The Krannert Institute's cardiac electrophysiology team provides excellent care for patients with heart rhythm disorder and advance heart failure. The institute also offers excellent patient care and research in cardiac electrophysiology. Our team consists of seven experienced cardiac electrophysiologists and two nurse practitioners. It has three world-renowned electrophysiologists, Dr. Douglas Zipes, Dr. John M. Miller and Dr. Peng-Seng Chen. The outpatient facility and cardiac electrophysiology laboratory provides a complete spectrum of management of disorders of heart rhythm. We perform electrophysiology study and radiofrequency ablation as well as implant devices (pacemakers and cardiac implantable defibrillators [ICD]) to treat cardiac arrhythmias. We have special expertise in radiofrequency ablation of atrial fibrillation and ventricular tachycardia, cardiac synchronization therapy and Laser lead extraction. In addition, we conduct clinical trials and participate in several multicenter clinical trials related to the management of the heart rhythm disorders.
Device Implant
Krannert Institute of Cardiology offers device implants to treat irregular heart rate, prevent sudden cardiac arrest and improve heart function in patients with heart failure.
Pacemaker Implant
What does it mean when your doctor recommends that you receive a permanent pacemaker for slow heart rates? Actually the heart is located in the center of the chest and beats at 60 to 100 per minute to pump the blood in whole body. This regular and rhythmic contraction is triggered by your heart's own pacemaker called sinus node. It results in contraction of upper chambers of the heart, which push the blood to the lower chambers called ventricles. The ventricles receive electrical impulse generated by the sinus node via the specialized electrical pathway through the AV node. The dysfunction of sinus node or AV node may cause bradyarrhythmia or slow heart rates. This results in decreased output of the heart pump and may result in loss of energy, tiredness, dizzy spells or even passing out spells. Bradyarrhythmia may sometimes be life threatening.
A pacemaker is a device that generates the electrical signal, which is conducted to the heart by wires called leads. It is designed to provide an electrical signal to the heart muscle and to help it maintain a desired rhythm. It is in standby mode and kicks off when the heart rate falls below a critical level. The desired heart rate to pace is programmed by the physicians. The pacemaker is generally implanted under the skin below the collarbone. One or two wires are passed through the veins nearby to the upper and lower chambers of the right side of the heart and connected to the pacemaker. The pacemaker can be programmed via a remote computer to set the desired heart rate at rest as well as during activities. The longevity of the battery of the pacemaker depends upon its use by the heart and usually lasts for approximately 10 years. The device implant is associated with rare complications (usually less than 1%), which include infections, bleeding, perforation of lungs, perforation of heart, and malfunction of the pacemaker as well as leads. There is a rare risk of death related to the procedure.
Cardiac Resynchronization (Biventricular Pacing) Therapy
A new treatment option for moderate to severe congestive heart failure is available and is called cardiac resynchronization or biventricular pacing therapy. This is a promising new therapy intended for heart failure patients with poorly contracting discordant lower heart chamber (ventricular) contraction. Leads of the pacemaker are placed on the right ventricle and the coronary sinus, a cardiac vein on the left ventricular chamber side to send electrical impulse along both ventricular chambers to make it contract simultaneously and function as a more effective synchronized heart pump.
Echocardiography is utilized to better identify the presence of ventricular synchrony, which occurs in up to 30% of heart failure patients. Measurement of tissue contraction velocity and the rate of change in-deformation (strain rate) of both lower chambers by echocardiography identify those who would benefit most from Biventricular pacing therapy. Echocardiography is also utilized to optimize the amount of forward blood flow and the extent of coordinated "synchronized" function of the ventricular chambers after the implantation of the device. Echocardiography helps to obtain the "best" settings of the pacemaker programmer that suits an individual patient under normal living conditions to create the ideal span of time between the upper and lower chamber and within the walls of the left ventricular chamber contractions. Additionally, echocardiography is also a simple, noninvasive ultrasound technique to track changes in the heart muscle "pump" function, detect post procedural complications and for assessing heart valve function as follow-up after this pacing therapy. At our institution, a dedicated team of electrophysiologists, echocardiographers, heart failure specialists, pacemaker and echocardiography technicians work together in providing this service. Most patients derive significant improvement in exercise tolerance, quality of life, reduced hospitalization and better survival with this approach of echocardiography in the use of Biventricular pacing therapy for heart failure.
