Electrophysiology

Atrial Fibrillation

Atrial fibrillation (A-Fib) is the most common chronic heart rhythm disorder in adults, affecting more than five million Americans and millions more worldwide. A-Fib is characterized by disorganized episodes of rapid, irregular beating of the heart’s upper chambers (atria). At Mount Sinai, we determine the severity of A-Fib based on the patient’s symptoms, how long each episode of irregular heartbeats lasts, how long the patient has experienced these episodes, the size of the patient’s left atrium (which can enlarge over time), and the presence of structural heart diseases, such as abnormalities in the valves, vessels, and other parts of the heart.

Symptoms of A-Fib typically include heart palpitations, fatigue, shortness of breath, chest discomfort, rapid heartbeat, dizziness, and, rarely, fainting. Many patients with A-Fib are at increased risk of stroke because blood can pool inside their heart, where it can thicken and cause clots. These clots can travel to the brain and cause a stroke. Because of this risk, people with A-Fib require ongoing care and, usually, medical management of their A-Fib.

A-Fib is commonly associated with an enlarged left atrium, a leaky mitral valve (mitral regurgitation), and fluid retention causing accumulation of water in the lungs with shortness of breath or congestive heart failure.

Treatment of A-Fib may include medication, cardioversion, or ablation. Some patients with A-Fib can have a slow heartbeat at times, which may be treated with a pacemaker. Mount Sinai also offers the innovative Hybrid Maze Procedure for patients with chronic A-Fib and enlarged left atria, which are generally difficult to treat with medication and single catheter ablation treatments. These procedures are minimally invasive and are very well tolerated procedures that can cure patients long-term of their atrial fibrillation. These procedures typically mean patients can stop medications and blood thinners long-term.

Atrial Flutter

Atrial flutter (AFL) shares many similarities with atrial fibrillation. However, AFL is caused by a single electrical wave that circulates very rapidly in the upper chambers of the heart (usually the right atrium) in an organized pattern. People with AFL usually continue to have a steady heartbeat, even though it is faster than normal. Patients with AFL may not have any symptoms, or they may experience symptoms similar to atrial fibrillation. Treatment for AFL typically includes medication, cardioversion, and catheter ablation.

Heart Block

Heart block is a condition characterized by an abnormally slow heartbeat (bradycardia). It occurs when some or all of the electrical impulses from the upper chambers of the heart are not properly transmitted to the lower chambers of the heart. Symptoms of heart block may include fainting, dizziness, lightheadedness, and shortness of breath. Treatment may include lifestyle changes to address other heart conditions, medication changes, and implanting pacemakers.

Long QT Syndrome

Long QT syndrome (LQTS) is an inherited electrical disorder that puts patients at risk for sudden cardiac death. At Mount Sinai, we diagnose LQTS by looking for abnormalities in a patient’s electrocardiogram and genetic testing. Long QT may also be acquired after taking certain medications, or it may be caused by a combination of heredity and medications.

Symptoms of LQTS include palpitations, rapid heartbeat, and fainting. Treatment includes limiting physical activity, taking medications to prevent chaotic heart rhythm, avoiding medications known to cause prolonged Q-T intervals, and implanting devices, such as internal defibrillators. Patients with LQTS may also be susceptible to Torsades de Pointes, a type of ventricular tachycardia.

Sick Sinus Syndrome

Sick sinus syndrome (SSS), or sinus node dysfunction, refers to the malfunction of the heart’s natural electrical regulator, the sinoatrial node. SSS often results in an abnormally slow heartbeat at rest (bradycardia), occasional heartbeat pauses, or a heartbeat that fails to speed up with activity or in response to adrenaline. Some patients with SSS will have a combination of slow and rapid heart rhythms. Many people have no symptoms, while others experience fatigue, fainting, shortness of breath, chest pain, disturbed sleep, confusion, and heart palpitations. Treatment for patients with severe SSS often requires your Mount Sinai cardiac experts to implant a permanent pacemaker.

Supraventricular Tachycardia

Supraventricular tachycardia (SVT) describes several types of fast heartbeats that are caused by electrical problems in the upper chambers (atria) of the heart but are not typically dangerous. Patients with SVT usually have a rapid and steady pulse that is accompanied by heart palpitations, fatigue, or shortness of breath. These episodes start suddenly and stop suddenly. Treatment options include medications or catheter ablation.

Ventricular Fibrillation

Ventricular fibrillation (VF) is a dangerous condition that can cause sudden cardiac death by causing rapid, disorganized beating of the heart’s main pumping chambers (ventricles). In these instances, the heart stops beating effectively; blood flow to the brain is cut off; the patient faints and then suddenly dies. VF can happen during a heart attack (myocardial infarction) or be caused by previous heart damage or a genetic heart condition. Life-saving shock (defibrillation) must be delivered to the heart within minutes of a VF episode to restore a normal heart rhythm and blood flow. In the interim, cardiopulmonary resuscitation (CPR) may keep blood flowing while emergency aid arrives.

Ventricular Tachycardia

Ventricular tachycardia (VT) is an electrical heart rhythm disorder, and its primary symptom is a very fast heart rate. VT has many features in common with ventricular fibrillation. It is usually seen in the setting of other serious heart diseases and can be life-threatening. If VT does not stop on its own, it usually requires treatment with medication, electrical cardioversion, catheter ablation, or implanting a defibrillator. VT requires aggressive monitoring and treatment, as it can lead to ventricular fibrillation and sudden death.