One of the medical specialities that has evolved the most in the last decades, Cardiac Arrhythmia has in Clínica São Vicente, a reference centre with respected and renowned professionals of our country. The Unit renders the following services:

- Electrophysiologic study
- Radiofrequency ablation
- Pacemaker, resynchroniser and Defibrillator implants
 

One hundred years after it was invented, the Electrocardiogram (ECG) incorporated the technological innovations and is still an important and effective tool to evaluate the heart structure, how it is behaving and to determine, when necessary, the type of cardiac arrhythmia – an alteration of the heart rhythm that expresses itself with irregular heart beats, accelerated hear beats, the well known palpitations (tachycardia) or slower beats (bradycardia).

The electrocardiogram graphically records the electric activities of the heart. For that, sensors that can pick up the electric flow (electrodes) are placed on the legs, arms and chest and signals are sent to the electrocardiograph.

This exam is the first step to determine the therapeutic procedures that must be followed. 

Electrophysiologic Study and Radiofrequency Ablation

The electrophysiologic study is an exam conducted by introducing catheters that reach the heart guided by radiology images (X-ray), in order to detect and evaluate the risks of cardiac arrhythmia.

After the electric mapping of the heart, the team defines what the patient’s needs are. If the patient has a benign arrhythmia, medication might be the only indication. In the cases of tachycardia, for which anti-arrhythmia drugs will not be effective, the indicated therapeutic method after strict evaluation criteria are established is the Radiofrequency Ablation. This is a treatment that uses radiofrequency energy applied directly on the source of arrhythmia to cauterize it and the cure rate is today between 95 and 98%, allowing the patient to live without medication. The main arrhythmias that benefit with this high cure rate are: atrioventricular nodal tachycardia, accessory pathways, Wolff-Parkinson-White syndrome, Atrial tachycardia and atrial flutter.

Another indication for the Radiofrequency Ablation treatment, with a success rate of 85%, are the cases of atrial fibrillation, the most frequent type of arrhythmia and one of the main causes of cerebral vascular accident or stroke.

Pacemaker, resynchroniser and Defibrillator implants

The Pacemaker implant is indicated for patients who have a very slow cardiac rhythm, in other words their heart beats are very slow, characterizing bradycardia that can be caused by an atrioventricular block – a disease that interrupts the electric stimulus that is responsible for the heart beat, reducing the beats.

The device, which weighs approximately 14 grams, is permanently implanted under the skin of the thorax and stimulates the heart using electrodes: very thin wires that transport electric impulses, working as the natural pacemaker when the latter is not functioning properly.

Patients with heart failure associated to a left branch block (alteration of the heart’s electric conduction) usually have cardiac dyssynchrony, in other words, the left ventricle beats before the left ventricle considerably worsening the heart failure. In these cases, a resynchronising pacemaker must be implanted, as it has the capacity to stimulate both ventricles simultaneously, thus eliminating the out-of-sync function of the heart; it improves the quality of life and reduces mortality in these patients.

Some ventricular arrhythmia are malignant, in other words, they can cause sudden death. In these cases, the indicated treatment, after a study conducted by the electrophysiologist is the implantable Cardioverter Defibrillator. This is a special type of pacemaker, that has basically three functions: if the heart beats slowly, it stimulates the beats to become normal, if it beats quickly, it functions in order to revert the arrhythmia; if it is beating too quickly, with a risk of ventricular fibrillation (an extremely severe type of arrhythmia that can lead to death) the device triggers an internal shock to the heart and saves the patient’s life.

New Routine

For those who implanted the pacemaker, the evaluation and programming of the device are crucial and will be part of the patient’s routine, and the periodicity depends on the type of device and is defined by the physician. It is verified using computer programs, with no need to hospitalize the patient. All the parameters are regulated in order to keep the device and consequently the heart operating in perfect conditions.

Some pacemakers already have a mechanism that makes the device directly interact with a cellular phone, alerting the physician via satellite if there is any important alteration in its functioning. This way, the patient, from anywhere in the world, can be told by the physician what are the necessary procedures that need to be taken.

There are devices that can detect an abnormal liquid retention in the organism, before a characteristic symptom appears. Indicated for people with heart failure, this technology allows the patient to receive a warning about the problem and to quickly seek medical assistance to avoid greater complications.

Follow-up

Cardiac Arrhythmias and implants: being aware that life depends on devices. All these factors the patient and their family members need to live with are concerns the physicians also have.