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When the Heart Skips a Beat - Arrhythmias


When the Heart Skips a Beat: Arrhythmias

It’s not uncommon to feel your heart skip a beat, and most of the time these “palpitations” are harmless.
But there are disorders of the heart’s rhythm that are serious and need medical treatment.
The causes of these more serious heart rhythm disorders, or “cardiac arrhythmias,” include such things as a heart attack, abnormal heart valves, heart failure, and even some medications.
These arrhythmias are caused by a disorder in the heart’s electrical system. Normally, this system makes sure the heart beats regularly and contracts in a smooth, coordinated fashion.
Arrhythmias occur when this system malfunctions and the natural rhythm is lost. In some cases, the heart may beat too fast; in others too slow.
Ventricular arrhythmias: Ventricular tachycardia and ventricular fibrillation
The most dangerous of these arrhythmias originate from the heart’s two large, lower chambers, the ventricles. Two common ventricular arrhythmias are called ventricular tachycardia and ventricular fibrillation. With a ventricular tachycardia the heart beats too fast; with a ventricular fibrillation the heart stops beating altogether.
Ventricular arrhythmias are often life-threatening and need careful evaluation, says Dr. Prutkin, a UW Medicine cardiologist, who specializes in the diagnosis and treatment of such heart rhythm disorders at UW Medicine’s state of the art Electrophysiology - Arrhythmia Service.
In some cases, ventricular arrhythmias can be cured by a procedure, such as an ablation, or by taking certain medications, but this may not be true for many people.
For those patients who had a cardiac arrest from a ventricular arrhythmia, or at who are at high risk for this, they are best treated with an implantable defibrillator, a small electronic device that can detect dangerous heart rhythms and automatically administer an electrical shock that resets the heart’s electrical system and restores the heart’s normal rhythm.
In the past, these devices were placed under the skin, usually just below the collarbone, and then connected to the heart by threading thin wires through veins into the chest and then into the chambers of the heart.
While these devices were a major advance when they were first introduced, the wires can be tricky to put in place, there is the chance of infection and there is a risk that they might puncture the lung and even the heart. Also, some patients with blocked veins couldn’t get the device because there was no way to reach the heart.
S-ICD: Subcutaneous-implantable cardiac defibrillators
Since 2012, UW Medical Center however, has been implanting a new device called the subcutaneous - implantable cardiac defibrillator or S-ICD. UW Medicine’s Regional Heart Center was one of the few research centers that participated in the national trial to evaluate the S-ICD and the first center to implant the device on the West Coast.
With the S-ICD, the wires from the device are placed just under the skin along side the breast bone, or sternum, outside the chest cavity but close enough to the heart to stop a dangerous rhythm.
This greatly reduces the risk of complications seen with the older devices, says Dr. Prutkin, and, because S-ICDs are safer, they can be offered to patients for whom placement of the older devices might be too risky.
The S-ICD is not for everyone, like someone who needs a pacemaker, says Dr. Prutkin, but “can be used in anyone at risk of cardiac arrest: this can be someone who has already had ventricular fibrillation, those with heart failure, and for some people with genetic defects.”
It was just right for Merle Yoney, a 78-year-old who came to UW Medical Center after developing an infection in his old implantable defibrillator. Yoney, a retired Boeing machinist from Marysville who had a heart attack in 1979, had the older style device implanted in 2000 after he developed a cardiac arrest.
Best option
“The new S-ICD was really the best option for Mr. Yoney. He had an infection of his old ICD, and S-ICD should have a lower chance of becoming infected while still keeping his heart rhythm on track,” says Dr. Prutkin.
Yoney’s surgery took only 60 minutes, and, the next day he and his wife were enjoying lunch at an Everett restaurant.
UW Medicine is able to offer such advanced care because as an academic research center its physicians are actively involved in the latest research, says Dr. Prutkin. “It’s one of the reasons I chose to practice at UW Medicine — all of my colleagues are leading experts in their field. And with all of us working together, that adds up to the best care for our patients.”
Take control of your heart health and schedule an appointment for a routine physical by calling 855.520.5151. Or, fill out an online form to request an appointment with experts at the UW Medicine Regional Heart Center.
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