UCSD’s renowned cardiologists are leaders in the treatment of abnormal heart rhythms, or arrhythmias. If you have been diagnosed with abnormal heart rhythm, our team of specialists will collaborate to determine the best course of treatment and follow up care for you. Depending on the cause and severity of the abnormal rhythm, arrhythmias may be treated with:
- Medications
- Medical devices such as pacemakers or defibrillators
- Surgical procedures such as catheter ablation
The majority of procedures, including placement of pacemakers and implantable cardioverter defibrillators (ICDs) are done with minimally invasive techniques on an outpatient basis (one day, or an overnight stay).
Patients who receive pacemakers or implantable cardioverter defibrillations can take advantage of UCSD’s advanced remote monitoring program. This program utilizes wireless technology to track any changes in heart function or rhythm recorded by the device on a daily basis. This information is in turn transmitted to UCSD’s Cardiovascular Center and is used for routine monitoring in addition to scheduled clinic visits.
In the event of a cardiac incident or irregularity, our physicians can contact you to schedule an immediate follow-up appointment.
Learn more about procedures and treatments at UCSD:
Radiofrequency catheter ablation destroys or disrupts parts of the electrical pathways causing the arrhythmias, providing relief for patients who may not have responded well to medications, or who would rather not or can't take medications.
At UCSD Medical Center, catheter ablation has been utilized to cure atrial fibrillation (AF) since 2000. Catheter ablation techniques are used to destroy the muscle fibers in the upper chambers of the heart that trigger and then sustain the abnormal rhythm. Gregory Feld, M.D., Medical Director of the UCSD Electrophysiology Program, has performed this procedure in more than 3,000 patients in the past 10 years.
- UCSD physicians have extensive experience in the various approaches to ablation for atrial fibrillation (AF), including the use of the new Hansen Sensei robotic system to aid ablation of AF. The Hansen robot provides added stability of the catheter, and therefore accuracy, during ablation treatment of patients with atrial fibrillation. The robotic system also markedly reduces physician fatigue and orthopedic strain, which likely improves physician competence for long procedures..
The success rate of catheter ablation for AF is between 60-95 percent, depending on the duration that patient has had atrial fibrillation. This cure for atrial fibrillation is now minimally invasive, compared to the conventional open-heart surgery used in the past.
- Catheter ablation for other atrial arrhythmias, including atrial flutter and supraventricular tachycardia with or without Wolff-Parkinson-White Syndrome, has been performed in several thousand patients over the last 20 years, with a success rate approaching 100 percent.
- Catheter ablation for ventricular tachycardia can also be performed, both in patients with and without other heart disease, with a success rate ranging from 70-95 percent.
Epicardial Catheter Ablation
This innovative new technique, performed by UCSD physicians, offers a less invasive alternative to conventional open-heart surgical ablation. Epicardial catheter ablation avoids the use of an arterial catheter through the groin, instead accessing the heart with a special catheter passed through the chest exterior. Radiofrequency energy is then used to destroy the tissues that are causing arrhythmias and restore normal function.
- UCSD’s Cardiovascular Center is the only medical center in the San Diego region to routinely perform this ablation technique.
Pacemakers work on "demand" and are used to treat slow heart rhythms. These small devices are implanted beneath the skin below the collarbone and connected to a set of permanent insulated wire(s) positioned inside the heart (right atrium and/or ventricle) via a vein. The pacemaker delivers a small electrical impulse to stimulate the heart to beat when it is going too slow.
Learn more about pacemakers in this patient tutorial. (Also available in Spanish)
An implantable cardioverter defibrillator is a device for people who are prone to life-threatening rapid heart rhythms originating from the lower chambers of the heart. If the heart has stopped (cardiac arrest) or is experiencing rapid, abnormal heart rhythms (life-threatening arrhythmias) that cannot be controlled by drugs or other approaches, this device may be used. It may also be used in patients with very weak heart muscle where there is an increased risk of developing dangerous heart rhythms.
The defibrillator is placed in a pocket under the skin of the chest. The device consists of leads and a pulse generator. The leads monitor the heart rhythm and deliver the energy for pacing, cardioversion and/or defibrillation. The generator contains the battery and a tiny computer that processes information to determine the heart's rhythm.
- There are three types of ICDs: single, dual chamber and biventricular devices.
- In a single-chamber ICD, a lead is attached to the right ventricle. In a dual-chamber ICD, leads are attached to the right atrium and the right ventricle. There is also a biventricular ICD, in which leads are attached in the right atrium, the right ventricle and the left ventricle. The biventricular ICD is for patients who have had heart failure to provide Cardiac Resynchronization Therapy (below).
- Learn more about Implantable Cardioverter Defibrillators in this patient tutorial.
Biventricular Pacemaker or Defibrillator
In addition to conventional pacemakers and ICDs, UCSD physicians also use biventricular pacemakers and ICDs for a treatment known as Cardiac Resynchronization Therapy or CRT. CRT devices work by pacing both the left and right ventricles simultaneously, which results in resynchronizing the muscle contractions and improving the efficiency of the weakened heart.
Cardiac resynchronization therapy (CRT), or biventricular pacing, is a new technology for patients with congestive heart failure. The technique uses specialized pacemakers and implantable cardioverter defibrillators that can pace both the left and right ventricles of the heart. Both devices allow precise, independent control of timing of both right ventricular and left ventricular pacing.
Using CRT to resynchronize or coordinate the action of the right and left ventricles improves pumping ability and overall function of the heart. In turn, this leads to increased energy, higher exercise capability and an increased feeling of wellness in most patients who receive this treatment.
Cardioversion is performed when medications have failed to restore a patient's abnormal rhythm back to a normal sinus rhythm. External cardioversion is performed by delivery of high energy shocks of 50 to 300 joules through two defibrillator pads attached to the chest, to convert an abnormal heart rhythms back to normal.
Internal cardioversion is performed by delivering a low energy electrical shock internally to the heart through two catheters inserted in a vein in the groin or neck and an electrode pad applied to the chest. This is done in some cases when external cardioversion has failed because the electrical current cannot travel through chest muscle and skeletal structures with enough energy to reach the heart. This procedure is performed in the electrophysiology lab by our electrophysiologist.
Both external and internal cardioversion are done after short-acting sedatives are given to make the patient sleepy.
This minimally invasive surgery, an alternative to catheter ablation, uses an ablation technique to create a “maze” of lesions in specific areas of the heart. Accessing the heart from between the ribs, the surgeon uses brief bursts of radiofrequency energy to cauterize the tissue. These lesions no longer conduct electrical impulses, which interrupts the transmission of the abnormal signals and allows the rest of the heart to resume beating normally.
- Research has shown this treatment to be curative in approximately 85 percent of atrial fibrillation patients.
Make an appointment
To schedule an appointment with an electrophysiologist, call (619) 543-5428 or (619) 471-9253.