Hospital Based Services

Catheter Ablation for Rhythm Disturbance
A catheter ablation, is an invasive procedure in which the abnormal electrical connection in the heart is evaluated and destroyed.  These abnormally fast rhythms are usually due to electrical signals that form "short circuits" and fast heartbeats (palpitations).  The procedure is accomplished by inserting multiple catheters (small tubes/wires) into a leg vein and/or artery in the groin which are guided to the heart.  During the diagnostic portion of the study, the location of the extra pathway, or source of the extra heartbeat is determined.  Once the abnormal electrical connection is identified, a special catheter will be positioned at the site.  A form of energy will be delivered to the area and it destroys the abnormal cells, responsible for the fast rhythm.  The procedure can last from 2 to 6 hours.

Diagnostic and Intervention Catheterization
Cardiac catheterization is a procedure that involves the insertion of a catheter (a long, thin, flexible tube) into the body.  The catheter is inserted into a vein or artery and directed toward the heart.  Special x-ray equipment is used to watch the movement of the catheter inside the body.  This procedure allows the physician to assess the pumping function of the heart and to examine the coronary arteries (the vessels that supply oxygen-rich blood to the heart muscle) and heart valves.  A cardiac catheterization provides more accurate and detailed information than other diagnostic tests and enables the doctor to diagnose a number of heart conditions such as coronary heart disease (a build-up of plaque inside the arteries), defective heart valves (narrow or leaky valves) or congenital heart defects.  The cardiac catheterization is an invasive procedure and the entire study generally lasts less than 2 hours.  Interventional catheterization include angioplasty and stents.  The purpose of this treatment is to eliminate or reduce cardiac symptoms and discomfort and to decrease the risk of having a heart attack.  The angioplasty is a technique to widen the narrowing of the coronary artery.  A small inflatable balloon on the end of a catheter is inflated within the narrowed section of the artery.  The inflation causes the balloon to push outward against the narrowing and surrounding wall of the coronary artery.  This reduces the narrowing until it no longer interferes with blood flow to the heart.  A stent is a small steel tube that is introduced into your blood vessel on a balloon catheter.  The doctor maneuvers the catheter into the blocked artery and inflates the balloon.  This causes the stent to expand and press against the vessel wall.  Once the balloon has been withdrawn, the stent stays in place permanently, holding the blood vessel open, and thus improving blood flow.  A stent is effective in preventing recurrent obstruction of the blood vessel.

Implantable Cardiac Defibrillator (ICD)
ICD's are one option for individuals with ventricular tachycardia (VT).  VT is a serious cardiac arrhythmia, in which each heartbeat is initiated from electrical activity in the ventricles rather than the sinoatrial node in the right atrium.  The result is an abnormally fast heart rate between 140 and 220 beats per minute.  It occurs in individuals who have structural heart problems, usually a scar from a previous heart attack, cardiomyopathy or rare inherited heart defects.  The small device is implanted below the collarbone, similar to pacemakers.  The procedure takes about two hours.  They have been shown to be 99% effective in stopping life threatening rhythms.  The ICD continuously monitors the heart's rhythm.  If your heart rate becomes too slow, the ICD is capable of pacing the heart to prevent pauses.  If your heart beats too fast, the ICD will stop the VT by delivering a burst of energy to restore a normal rhythm.

Pacer Lead Extractions
Although they are designed to be implanted permanently in the body, occasionally these leads must be removed, or extracted.  The most common reason for lead extraction is device infection.  If any part of the system becomes infected, it is usually impossible to cure the infection without completely removing all hardware from the body.  This requires removal of the pulse generator from the chest wall, as well as removal of all leads from the veins and heart.  Another reason for lead extraction is when a lead fails to work properly (for example, due to a break in the metal wire or surrounding insulation).  Sometimes, the broken lead can be abandoned in the heart, with a new lead placed alongside.  However, veins can only accommodate a limited number of leads due to space constraints, and sometimes, non-functioning leads must be extracted to make space for a new lead.  Occasionally, younger patients opt for removal of broken leads even if there are no space limitations because they will probably need more leads in the future, and leads are more difficult to extract after more time in the body.  An uncommon reason for lead extraction is a mechanical lead failure that could be dangerous to the patient, such as a protruding wire.

Permanent Pacer Implantation
A small internal battery powered device that supplies electrical impulses to the heart.  This device causes your heart to beat regularly.  It is used in the treatment of bradycardia, an abnormally slow heart rhythm.  The pacemaker continuously monitors your hearts electrical activity, and generates an electrical impulse to stimulate your heart's contraction if your heart beats too slowly.  The implant procedure takes less than 2-hours and most patients leave the hospital the next day.  Each year tens of thousands of Americans have a pacemaker implanted.

Transesophageal Echo (TEE)
An echocardiogram (echo) is a test that uses ultrasound waves to examine the internal structure of the heart.  A TEE, is an echocardiogram that is performed from inside the esophagus.  Because the esophagus lies just behind the heart, the TEE provides much clearer images of the heart.  Under sedation, a long flexible tube is inserted in the mouth down the esophagus.  A small transducer at the tip of the probe sends sound waves that echo off the various parts of the heart.  The sonogram is converted into moving images of the heart.  The images that are displayed show the flow of blood through the heart chambers and valves.  A TEE is performed: to detect blood clots/masses in the heart, to assess the severity of some valve defects, to examine artificial heart valves, and to detect infection of the heart valves.  A TEE may also be performed when a standard echo is of poor quality or inadequate in people who are obese or have chronic lung disease.  The test takes about 20 minutes but you should allow about 2 hours from arrival to the time you leave the hospital.