The Steps and the Tools for treating your cardiac arrythmia

Through basic but invaluable tools, as in the data recorded in an ECG, many suspected arrythmia problems are first spotted.  Your primary care physician or diagnostic cardiologist may have ordered an  ECG test as part of your routine examination or because you specifically indicated to your physician in their office your heart has been racing lately or you have been experiencing dizzy spells. Perhaps your physician sent you home with an event monitoring device which can automatically record your heart's activity (ECG) which then can be sent directly to your physician's office or an authorized ECG technician over the phone or via the Internet.  In some situations you felt something was just not right and went to an an emergency room and an ECG was taken there. If your primary physician makes a definite diagnosis that you have cardiac arrythmia or suspects a high probablity you might, he or she would seek the expertise of a  cardiac electrophysiologist (EP) physician. The EP cardiologists has specific training in the specific diagnosis and treatment of cardiac arrythmia. Following, is a description of the usual first steps your EP physician would take, the specific technology "tools" used in this first step and the goal of the step.
Goal: To determine the type of arrythmia you might have, the exact location of the arrythmia source within your heart's chambers and to determine the best therapy for you moving forward.
Essential Tools:  diagnostic EP catheter, X-ray and PC based technology to display the catheter data

Step Two will be discussed in detail in the next few days.  I welcome any and all comments and additions from professionals or patient consumers.

Regards,
Jim

James Accord
Atlanta, GA

The Challenge With AF Ablation Therapy

Atrial Fibrillation (AF) from an ablation therapy standpoint is the proverbial good news bad news challenge. The good news is AF is a quick and certain diagnosis once documented via an ECG and the specific location in the left atrium to ablate or "short circuit" the AF arrythmia can be determined with a high degree of certainty. The not so good news is navigating the ablation catheter ( device that delivers the radio frequency energy) to this specific spot is difficult and can be very time consuming. Why? The electrophysiologist (cardiologist that specializes in cardiac arrythmia) encounters a few daunting challenges while navigating the ablation catheter along its' journey. To reach the chosen destination in the left atrium, the physician has two routes that the ablation catheter can follow. The longer route is called the retrograde approach. This route has a few hair pin turns the catheter must follow which can pose some catheter handling problems once it has reached its' destination, but has been considered a safer and more sure route. The second, more direct route, requires the physician to "build a tunnel" from the right side of the heart directly to the left atrium. The clinical term for this procedure is trans-septal puncture.  To build the tunnel, the physician "pokes a hole" or puntures the septum which is the heart structure seperating the right and left sides of the heart. Follow the link above to get an idea of the two routes. The trans-septal puncture raises the risk of certain complications. This procedure has been utilized for several years now and most certified electrophysiologists have performed hundreds of successful left sided ablations using the trans-septal approach. In deciding on an EP physician to perform your AF ablation, it is a good idea to talk with them and learn their chosen route to the left atrium and if they do take the shortcut, how many trans-septal punctures have they performed? Next time, I will give an overview of the essential technology that is used by the electrophysiologists to assist in navigating the abalation catheter.
If anyone, particularly a post AF ablation patient, would share personal experiences regarding catheter navigation approaches their physician utilized, it would benefit all of us.

Thanks,
Jim Accord