In the last 20 years or so we have learned so much more about the electrical component to your heart: electrophysiology. Chrys Peterson talked with Kamala Tamirisa, MD, FACC, FHRS, a cardiac electrophysiologist with ProMedica Physicians.
Chrys Peterson: So we know that hearts pump blood but there’s an electrical circuitry in there, too. How does that work exactly?
Dr. Tamirisa: The electrical circuitry helps the heart keep in rhythm and go at a steady rate. If there is a problem with it, it can manifest and affect overall health of the patient, cause symptoms and cause problems with the heart, leading up to heart disease.
How can you distinguish between an electrical problem from a problem from one of the components of your heart, or the physical part of your heart?
The electrical problems could be a slow heartbeat, where the nerves have slowed down. In that case people need a pacemaker. Or, it could be a very rapid heartbeat coming from the top chamber called atrial fibrillation, or it could be a rapid heartbeat coming from the bottom chambers or the main nerves of the heart called ventricular tachycardia or supraventricular tachycardia.
Many of those conditions are things that could actually lead you to have a heart attack or even sudden cardiac death in some cases. That is important if you feel that might be an issue to see a doctor and talk about that. Tell me about some of the technologies. You mentioned a pacemaker. What exactly would a pacemaker be used for?
A pacemaker brings up the heartbeat. If the heart rate of a patient is very slow, the pacemaker brings up the heartbeat. The newer technology we offer at the Heart Rhythm Center at ProMedica Toledo Hospital is a leadless pacemaker. These are just a little bit over the size of a Tylenol tablet. We place them inside the muscle in the right ventricle. So a pacemaker is a device that brings up the heartbeat.
Isn’t that remarkable? That you have something so small that can help somebody live a much fuller life. Because if you have those symptoms from AFib or one of the other conditions, your life probably isn’t what you’d want it to be. You’d notice some symptoms from those types of things. We have done some stories here with ICD’s, now what is that and when would you use that?
ICD or (implantable cardioverter) defibrillator is a shock box. This is placed in people with a very weak heart pump, whether it’s from a heart attack, bypass surgery, or unknown causes. We place these devices to protect a patient from dying suddenly and there are two ways we do them. One with leads that enter the heart, those are the standard, transvenous defibrillators and the newer technology is the subcutaneous defibrillators. We do provide that care at ProMedica Toledo Hospital and the beauty of these devices is that there are now wires hooked up that enter the heart. The wire is placed under the skin and the device is under the skin.
So amazing technologies are available now for us to treat these conditions. Is age a factor in some of these treatments?
Not really. Age alone is not a clear cut for us to do any of these procedures, but age combined with their mobility, activities of daily living and other co-morbitities do help us guide so we can make the right decision for that given patient.