experience and Outcomes
  • Physician Expertise
  • State-of-the-Art Patient-Centered Care
  • Innovative Technology & Treatment


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.


Medical Management

The most common treatment option for patients with atrial fibrillation is medical management. In this conservative approach, medications can be used to control heart rhythm or heart rate. Millions of patients with Afib are treated with a combination of rate control medications, anti-arrhythmic medication, and an oral anticoagulant. Hoag physicians offer great expertise in the field of new oral anticoagulants which are known to be safer and provide significant improvement in the lifestyle of the patients.


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 diseases 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 groundbreaking procedures that are not readily available at other centers.


Catheter ablation

A minimally invasive procedure that is performed in Hoag’s state-of-the-art Allan and Sandy Fainbarg Electrophysiology Cath Lab Suite, catheter ablation aims to modify the heart tissue causing an arrhythmia. During the procedure, an electrophysiologist threads thin, flexible catheters through a vein or artery in the upper thigh to the heart. The physician will perform mapping of the heart to locate areas contributing to the patient’s specific arrhythmia. The catheter emits an energy source that the physician uses to destroy (ablate) a small area of heart tissue that is contributing to the abnormal heart rhythm. Destroying, or rather scarring, this tissue helps restore the heart’s normal rhythm.


Surgical Concomitant Maze

For patients who have atrial fibrillation and who are undergoing surgery for cardiac issues such as coronary artery disease or valve disease, ablation for atrial fibrillation can be performed by a cardiothoracic surgeon in the operating room at the same time to address all the cardiac needs at once. This provides patients with faster recovery and more complete, comprehensive care. Hoag’s specialists are among the most experienced in the region in performing this procedure.


Total Thoracoscopic Maze Procedure

The Total Thoracoscopic Maze procedure is a minimally-invasive surgical procedure for the treatment of atrial fibrillation. It is accomplished through 4 small incisions about the size of a dime on each side of the chest. Using special instruments, the cardiothoracic surgeon creates ablation lines (scars) on the heart that will block and or redirect the abnormal electrical impulses. The left atrial appendage may also be excluded with a clip at the same time. Hoag was the first hospital in Orange County to provide this option for the treatment of AFib.


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 the treatment of atrial fibrillation, a common type of arrhythmia.


Hybrid Treatment Approach

Hoag is leading the region in this new procedure that combines catheter ablation and minimally invasive surgery for certain patients with persistent or chronic atrial fibrillation. This involves both an electrophysiologist and a cardiothoracic surgeon who work together for this minimally invasive procedure. Through a small incision in the chest, the surgeon ablates the tissue on the back wall of the left atrium from the outside of the beating heart. The left atrial appendage may also be excluded with a clipped at the same time. For the second part of the procedure, an electrophysiologist threads a catheter through a vein to map and ablate other areas inside of the heart known to play a role in atrial fibrillation.


Topera RhythmView – 3D Mapping

Topera RhythmView is a 3D graphical display that pinpoints the exact “starting point” of heart arrhythmia, better identifying wherein 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.


Left Atrial Appendage Occlusion (LAAO) – Reducing Stroke Risk in Afib Patients

The left atrial appendage (LAA) is a small, appendix-like structure off of the left atrium. In healthy patients, the blood circulates in and out of the left atrium and LAA. For patients with non-valvular atrial fibrillation, non-rhythmic/chaotic impulses cause blood to pool and not completely circulate out of the LAA, leaving a person at an increased risk for stroke. Blood thinners are a common treatment option to reduce this risk, however, some patients cannot tolerate blood thinners and use an alternative technique – closing the left atrial appendage. Left atrial appendage occlusion (LAAO) is done using a transcatheter device or a minimally invasive surgical clip. LAAO is not a treatment option to cure atrial fibrillation, but rather a way to decrease the risk of stroke in afib patients.

Transcatheter Device – The device fits right into the LAA and is designed to permanently close it off and secure existing blood clots. This is a one-time procedure and is completed using a catheter through the groin.

Minimally Invasive Surgical Clip – A clip is another option for permanently closing the LAA, and is completed through minimally invasive access points. Through this minimally invasive surgery, the clip is placed on the LAA, closing off the opening which allows most patients to be off anticoagulations immediately.


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. When the pacemaker senses an abnormal heartbeat, it sends electrical signals to the heart to return it to a normal rhythm.

A traditional pacemaker is implanted under the skin near the collarbone. It is connected to the heart through small wires (called leads).

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

Unlike traditional pacemakers, there is a new minimally invasive option called a “leadless pacemaker” which is implanted directly into the heart through a minimally invasive procedure. The leadless device eliminates the need for pacemaker wires (cardiac leads). As a result, leadless pacemakers reduce people’s exposure to potential pacemaker lead and pocket-related complications and offer a less restrictive and shorter recovery period post-implantation. Hoag is one of the first hospitals to use Abbott’s AVEIR DR, the world’s first dual chamber leadless pacemaker system.


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 heartbeat (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.​