Congenital Heart Rhythm Management

Care Provided By Dr. Lyne

Overview

An electrical impulse signals the start of every heart beat and instructs the heart muscle to contract.  When a person is born with a congenital heart defect, one or more parts of the heart usually do not function correctly. A non-functional valve, a hole in the heart or a malformed section of the heart may alter the hearts normal electrical signalling system. This may result in an abnormally fast or slow heart beat or in an irregular heartbeat- a condition known as an ‘arrhythmia’ (abnormal heartbeat). As patients who’ve had congenital heart surgery now live longer, doctors are  diagnosing more heart rhythm abnormalities amongst adult survivors.

 

Congenital Heart Rhythm Management Services

A heart rhythm abnormality is evaluated in ways much like those used to evaluate other health problems. The history of symptoms, including a sensation of your heart beating fast, dizziness and fainting are very important.

We use several tests to diagnose an arrhythmia. These may include ECG, exercise testing, Holter monitoring, event recorders and electrophysiologic studies.

The first test is usually an electrocardiogram (ECG).

An ECG machine records your heart’s electrical activity. The tracings can be recorded on paper or a computer. However, an ECG is only a brief snapshot of heart rhythm and may not detect the actual arrhythmia.

Holter/Event Monitor: Arrhythmias which are not detected on an ECG may be diagnosed on a more long term heart monitor such as an event or holter monitor. These monitors can usually be worn for up to 1 week at a time, and often increase the likelihood of us detecting a heart rhythm problem.

Electrophysiology studies: test the electrical activity of your heart to find where an abnormal heartbeat (arrhythmia) is coming from. During EPS, doctors insert a thin tube called a catheter into a blood vessel that leads to your heart. A specialized electrode catheter designed for EP studies lets them send electrical signals to your heart and record its electrical activity. This helps the doctor to find out where an arrhythmia is coming from, how well certain medications might work to treat the abnormal heartbeat and whether or not they should treat the problem with a procedure called a catheter ablation.

 

A heart rate that is faster than normal is called a tachycardia. Tachycardia may reduce the hearts pumping ability and may require treatment. Sometimes a tachycardia is due to an abnormality of the heart’s electrical circuits, while other times it may be due to abnormally high adrenaline levels as seen, for example, after surgery. Medications, such as beta-blockers, are sometimes used to prevent the tachycardia or at a minimum, slow down the heart rate to prevent symptoms or problems.

A heart rate that is slower than normal is called bradycardia. Bradycardia may be associated with certain congenital heart defects or may develop by itself before birth or after heart surgery. In some more serious cases and/or if the heart rate is very slow, an artificial pacemaker may be needed.

Irregular beats or early (premature) heartbeats are often seen in normal infants and children. They may be related to a congenital heart defects or may occur after surgery. In some cases they do not require further treatment. In some cases however they do require specific investigations, tests or treatment.

 

Some patients are treated with medication alone and followed up to check on the response of their condition. However, some require more specialised treatments for heart rhythm disorders including ablation to target the abnormal electrical circuits involved in the initiation and maintenance of the abnormal heartbeat.

Cardiac ablation: Cardiac ablation is a procedure that can correct heart rhythm problems (arrhythmias). It works by scarring or destroying the tissue in your heart that is responsible for creating or sustaining an abnormal heartbeat. In some cases, cardiac ablation prevents abnormal electrical signals from entering your heart and, thus, stops the arrhythmia.

Cardiac ablation usually uses long, flexible tubes (catheters) inserted through a vein or artery in your groin and threaded to your heart to deliver energy in the form of heat or extreme cold to modify the tissue in your heart that are responsible for the  abnormal heartbeat.

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