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Atrial Fibrillation

What is atrial fibrillation?

Fibrillation is an abnormally fast and chaotic heartbeat, or heart rhythm. An abnormal heart rhythm is called an arrhythmia. Arrhythmias result from a problem in your heart's electrical system. When fibrillation occurs in the heart’s upper chambers (the atria), it is called atrial fibrillation. Atrial fibrillation is the most common type of arrhythmia.

Fibrillation is not only a very fast heart rate, it is also a chaotic rhythm. The atria try to beat 200-300 times per minute, rather than the normal rate of 60-100 beats per minute. In fact, the atria try to contract so fast they are quivering rather than beating. This doesn't allow enough time for the atria to fill with blood before the blood is pumped into the lower chambers (the ventricles).

When the atria are in fibrillation, the pumping rate in the ventricles varies widely. The rate in the ventricles can go from 80 to 40 to 100 beats per minute—all in the space of a few seconds. That’s why you usually have symptoms like fatigue and shortness of breath.

However, atrial fibrillation has a more serious risk. Because blood pools in the atria rather than being pumped out normally, it's easier for the blood in the atria to clot. If a blood clot travels through an artery to the brain, it can cause a stroke. So people with atrial fibrillation have a much greater risk of stroke. But once atrial fibrillation is diagnosed, treatment can reduce the risk of stroke. Other names for atrial fibrillation: AF, AFib.

What is the cause?
Atrial fibrillation is caused by an abnormality in your heart's electrical system. Electrical signals follow a certain path, which causes your heart to contract. During atrial fibrillation, however, there are far too many signals in the atria. In addition, the signals do not travel down the proper pathways. To learn more about your heart's electrical system, go to the Heart & Blood Vessel Basics section.

The underlying cause of atrial fibrillation varies from person to person. The abnormal electrical signals can result from:

• Aging
• Coronary artery disease (CAD)
• High blood pressure
• Heart valve disease
• Heart failure
• Congenital heart problems (present from birth)
• Sleep apnea
• Drinking too much alcohol

What are the symptoms?
Symptoms of atrial fibrillation vary. Some people have palpitations (a feeling that your heart is racing or that your heartbeat is irregular). Other people have fatigue, weakness, or shortness of breath.

What tests could I have?
Your doctor might begin by checking your blood pressure, since low blood pressure can be a sign of atrial fibrillation. Then your doctor may suggest one or more of the tests listed below. The test results can also help your doctor choose the best treatment(s) for you.

In some cases you may be sent to specialists for diagnosis and testing—and sometimes for treatment. To learn more, go to the Your Treatment Team section.

• Echocardiogram
• Electrocardiogram (ECG or EKG)
• Electrophysiology (EP) Study
• Event Recorder
• Holter Monitoring

Echocardiogram

What is an echocardiogram?
An echocardiogram (also called an echo) is a three-dimensional, moving image of your heart. An echo uses Doppler ultrasound technology. It is similar to the ultrasound test done on pregnant women. The echo machine emits sound waves at a frequency that people can't hear. The waves pass over the chest and through the heart. The waves reflect or "echo" off of the heart, showing:

• The shape and size of your heart
• How well the heart valves are working
• How well the heart chambers are contracting
• The ejection fraction (EF), or how much blood your heart pumps with each beat

When you have an echocardiogram, you undress from the waist up, put on a hospital gown, and lie on an exam table. The technician spreads gel on your chest and side to help transmit the sound waves. The technician then moves a pen-like instrument (called a transducer) around on your chest or side. The transducer records the echoes of the sound waves. At the same time, a moving picture of your heart is shown on a special monitor. You may be asked to lie on your back or your side during different parts of the test. You may also be asked to hold your breath briefly so that the technician can get a good image of your heart. An echo is a painless test. You feel only light pressure on your skin as the transducer moves back and forth.

Electrocardiogram (ECG or EKG)

What is an ECG?
An electrocardiogram (ECG or EKG) reveals how your heart’s electrical system is working. The ECG senses and records your heartbeats, or heart rhythms. The results are printed on a strip of paper. An ECG can also help your doctor diagnose whether:

• You have arrhythmias
• Your heart medication is effective
• Blocked coronary arteries (in the heart) are cutting off blood and oxygen to your heart muscle

Your blocked coronary arteries have caused a heart attack In all, there are three kinds of tests that record your heart's electrical activity, each for a different period of time:
Electrocardiogram (ECG)—done in the doctor's office. It records your heart rhythms for a few minutes.
Holter monitoring—records and stores (in its memory) all of your heart rhythms for 24-48 hours.
Event recorder—constantly records your heart rhythms. But it stores the rhythms (in its memory) only when you push a button.

What are the parts of an ECG strip?
The peaks on an electrocardiogram (ECG) strip are called waves. Together, all the peaks and valleys give your doctor important information about how your heart is working:

• The P-wave shows your heart's upper chambers (atria) contracting
• The QRS complex shows your heart's lower chambers (ventricles) contracting
• The T-wave shows your heart's ventricles relaxing

What can I expect?
When you have an electrocardiogram (ECG) you undress from the waist up, put on a hospital gown, and lie on an exam table. As many as 12 small patches called electrodes are placed on your chest, neck, arms, and legs. The electrodes, which connect to wires on the ECG machine, sense the heart's electrical signals. The machine then traces your heart’s rhythm on a strip of graph paper.

Electrophysiology (EP) Study

What is an EP study?
An electrophysiology (EP) study is a test of your heart's electrical system. While an electrocardiogram (ECG) gives an overview of your heart's electrical system, the EP study gives a more in-depth view. The test helps find out details about abnormal heart rhythms, called arrhythmias. The EP study can reveal:

• If you have an arrhythmia
• The cause of the arrhythmia
• Where the arrhythmia begins in the heart
• If you are at risk for sudden cardiac arrest (SC)
• The best treatment for an arrhythmia

The EP study begins when one or more leads are inserted into a blood vessel, usually in the groin. The doctor gently "steers" the leads toward your heart. Once in place, the leads sense your heart's electrical activity. One special lead also delivers electrical signals to your heart to trigger an arrhythmia. That’s to help find out how easily your heart can produce arrhythmias on its own.

During the EP study, your doctor closely monitors your heartbeats. If an arrhythmia occurs, the doctor treats you with:

Medications given through the intravenous (IV) line in your arm or hand Electrical signals delivered to the outside of your chest through patches In some cases, ablation (a form of treatment) is done at the same time as your EP study. (To learn about ablation, go to the Procedures part of the Medications& Procedures section.) Or your doctor can suggest other types of treatment after the EP study.

What can I expect?
Your test will be performed in a "cath lab." You undress, put on a hospital gown or sheet, and lie on an exam table. An intravenous (IV) line put into your arm delivers fluids and medications during the test. The medication makes you groggy, but not unconscious. Patches called electrodes are put on your chest. The electrodes monitor your heart's electrical signals during the test. A blood pressure cuff on your arm also regularly takes your blood pressure.

The doctor makes a small incision (usually in the groin) for the catheter. The groin area will be numbed so you shouldn't feel pain, but you may feel some pressure as the catheter is inserted. If the doctor delivers electrical signals to your heart, you might feel your heart racing or pounding. You won't be fully asleep, so during the test your doctor or nurse might ask you questions. Afterwards you may be in the hospital overnight, but most people have a fairly rapid recovery.

Event Recorder

What is an event recorder?
An event recorder is a small device that tracks your heart's electrical activity. An event recorder monitors your heart's electrical activity for an extended period of time—usually from a week to a month or more. The recorder is always on, but it saves your heart rhythms into its memory only when you push a button. Many recorders save recordings of your heart rhythms for 30-60 seconds both before and after you push the button.

An event recorder can help your doctor find out if you have abnormal heart rhythms, or arrhythmias. Arrhythmias might happen rarely, yet it is still important for your doctor to know about them and to treat them.

In all, there are three kinds of tests that record your heart's electrical activity, each for a different period of time:

• Electrocardiogram (ECG)—done in the doctor's office. It records your heart rhythms for a few minutes.
• Holter monitoring—records and stores (in its memory) all of your heart rhythms for 24-48 hours.
• Event recorder—constantly records your heart rhythms. But it stores the rhythms (in its memory) only when you push a button.

When the heart rhythms from any of these three tests are printed out, they all look the same: the electrical signals look like peaks and valleys. A doctor may suggest an event recorder when you have symptoms only once a week or once a month.

What can I expect?
Two sticky patches called electrodes are placed on your chest. The electrodes connect to wires on the event recorder. The electrodes sense your heart rhythms, while the event recorder records and stores the rhythms. Your doctor or nurse will show you how to take the electrodes off for bathing and then put them back on. The event recording device itself is the size of a small portable tape recorder. It fits easily on a belt or in a pocket.

You press the button when you feel symptoms. This causes the device to store a small segment of the recordings. Make sure your family and friends know how to start the recorder too. In case you have symptoms, they can help you press the recorder. Any stored recordings can be sent to your doctor's office, clinic, or hospital. The staff there will let you know if you need to follow up with your doctor.

You should be able to do most or all of your daily activities at home and work while using the event recorder. You won't feel anything while the event recorder is tracking your heart rhythms. However, sometimes your skin can become irritated from the sticky patches.

Holter Monitoring

What is Holter monitoring?
Holter monitoring uses a small recording device called a Holter monitor. The monitor tracks and records your heart's electrical activity, usually for 24-48 hours.

Holter monitoring can help your doctor find out if you have abnormal heart rhythms, or arrhythmias. Arrhythmias might happen rarely, yet it is still important for your doctor to know about them and to treat them.

In all, there are three kinds of tests that record your heart's electrical activity, each for a different period of time:

• Electrocardiogram (ECG)—done in the doctor's office. It records your heart rhythms for a few minutes.
• Holter monitoring—records and stores (in its memory) all of your heart rhythms for 24-48 hours.
• Event recorder—constantly tracks your heart rhythms. But it stores the rhythms (in its memory) only when you push the button.

When the heart rhythms from any of these three tests are printed out, they all look the same: the electrical signals look like peaks and valleys. A doctor may suggest Holter monitoring when you have symptoms at least once every day or two.

Your doctor may ask you to write down any symptoms you have during the test. Symptoms might include faintness, dizziness, or fluttering in the chest. You should note the time and how long the symptoms last. Your doctor might also ask you to write down when you exercise, take medications, or get upset. This can help your doctor see if there is a connection between your heart rhythms and your symptoms or activities.

What can I expect?
As many as seven 4-7 sticky patches called electrodes are placed on your chest. The electrodes connect to wires on the Holter monitor. The electrodes sense your heart rhythms, while the monitor records and stores the rhythms. Since the electrodes cannot get wet, you should shower or bathe before you begin the Holter monitoring, and not at all during the testing. The Holter monitor device itself is the size of a small portable tape recorder. It fits easily on a belt or can be worn on a shoulder strap.

You should be able to do most or all of your daily activities at home and work while using the Holter monitor. You won't feel anything while the Holter monitor is tracking your heart rhythms. After 24-48 hours, you return the monitor. A technician examines the recordings, notes whether you had any arrhythmias, and prepares a report for your doctor.

What are the treatment options?
Your treatment depends on your test results. Your doctor may recommend one
or more of these medications or procedures.

Medications
Antiarrhythmics
Anticoagulants
Beta Blockers
Calcium Channel Blockers
Inotropes
Vasodilators

Procedures
Ablation
Maze Procedure
Pacemaker Implant

MEDICATIONS

Tips for Taking Heart Medications
If you have a heart or blood vessel condition, you might want to know more about some of the medications you take. The information in this section describes some medications commonly prescribed for heart or blood vessel conditions. It also includes some tips to help you take your medications as ordered.

Make sure you tell your doctor—or any new doctor who prescribes medication for you—about all the medications and supplements you take. Your doctor can then help make sure you get the most benefit from your medications. Telling your doctor this information also helps avoid harmful interactions between medications.

You may also want to discuss these topics with your doctor or nurse each time you get a new medication:

• The reason you're taking the medication, its expected benefits, and its possible side effects
• How and when to take your medications
• If you take other medicines, vitamins, supplements, or other over-the-counter products

In some cases, your heart needs several months to adjust to new medications. So you may not notice ny improvement right away. It also may take time for your doctor to determine the correct dosage.

The blood tests help your doctor determine the correct dosage—and therefore help avoid harmful side effects.

Never stop taking your medication or change the dosage on your own because you don't believe you need it anymore, don't think it's working properly, or feel fine without it.

Be sure to talk to your doctor or nurse if you have:

• Questions about how your medications work
• Unpleasant side effects
• Trouble remembering to take your pills
• Trouble paying for your medications
• Other factors that prevent you from taking your medications as needed
• Questions about taking any of your medications

And don't hesitate to ask your pharmacist if you have questions about how and
when to take your medications.

Antiarrhythmics
Antiarrhythmics affect the electrical system in your heart. You can understand the purpose of antiarrhythmics by looking at the root words of the term. Anti = counter or against; arrhythmia = an abnormal heartbeat or heart rhythm.

Some generic (and Brand) names
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.

amiodarone (Cordarone, Pacerone)
disopyramide (Norpace)
dofetilide (Tikosyn)
flecainide (Tambocor)
procainamide (Procanbid)
propafenone (Rythmol)
quinidine (Quinaglute)

Sometimes other categories of medications—beta blockers and calcium channel blockers—are used to help prevent arrhythmias.

What they're used for
To prevent and treat arrhythmias (abnormally fast or slow heartbeats, or heart rhythms)

To restore normal heart rhythms

Antiarrhythmic drugs work in different ways to change the electrical activity in your heart. Different drugs are used because the source of the arrhythmia can come from different places in the heart.

Taking antiarrhythmics can:
Restore a normal heart rhythm
Prevent abnormally fast rhythms.
Anticoagulants (Blood Thinners)

You can understand the purpose of anticoagulants by looking at the root words of the term. Anti = counter or against; coagulant = thicken or clot.

Some Generic (and Brand) Names
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.

clopidogrel (Plavix)
ticlopidine (Ticlid)
warfarin (Coumadin)

What They're Used For
To reduce the risk of blood clots that could lead to stroke and other medical conditions

How They Work
Anticoagulants are often called blood thinners, although they don't actually thin the blood. Rather, they help prevent clots from forming in your blood.

These medications treat conditions related to atherosclerosis, or arteries blocked by plaque. Plaque buildup can lead to a blood clot.

A blood clot in the coronary arteries (which carry blood to the heart muscle) can cause angina (chest pain). A clot or blockage in the coronary arteries is called coronary artery disease (CAD) and could lead to a heart attack.

A blood clot in the carotid arteries (in the neck) can travel to the brain and cause a stroke.

A blood clot in the vessels in the arms or legs, called peripheral vascular disease (PVD), can cause pain.

Taking anticoagulant medications can:
Decrease the stickiness of the blood
Reduce the likelihood of blood clots forming

Beta blockers get their name because they "block" the effects of substances like adrenaline on your body's "beta receptors."

Some generic (and brand) names
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.

acebutolol (Monitan)
atenolol (Tenormin)
betaxolol (Kerlone)
bisoprolol (Zebeta)
carteolol (Cartrol)
carvedilol (Coreg)
labetalol (Trandate)
metoprolol (Lopressor, Toprol)
nadolol (Corgard)
penbutolol (Levatol)
pindolol (Visken)
propranolol (Inderal)
sotalol (Betapace, Sorine)
timolol (Blocadren)

What they're used for
To treat high blood pressure
To slow fast arrhythmias (abnormal heartbeats, or heart rhythms)
To prevent angina (chest pain due to blocked blood flow to parts of the heart)
To prevent long-term damage after a heart attack
To treat heart failure and related conditions, such as low ejection fraction (EF)

How they work
These medications block activity of your sympathetic nervous system. The sympathetic nervous system reacts when you are stressed or when you have certain health conditions. When your system responds, your heart beats faster and with more force. Your blood pressure also goes up.

Beta blockers block signals from the sympathetic nervous system. This slows your heart rate and keeps your blood vessels from narrowing. These two actions can result in:

Lower heart rate
Lower blood pressure
Less angina (chest pain related to the heart)
Fewer arrhythmias (abnormal heartbeats, or heart rhythms)

Calcium channel blockers help relax the heart muscle and blood vessels.

Some generic (and Brand) names
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.

amlodipine (Norvasc)
diltiazem (Cardizem, Dilacor, Diltia, Tiazac, Taztia)
felodipine (Plendil)
isradipine (DynaCirc)
nicardipine (Cardene)
nifedipine (Adalat, Procardia)
verapamil (Calan, Covera, Isoptin, Verelan)

What they're used for
To treat high blood pressure
To treat angina (chest pain) which can result from atherosclerosis (blocked blood vessels) and coronary artery disease (CAD)
To treat some arrhythmias (abnormal heartbeats, or heart rhythms)—usually fast arrhythmias

How they work
Calcium channel blockers prevent calcium from entering parts of the cells in blood vessels. When calcium is blocked from entering these cells, it relaxes the blood vessels and the heart. As a result, calcium channel blockers:

Decrease the work of the heart by allowing more blood and oxygen to flow to the heart muscle
Lower the heart rate
Lower blood pressure
Inotropes
The word "inotrope" refers to the strength of the heart muscle's pumping action, or contractions.

Some generic (and Brand) names
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.

digoxin (Digitek, Lanoxicaps, Lanoxin)

To improve symptoms of heart failure and related conditions, such as low ejection fraction (EF)
To slow the heart rate in response to atrial fibrillation (fast rhythm in the heart's upper chambers)

How they work
The term "inotrope" describes the strength and force of the heartbeat. Taking
inotropic medications can:

Make the heart beat more strongly and efficiently
Help slow and control the heart rate for certain arrhythmias
Vasodilators
One purpose of vasodilators is to lower blood pressure. To understand how vasodilators work, imagine the same amount of water moving through a 1-inch diameter hose versus a 2-inch diameter hose. The bigger the hose, the less pressure on the walls of the hose.
Medications such as vasodilators can help relax and dilate blood vessels that have become narrowed (constricted).

Some generic (and Brand) names
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.

doxazosin (Cardura)
guanabenz (Wytensin)
guanfacine (Tenex)
hydralazine (Apresoline)
isosorbide dinitrate (Dilatrate, Isordil, Isochon)
isosorbide mononitrate (Imdur, ISMO, Monoket
methyldopa (Aldomet)
minoxidil (Loniten)
nitroglycerin (Minitran, Nitro-Bid, Nitro-Dur, Nitrogard, Nitrolingual, NitroQuick,
Nitrostat))
prazosin (Minipress)
reserpine (Serpalan)
terazosin (Hytrin)

You may have heard of other types of vasodilators. Beta blockers, which are a common heart and blood vessel medication, are one type of vasodilator. Another type is calcium channel blockers.

To treat high blood pressure
To treat/prevent angina (chest pain related to the heart) which can result from atherosclerosis (blocked blood vessels) and coronary artery disease (CAD)

How they work
Vasodilators help relax and dilate the blood vessels, so blood moves through them more easily. This helps to:

Lower blood pressure
Allow the heart to work with less effort
Decrease the amount of angina (chest pain)

PROCEDURES

Ablation

What is ablation?
Ablation destroys (ablates) targeted portions of the heart muscle. Your doctor carefully chooses portions of the heart muscle to treat. Then your doctor delivers small amounts of energy to these selected areas. This creates lesions (helpful scars) on the heart muscle.

Ablation can be done as a type of surgery or as a procedure using a catheter. A catheter is a flexible tube that is inserted into a blood vessel.

Your doctor will decide whether a catheter ablation or a surgical ablation is right for you. This section describes both catheter and surgical ablation.

Other names for ablation: cardiac ablation, catheter ablation, cryoablation, microwave ablation, radiofrequency ablation, surgical ablation.

How is it done?

Catheter ablation
Catheter ablation does not require incisions in the chest. This type of ablation begins with a catheterization. During a catheterization, a small flexible tube called a catheter is inserted through a blood vessel in your groin (or sometimes in your neck). Your doctor gently “steers” the catheter into your heart. Your doctor can see where the catheters are going by watching a video screen with real-time images, or moving x-rays, called fluoroscopy.

The electrode at the tip of the catheter senses your heart’s electrical signals and takes electrical measurements. Your doctor tests your heart and then “ablates” sections of the muscle tissue using the catheter. Catheter ablation can be done using:

• Intense cold, called cryoablation
• High-frequency energy, called radiofrequency ablation

In some cases, when ablation is done in certain parts of the heart, you may need a pacemaker afterwards.

Surgical ablation
Minimally invasive surgical ablation requires six small incisions in the sides of your chest. These incisions (_ to _ inches in size) are much smaller than the incisions needed for traditional open-heart surgery. Through these incisions, your doctor inserts a tiny camera to view the heart. Your doctor then inserts small instruments to test your heart and ablate the tissue as needed.

Open-heart surgical ablation requires a longer incision down the middle of the chest, through the breastbone (sternum). This type of ablation is usually done if you also need to have another type of treatment, such as a valve replacement or bypass surgery.

With either type of surgical ablation, your doctor ablates sections of the heart muscle tissue by delivering energy to the heart and creating lesions (scars).

Surgical ablation can be done using:
• Intense cold, called cryoablation
• Microwave energy, called microwave ablation
• High-frequency energy, called radiofrequency ablation
• Ultrasound energy
• Laser energy

What can I expect?
Usually you are told not to eat or drink anything for a number of hours beforehand. Catheter ablation is performed in a “cath lab.” And surgical ablation is performed in an operating room. You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications.

A few details about each type of procedure or surgery is explained as follows. Catheter ablation
The medications in the IV make you groggy, but not unconscious. To insert the catheter, the doctor makes a small incision in the groin (or the neck), but not in the chest. The area will be numbed so you shouldn't feel pain, but you may feel some pressure as the catheter is inserted. During ablation your doctor or nurse might ask you questions. Afterwards you may be in the hospital overnight.

Minimally invasive surgical ablation
During a surgical ablation, you will receive medication that makes you unconscious. You will not be aware of the incisions made in the side of your chest, or of the ablation itself. After surgery you will probably be in the hospital for one to two days.

Open-heart surgical ablation
During a surgical ablation, you will receive medication that makes you unconscious. You will not be aware of the incision in your chest, or of the ablation itself. After surgery you may spend several days in the hospital. You may have pain at the incision site for several weeks. Your recovery will depend in part on the other heart surgery you likely had done at the same time as the ablation.

Ablation References
Atrial Fibrillation: Fuster V, Ryden LE, Asinger RW, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary, a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences. Circulation. 2001;104:2118-2150.

Supraventricular Tachycardia : Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias-- executive summary, a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines. J Am Coll Cardiol. 2003;42:1493-1531.

Ventricular Tachycardia: Scheinman M, Calkins H, Gillette P, et al. NASPE Policy Statement on Catheter Ablation: personnel, policy, procedures, and therapeutic recommendations. PACE. 2003;26:789-799.

Maze Procedure
A maze procedure is a way of stopping chaotic electrical signals from traveling throughout the atria. The procedure uses many tiny incisions in the heart tissue to interrupt these chaotic electrical signals. Although called a “procedure,” it is often performed as a type of open-heart surgery that requires general anesthesia.

The doctor makes a maze-like pattern of tiny incisions in the tissue of the atria. These incisions form scar tissue. Scar tissue interrupts the flow of electrical signals. Because so many tiny incisions are made, the electrical signals can no longer cause a chaotic rhythm. Instead, the signals are forced to follow only one pathway from the top to the bottom of the atria.

Some people may need a pacemaker to help regulate their heart rhythm after they have a maze procedure.

What is a pacemaker?
A pacemaker is a small implanted device that treats abnormal heart rhythms called arrhythmias. Specifically, a pacemaker treats slow arrhythmias called bradycardia. A pacemaker can usually eliminate symptoms like shortness of breath, fatigue, and dizziness caused by bradycardia.

Arrhythmias result from a problem in your heart's electrical system. Electrical signals follow a certain path throughout the heart. It is the movement of these signals that causes your heart to contract. During bradycardia, however, too few signals flow through the heart. To learn more about your heart's electrical system, go to the Heart & Blood Vessel Basics section.

A pacemaker restores your heart to a normal rhythm. The pacemaker can also adjust to your body's needs. This is because the device has sensors that can detect:

• When you rest and need a slow heart rate
• When you exercise and need a faster heart rate

Perhaps your heart does a good job of regulating your heart rhythm most of the time. A pacemaker is used as backup treatment only when your heart needs it. In other cases, a person's heart can no longer create its own electrical signals, or send them down the proper pathways. For example, sometimes aging, or an ablation procedure in certain parts of the heart, can make pacemaker therapy necessary. In such cases the pacemaker might deliver continual treatment, in order to cause each heartbeat.

The pacemaker delivers electrical signals to the heart. The device does this by sending tiny amounts of electrical energy (too small to feel) to either the top or the bottom chambers of the heart, or to both.

A device implant is a procedure that uses local numbing. General anesthesia usually is not needed.

How is the implant procedure done?
A pacemaker system has two parts.

Device—the device is quite small and easily fits in the palm of your hand. It contains small computerized parts that run on a battery.

Leads—the leads are thin, insulated wires that connect the device to your heart. The leads carry electrical signals back and forth between your heart and your device.

Your doctor inserts the leads through a small incision, usually near your collarbone. Your doctor gently steers the leads through your blood vessels and into your heart. Your doctor can see where the leads are going by watching a video screen with real-time, moving x-rays called fluoroscopy.

The doctor connects the leads to the device and then tests to make sure both work together deliver treatment. Your doctor then places the device just underneath your skin and stitches the incision closed.

What can I expect?
Usually you are told not to eat or drink anything for a number of hours before the procedure. You undress and put on a hospital gown or sheet. Your procedure will be performed in a ”cath lab." You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious.

The doctor makes a small incision near your collarbone to insert the leads. The area will be numbed so you shouldn't feel pain, but you may feel some pressure as the leads are inserted. You may be in the hospital overnight, and there may be tenderness at the incision site. Most people have a fairly quick recovery.

Important Safety Information
Medications, procedures and tests can have some risks and possible side effects. Results may vary
from patient to patient. This information is not meant to replace advice from your doctor. Be sure to talk
to your doctor about these risks and possible side effects.

A pacemaker system can monitor and treat your heart rhythm by delivering electrical energy to pace your heart when it senses a slow rhythm. But it is not for everyone, including patients with certain steroid allergies. Patients who have additional medical conditions that may not allow the pacemaker to function appropriately should not receive a device. Procedure risks include infection, tissue damage and kidney failure. In some cases, the device may not respond to your heart rhythm. In rare cases severe complications or device failures can occur. Electrical or magnetic fields can affect the device. Only your doctor knows what is right for you.

GUIDANT is a trademark and HEARTISTRY is a service mark of Guidant Corporation. All other brand names mentioned are used for identification purposes only and are trademarks of their respective owners.

Guidant Corporation
4100 Hamline Avenue North
St. Paul, MN 55112-5798 USA
Tel: 651.582.4000 Fax: 651.582.4166
Medical Professionals: 1.800.CARDIAC (227.3422) Toll Free
Patients and Families: 1.866.GUIDANT (484.3268) Toll Free
www.guidant.com

©2006 Guidant Corporation All rights reserved. C4-196-0506

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Cardiology Associates of Fort Lauderdale, P.A.
4725 N. Federal Hwy, Suite #401
The Jim Moran Heart and Vascular Center
Fort Lauderdale, FL 33308
Phone: (954) 772-2136
Fax: (954) 772-7156

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