Category: Heart Rhythm Disorders

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Please watch my short presentation given at the 2021 Annual Sessions of the Heart Rhythm Society on July 30, 2021. A 2.1 ampere-hour (Ah) battery capacity biventricular defibrillator (CRT-D) was recently shown to be the first to exceed patient survival in a chronic heart failure cohort. There is consensus that extended battery longevity (based on Ah) can reduce the costs and complications related to generator replacements. Our model revealed that increased utilization of extended longevity CRT-D battery technology (2.1Ah) leads to substantial annual reductions in major complications and costs of replacement procedures.

We developed a model to estimate cost and complication rate variations associated between 1.0Ah, 1.6Ah, and 2.1Ah battery CRT-D generator replacements over a period of 20 years.

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This is the final podcast in the What are Palpitations? series and we will be discussing how patients can adjust to living with heart rhythm disorders. We will start with adjusting to life after being diagnosed with heart-rhythm abnormalities. Next, we’ll talk about the quality of life in heart-rhythm patients and how do arrhythmias affect you and your family. Arrhythmias in children and young adults can be challenging and we’ll spend time on this issue. Finally, we’ll examine patients that have palpitations without arrhythmias.

Please check back with the Heart Rhythm Center as we begin the new series What is a Defibrillator?

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This is the eleventh podcast in the What are Palpitations? series and we will be discussing the postoperative care following EP studies. We will cover care of the vascular access sites including showering/bathing restrictions. Other activity limitations including driving issues will be addressed. Finally, the first followup appointment after the EP study will be explained as well as lifestyle limitations that may be recommended.

Please check back with the Heart Rhythm Center for the final podcast in the What are Palpitations? series: Psychosocial Impact of Arrhythmias.

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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.

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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

 

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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

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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

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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

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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

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Thousands of patients every year are admitted to hospitals because of irregular, fast, or strong heartbeats. For the portion that will eventually be diagnosed with a heart condition, there are important choices to make moving forward. But there is rarely time in a short doctor’s visit to go over all the details.

The Heart Rhythm Center’s podcast What are Palpitations? serves as a comprehensive overview fills that information gap by imparting everything there is to know about abnormal heart rhythms through all stages of care. Dr. Jeffrey L. Williams, MD, MS, FACC, FHRS, CPE, has worked to provide patients with complete information. There are various types of arrhythmias, and the benefits and risks of treatments for each will vary for each individual patient. Patients, as well as their families, need a thorough understanding to make a fully informed decision.

Along with types of treatments, Dr. Williams discusses what is happening on a physiological level and explains the full evaluation process that doctors use. His knowledge, gained over years of study and practice, offers the what, why, and how of this medical issue, so anyone can make the best decisions for the health of his or her family.

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

  1. Palpitations and Other Symptoms That May Represent Heart-Rhythm Abnormalities (Arrhythmias)
  2. How Are Heart-Rhythm Abnormalities Diagnosed?
  3. Work-up and Evaluation of Heart-Rhythm Disorders (Meeting the Heart-Rhythm Physician)
  4. What Are the Common Supraventricular (Top-Chamber) Tachycardias?
  5. What Is Atrial Fibrillation?
  6. What Are the Common Ventricular (Bottom-Chamber) Tachycardias?
  7. Treatment Options for Arrhythmias
  8. The Electrophysiology Study and Ablation Procedure
  9. Possible Complications of Electrophysiology Studies and Ablations
  10. Postoperative Care after an EP Study (and possible ablation)
  11. Psychosocial Impact of Arrhythmias