Prof. Tolga Aksu, MD

Electrophysiology is a subspecialty of cardiology abroad and is practiced in certain centers in our country. The focus of electrophysiology is the treatment of disorders related to the heart’s electrical system. At Heart Rhythm Centers, electrophysiology teams can address abnormal heart rhythms using the latest technology.

Cardiac arrhythmia is the medical term for problems related to heart rate or rhythm that affect thousands of our citizens each year. During an arrhythmia, the heart beats too fast or too slow, to the extent that it impacts blood flow throughout the body. Heart Rhythm Centers are dedicated to managing the best diagnostic approach and treating cardiac arrhythmias.

Common symptoms of cardiac arrhythmias include palpitations, dizziness, fatigue, shortness of breath, chest pain, and fainting. These symptoms can vary depending on the type and severity of the arrhythmia. If you experience any of these symptoms, it’s important to consult a healthcare professional for proper evaluation and management.

At Heart Rhythm Centers, tests or procedures that may be used in the diagnosis of cardiac arrhythmias include one or more of the following:

1. Electrocardiogram (ECG/EKG): A test that records the electrical activity of the heart to identify abnormal rhythms.
2. Holter Monitoring: A portable ECG device worn for 24-48 hours to monitor heart rhythms over time.
3. Event Monitor: Similar to a Holter monitor, but used for a longer period to detect intermittent arrhythmias.
4. Electrophysiological Study (EPS): A procedure that involves inserting catheters into the heart to map the electrical activity and identify sources of arrhythmias.
5. Stress Testing: A test to monitor heart function under physical stress to assess arrhythmias triggered by exercise.
6. Tilt Table Test: Used to evaluate the cause of fainting spells by changing the position of the patient while monitoring heart rhythms.
7. Implantable Loop Recorder: A small device implanted under the skin to continuously monitor heart rhythms for an extended period.

These tests help in accurately diagnosing the type, cause, and severity of arrhythmias for appropriate treatment.

Treatment options for cardiac arrhythmias depend on the type, severity, and underlying cause of the condition. Common treatment options include:

1. Medications:
• Antiarrhythmic drugs to control or prevent abnormal heart rhythms.
• Beta-blockers to slow the heart rate and reduce symptoms.
• Anticoagulants to reduce the risk of stroke, especially in atrial fibrillation.

2. Electrical Cardioversion:
• A procedure where an electric shock is delivered to the heart to restore a normal rhythm, often used for atrial fibrillation or atrial flutter.

3. Catheter Ablation:
• A minimally invasive procedure where a catheter is used to destroy abnormal electrical pathways in the heart, providing long-term relief from certain arrhythmias.

4. Pacemaker:
• A small device implanted under the skin to regulate the heart rate in cases of slow heart rhythms (bradycardia).

5. Implantable Cardioverter-Defibrillator (ICD):
• A device implanted under the skin to monitor the heart’s rhythm and deliver shocks if a life-threatening arrhythmia (like ventricular tachycardia) is detected.

6. Surgical Intervention:
• In some cases, surgery may be required to correct structural issues or install devices like pacemakers or ICDs.

7. Lifestyle Modifications:
• Avoiding triggers such as excessive caffeine, alcohol, or stress.
• Managing underlying conditions like hypertension, diabetes, or sleep apnea.

Each treatment option is tailored to the individual patient based on their specific arrhythmia type and health condition.

3D mapping systems are revolutionizing the treatment of arrhythmias by providing detailed, real-time visualization of the heart’s electrical activity and anatomy. These systems enhance precision during electrophysiological (EP) studies and ablation procedures. Here’s how they are used:

1. Creating a 3D Model of the Heart
• Electroanatomical Mapping: Sensors on specialized catheters detect electrical signals from inside the heart. This data is combined with anatomical information to create a 3D map. Systems like CARTO, EnSite, and Rhythmia offer precise models.
• Imaging Integration: Advanced systems can integrate pre-procedural imaging (CT, MRI) to improve anatomical accuracy.

2. Pinpointing Arrhythmogenic Areas
• The 3D map identifies the origin and propagation of abnormal electrical signals.
• It differentiates between healthy, scarred, or electrically inactive tissues, guiding the operator to the arrhythmia source.

3. Guiding Catheter Navigation
• With real-time visualization, catheters are maneuvered accurately, avoiding critical structures.
• Fluoroscopy use is minimized, reducing radiation exposure to both patients and medical staff.

4. Performing Ablation
• Once the arrhythmogenic area is identified, ablation (radiofrequency or cryotherapy) is precisely delivered to eliminate the abnormal tissue.
• Continuous mapping ensures immediate feedback, confirming successful ablation or the need for further intervention.

5. Monitoring and Post-Ablation Validation
• Post-ablation, the system rechecks electrical activity to ensure the arrhythmia circuit is interrupted.

Advantages
• Increased Accuracy: Enhanced precision reduces complications and improves outcomes.
• Reduced Procedure Time: Efficient localization of arrhythmogenic foci.
• Patient Safety: Less invasive and reduced radiation exposure.

3D mapping has become essential for treating complex arrhythmias like atrial fibrillation, ventricular tachycardia, and atypical atrial flutters, ensuring more effective and safer treatments.