The electrical impulses of the heart cause it to contract and relax. This enables the heart to pump blood throughout the body and to vital organs. Irregular or abnormal electrical impulses can cause the heart to beat too slowly or too fast. These electrical heart rhythm abnormalities are known as arrhythmias. Electrophysiology focuses on the diagnosis and treatment of arrhythmias and other heart rhythm disorders related to the heart’s electrical system.
The Electrophysiology (EP) Laboratory at Conemaugh Memorial Medical Center is equipped with the latest technology to diagnose and treat an array of abnormal heart rhythm conditions. The state-of-the-art facility is the only one of its kind in the Cambria/Somerset region. The Conemaugh Memorial Electrophysiology team is specially trained to perform a wide range of minimally invasive procedures designed to monitor, manage, and cure rhythm abnormalities.
Common Electrophysiology Conditions
Arrhythmias are perhaps the most common electrical impulse conditions. They can be harmless, serious or even life-threatening conditions. The impact of an arrhythmia largely depends on the structural condition of the heart, as well as the presence of heart disease. Arrhythmia warning signs include palpitations, skipped beats, fluttering, slow heartbeat (Bradycardias), rapid heartbeat (Tachycardias), inability to tolerate exercise or exertion, fainting or almost fainting.
Supraventricular Tachycardia (SVT)
Cardiac diseases often affect the area above the ventricles in the artia, causing an elevated heartbeat. The artia of the heart receives blood returning to the heart from other areas of the body.
- Artial Fibrillation: Irregular and often rapid heart rate that commonly causes poor blow flow to the body.
- Atrial Flutter: Overly rapid regular contraction of the atrium of the heart.
- Atrioventricular Nodal Reentry Tachycardia (AVNRT): AVNRT is the most common form of SVT. In patients with this condition, the atrioventricular node is divided into two longitudinal pathways that form the reentrant circuit. AVNRT is caused by the circular movement of electricity between the slow and fast pathways of the circuit. The slow pathway and fast pathway allow the AV node to receive multiple signals causing a fast heartbeat. The condition is typically well tolerated and often occurs in patients with no structural heart disease. AVNRT accounts for 80-90% of all SVTs.
- Atrioventricular Reciprocating Tachycardia (AVRT): AVRT is the second most common type of SVT, accounting for about 30% of all SVTs. Patients with AVNRT have been born with an extra, abnormal electrical connection in the heart. The extra connection joins one of the upper chambers of the heart (atria) with one of the lower chambers (ventricles). AVRT occurs when the heart beats too fast due to the extra electrical pathways between the upper and lower chambers.
- Junctional (AV Nodal) Tachycardia: Junctional Tachycardia can be temporary (Automatic Junctional Tachycardia) or persistent (Junctional Reentrant Tachycardia, PJRT). Automatic junctional tachycardia can be caused by drug toxicity or unknown cause.
Ventricle Tachycardia (VT)
Ventrical Tachycardia (VT) is a rapid heartbeat that begins in the ventricles, muscular chambers that pump blood out of the heart to the lungs and other organs.
- Premature Ventricular Contractions (PVC): PVCs are abnormal heartbeats that occur in one of the heart's ventricles earlier than the next expected beat. PVCs are common and can feel as if your heart skipped beat.
- Risk for Sudden Death
- Coronary Heart Disease (CAD): A narrowing of the small blood vessels that supply blood and oxygen to the heart.
- Cardiomyopathy: Weakening or change in the heart muscle that occurs when the heart cannot pump blood as it should or has difficulty with other heart functions.
- Inheritable Cardiac Disease
- Long QT: a heart rhythm disorder that can cause fast, chaotic heartbeats. The rapid heartbeats may result in sudden fainting.
- Brugada: a genetic disease characterized by abnormal electrocardiogram (ECG) findings and an increased risk of sudden death.
- Non-Compaction: a heart muscle condition affecting the left ventricular muscle wall causing it to be non-compact and consisting of a meshwork of muscle bands called trabeculations.
- Arrhythmogenic Right Ventricular Dysplasia / Cardiomyopathy (ARVD/ARVC): a genetic condition that causes the replacement of the right ventricle cardiac muscle with fibrous, fatty issue. Resulting arrhythmias can produce palpitations or loss of consciousness.
- Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT): a rare condition causing the heart to beat abnormally quickly during physicial activity or high levels of emotion, but shows no structural problems of the heart. The rapid heartbeat may cause dizziness, loss of consciousness or sudden death.
Contrary to tachycardia, bradycardia is a slow or irregular heart rhythm typically fewer than 60 beats per minute. The slowed heart rate causes a decrease of blood flow to the body and may cause dizziness, lack of energy, shortness of breath or fainting during periods of normal activity or exercise. Intracardiac Electroanatomical Mapping can be used to diagnose problem areas in the heart, and devices such as pacemakers can be used for treatment.
Procedures and Treatments
An Electrophysiology (EP) study is a test which records the electrical activity of the heart. This test is used to help determine the cause of a rhythmic disturbance that the heart may be having and can also determine the origin of the problem. After having this test done, the doctor will have a better understanding of the patient's condition determine the best treatment.
Conemaugh's advanced arrhythmia management team works in a state-of-the-art lab to provide the highest quality of care for patients.
The WATCHMAN device offers a trusted alternative to blood thinning medication for individuals with Non-Valvular AFib (NVAF) who are at an increased risk of stroke. Typically performed in less than an hour, the WATCHMAN device closes an area of the heart known as the Left Atrial Appendage (LAA). The LAA is a tube-like sac that creates an environment for clots to form within the heart, heightening the risk of stroke. WATCHMAN reduces both stroke risk and bleeding risk while allowing patients to ultimately stop taking their blood thinning medication.
There are many reasons an individual may not be able to tolerate blood thinning medication. These include, but are not limited to, those with: a history of bleeds, high risk of recurrent falls, an occupation or lifestyle that makes them a poor candidate for blood thinning medication, severe renal failure, or documented poor adherence which can be due to side effects or the financial burden of life-long blood thinners. To find out if you are a candidate for the WATCHMAN procedure today, please contact Michele Adams, Watchman Coordinator, at (814) 534-1548 or firstname.lastname@example.org.
To watch a brief video on this procedure, please click here: vimeo.com
“Having the Watchman procedure was one of the best decisions I ever made,” shared Ralph Wilson, a Watchman patient at Conemaugh. The cost of being on blood thinners was getting high and now I do not have to worry about blood clots causing a stroke. Now that I am off my blood thinners, I can lead an active lifestyle and enjoy hunting and camping, without worrying about the possibility of bleeding if an injury occurs.”
"I have been treating Ralph for atrial fibrillation since 2016," Dr. Mastrine added, "It was very gratifying to see his relief after stopping his blood thinners and avoiding the long-term risks of significant bleeding.”
Cardiac ablation is a non-surgical procedure where a thin flexible catheter, called a therapeutic catheter, is inserted into a vessel in the groin and threaded up into the heart. Heat or a cooling agent is sent through the catheter to extinguish the electrical triggers and circuits which cause arrhythmias.
Pacemakers may be used for the treatment of Bradycardias including those caused by sinus node disease and conduction disease. Pacemakers monitor and regulate the rhythm of the heart and transmit electrical impulses to stimulate the heart if it is beating too slowly. Pacemakers offer single and dual chamber options, minimize ventricular pacing, rate response, and mode switching.
The world's smallest pacemaker was successfully implanted by Dr. Lou Mastrine and team on February 3, 2023. Pictured left to right are Matt Hodge PAC, Dr. Mastrine, DO, Electrophysiology, Cardiology, Manuel Alcantara, Crystal Hite, Jeff McKissick
Implantable Cardioverter Defibrillators (ICD)
These defibrillators are used for primary and secondary prevention of sudden cardiac death. All defibrillators have pacing functionality and assist in finding balance for the heart. ICDs are 99% effective in stopping life-threatening arrhythmias and are the most successful therapy to treat ventricular fibrillation, the major cause of sudden cardiac death. ICDs continuously monitor the heart rhythm, automatically function as pacemakers for the heart rates that are too slow, and deliver life-saving shocks if a dangerously fast heart rhythm is detected.
Cardiac Resynchronization Therapy (Biventricular Pacing)
This therapy is used for patients with heart failure. The inserted device can be a defibrillator or just a pacer. The implanted device paces both the left and right ventricles (lower chambers) of the heart simultaneously. This resynchronizes muscle contractions and improves the efficiency of the weakened heart.