This is the tenth podcast in the What are Palpitations? series and we will be discussing the complications that can occur during or after EP studies. We begin the discussion with an explanation of the types of complications and their treatment. We will end by discussing special EP studies and ablations that may have higher rates of complications and lower success rates.

Chest Radiograph Appearance of Large Pericardial Effusion after Cardiac Perforation. (A) Immediately following the implantation of a pacemaker, the chest x-ray (CXR) shows a normal appearance of the cardiac silhouette. (B) At two weeks postoperative, the CXR (performed because the patient reported symptoms of chest pressure) shows an enlarged cardiac silhouette. The patient responded to pericardiocentesis with no lead repositioning. (Figure originally published by Williams and Stevenson 2012.)

Please check back with the Heart Rhythm Center for future podcasts:

  • Postoperative Care after an EP Study (and possible ablation)
  • Psychosocial Impact of Arrhythmias

This is the ninth podcast in the What are Palpitations? series and it focuses on the preparations necessary before proceeding with an electrophysiology study including elements of the preoperative workup. We will discuss the electrophysiology laboratory where the procedure is performed and steps involved in performing the procedure. We’ll talk about what happens if your doctor cannot find or ablate the arrhythmia as well as postoperative care. Finally, we will discuss advanced treatment options for atrial fibrillation. A brief outline includes:

  1. Preoperative risk assessment
  2. Use of contrast agents during EP studies or ablations
  3. Thyroid issues
  4. Allergies
  5. Registration and check-in
  6. Informed-consent process
  7. The procedure room
  8. The EP study
  9. How does the doctor place catheters inside the heart?
  10. What happens if my doctor cannot successfully find an arrhythmia?
  11. What happens if my doctor cannot successfully ablate the arrhythmia?
  12. Immediately after the EP study
  13. Day after the EP study
  14. Advanced treatment options for atrial fibrillation

Please check back with the Heart Rhythm Center for future podcasts:

Possible Complications of Electrophysiology Studies and Ablations
Postoperative Care after an EP Study (and possible ablation)
Psychosocial Impact of Arrhythmias

This shows a typical office visit for a defibrillator check (called interrogation). The programmer (A) has all the software necessary to check and program the defibrillator (or pacemaker). Many devices allow wireless interrogations but many still require a wand (B) that is held over the pacemaker to communicate with the device. Part of the shared decision making process is ensuring patients understand the long-term followup required after device implantation.

What is a Defibrillator? Cardiologist’s Guide for Patients and Care Providers can be used as a Shared Decision Making (SDM) tool as mandated by Medicare’s recent Decision Memo for Implantable Cardioverter Defibrillators (https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=288). The Medicare memo states the “a SDM encounter prior to initial ICD implantation is a critical step in empowering patient choice in their treatment plan. While ICDs have remained a common treatment option for many years, the strength of evidence for an ICD benefit is different for different patient populations.” This SDM encounter mandates an evidence-based decision tool that discusses more than just the risk and benefits of defibrillator implantation. What is a Defibrillator? is a 216-page, evidence-based SDM tool that addresses all aspects of how defibrillators work and the conditions they treat. We discuss how doctors determine whether patients are good candidates for defibrillators and provides an overview of the implantation process. Potential complications both before and after defibrillator implantation are discussed, as is surgical recovery and follow-up treatment. There are extensive discussions on the long-term care and follow-up required including the psychosocial aspects of defibrillator implantation. Particular emphasis is placed upon possible device advisories as well as end-of-life issues including possible deactivation of defibrillators. For readers having difficulty with medical terminology, there is a helpful glossary at the back of the book. Patients, caregivers, and family members involved in the Shared Decision Making process will benefit from the straightforward explanations. If you’re patients are candidates for defibrillator implantation, this book meets the requirements of the SDM decision tool and helps your patients approach surgery with a full understanding of the procedure and what it means to their quality of life. Please message me if your practice or facility is interested in bulk discount pricing as well as customized editions that feature your logo on the cover as well as an introduction from your Heart Rhythm Center director or CEO of health system.

This is the eighth podcast in the What are Palpitations? series and it focuses on the treatment options for arrhythmias. We will be discussing everything from lifestyle modifications that may help reduce arrhythmias as well as medications that are often used in arrhythmia treatment.  A brief outline includes:

  1. Lifestyle
  2. Can exercise cause heart-rhythm problems?
  3. Medications
  4. Anticoagulation
  5. Ablation
  6. Cardioversion
The Vaughan-Williams Classification (Classes 1, 2, 3, and 4) is a system used to classify antiarrhythmics based on their mechanism of action. This Table describes the different classes of antiarrhythmics and how they are used, as well as side effects.

Please check back with the Heart Rhythm Center for future podcasts to include:

  • The Electrophysiology Study and Ablation Procedure
  • Possible Complications of Electrophysiology Studies and Ablations
  • Postoperative Care after an EP Study (and possible ablation)
  • Psychosocial Impact of Arrhythmias

This is the sixth podcast in the What are Palpitations? series and it focuses on the common ventricular arrhythmias that many patients may experience. We will be discussing premature ventricular contractions (called PVC’s) which are very common and thankfully usually quite harmless. We will also be discussing various types of ventricular tachycardias; many are easily treated though some may require defibrillator therapy. A brief outline includes:

  1. Premature ventricular contractions
  2. Ventricular tachycardia
  3. Non–coronary disease VT
  4. What are defibrillators?

Please check back with the Heart Rhythm Center for future podcasts to include:

  • Treatment Options for Arrhythmias
  • The Electrophysiology Study and Ablation Procedure
  • Possible Complications of Electrophysiology Studies and Ablations
  • Postoperative Care after an EP Study (and possible ablation)
  • Psychosocial Impact of Arrhythmias

 

This is the sixth podcast in the What are Palpitations? series and it focuses on atrial fibrillation. We will be discussing the most common arrhythmia seen in clinical practice. The listener will be introduced to the mechanisms, causes of, and treatments for atrial fibrillation. There are extensive explanations about the noninvasive and invasive treatments available for atrial fibrillation. A brief outline includes:

  1. Normal electrical activation versus atrial fibrillation
  2. Signs and symptoms
  3. Causes of atrial fibrillation
  4. Understanding your risk of stroke
  5. Is there a difference between atrial fibrillation and ventricular fibrillation?
  6. Is there a cure for atrial fibrillation?
  7. What is atrial flutter?

Please check back with the Heart Rhythm Center for future podcasts to include:

  • What Are the Common Ventricular (Bottom-Chamber) Tachycardias?
  • Treatment Options for Arrhythmias
  • The Electrophysiology Study and Ablation Procedure
  • Possible Complications of Electrophysiology Studies and Ablations
  • Postoperative Care after an EP Study (and possible ablation)
  • Psychosocial Impact of Arrhythmias

 

This is the fifth podcast in the What are Palpitations? series and it focuses on what are the most common supraventricular (top-chamber) tachycardias (SVT). We will be discussing a variety of the more common SVT seen in clinical practice and clinical scenarios are used to introduce the listener to these types of arrhythmias.  A brief outline includes:

  1. Premature atrial contractions
  2. AV-node reentrant tachycardia
  3. AV reentrant tachycardia
  4. Atrial tachycardia
  5. Atrial flutter
  6. Atrial fibrillation (will be discussed in great detail in podcast 6)
Electrocardiograms of Common Arrhythmias. Panel A, shows normal sinus rhythm, which is the heart’s baseline rhythm; the tall, narrow spikes are the QRS complexes. Panel B shows what a supraventricular tachycardia (in this case, atrioventricular nodal tachycardia) looks like; notice how narrow the QRS complex is. Panel C shows atrial fibrillation with the very irregular-appearing QRS complexes. Panel D shows ventricular tachycardia; note the very wide QRS complexes, especially when compared to the narrow QRS complexes after the VT stops. The main difference between SVT and VT is the wide QRS complexes, but some SVTs may have wide QRS complexes (this is called aberrancy). Panel E shows atrial flutter, which has a “sawtooth” appearance of the baseline between QRS complexes. Atrial flutter is treated using the same techniques and medicines as those for atrial fibrillation.

Please check back with the Heart Rhythm Center for future podcasts to include:

  • What Is Atrial Fibrillation?
  • What Are the Common Ventricular (Bottom-Chamber) Tachycardias?
  • Treatment Options for Arrhythmias
  • The Electrophysiology Study and Ablation Procedure
  • Possible Complications of Electrophysiology Studies and Ablations
  • Postoperative Care after an EP Study (and possible ablation)
  • Psychosocial Impact of Arrhythmias

This is the fourth podcast in the What are Palpitations? series and it focuses on what to expect during a visit with the heart rhythm specialist. We will be discussing the information we hope to glean from the patient during our initial visit and what may help us determine if one is at risk for heart rhythm disorders.  A brief outline includes:

  1. History of present illness
  2. Past medical and surgical history
  3. Social history
  4. Family history
  5. Physical exam (including vital signs)
  6. Pertinent studies

Please check back with the Heart Rhythm Center for future podcasts to include:

  • What Are the Common Supraventricular (Top-Chamber) Tachycardias?
  • What Is Atrial Fibrillation?
  • What Are the Common Ventricular (Bottom-Chamber) Tachycardias?
  • Treatment Options for Arrhythmias
  • The Electrophysiology Study and Ablation Procedure
  • Possible Complications of Electrophysiology Studies and Ablations
  • Postoperative Care after an EP Study (and possible ablation)
  • Psychosocial Impact of Arrhythmias

The third podcast in the What are Palpitations? series focuses on what tools/techniques your care providers have to diagnose abnormal heart rhythms. A brief outline includes:

  1. Electrocardiogram (ECG or EKG)
  2. Twenty-four-hour Holter monitor
  3. Two- to four-week outpatient telemetry monitor
  4. Hospital telemetry
  5. Smartphone-based applications
  6. Tilt-table test
  7. Implantable loop recorders
  8. Summary

Please check back with the Heart Rhythm Center for future podcasts to include:

  • Work-up and Evaluation of Heart-Rhythm Disorders (Meeting the Heart-Rhythm Physician)
  • What Are the Common Supraventricular (Top-Chamber) Tachycardias?
  • What Is Atrial Fibrillation?
  • What Are the Common Ventricular (Bottom-Chamber) Tachycardias?
  • Treatment Options for Arrhythmias
  • The Electrophysiology Study and Ablation Procedure
  • Possible Complications of Electrophysiology Studies and Ablations
  • Postoperative Care after an EP Study (and possible ablation)
  • Psychosocial Impact of Arrhythmias

This second podcast in the What are Palpitations? series focuses on palpitations and other symptoms that may represent heart-rhythm abnormalities. A brief outline includes:

  1. Introduction
  2. What is a normal heart rhythm?
  3. What are abnormal heart rhythms?
  4. What are palpitations?
  5. Other symptoms that may represent heart-rhythm abnormalities
  6. Know your ejection fraction
  7. What are ventricular fibrillation and ventricular tachycardia?
  8. Is there a difference between atrial fibrillation and ventricular fibrillation?
  9. Congestive heart failure and risk of arrhythmia

Please check back with the Heart Rhythm Center for future podcasts to include:

  • How Are Heart-Rhythm Abnormalities Diagnosed?
  • Work-up and Evaluation of Heart-Rhythm Disorders (Meeting the Heart-Rhythm Physician)
  • What Are the Common Supraventricular (Top-Chamber) Tachycardias?
  • What Is Atrial Fibrillation?
  • What Are the Common Ventricular (Bottom-Chamber) Tachycardias?
  • Treatment Options for Arrhythmias
  • The Electrophysiology Study and Ablation Procedure
  • Possible Complications of Electrophysiology Studies and Ablations
  • Postoperative Care after an EP Study (and possible ablation)
  • Psychosocial Impact of Arrhythmias