Electrophysiology

Since we opened our doors to the community in 2000, Waccamaw Cardiology, with Dr. Andrew Gresko, has been the leader in pacemaker care since 2000 and since 2008 Dr. Frank Cuoco has been with them to place AICD. Providing these services at Conway Medical Center has allowed our patients to stay close to home while benefiting from the latest cardiac technology. In partnership with the Medical University of South Carolina, headed by Dr. Frank Cuoco, we have created a vital arrhythmia management center here at Waccamaw Cardiology which allows us to follow up and monitor patients with pacemakers, ICD's and biventricular pacemakers right here in our office. Dr. Keith Wyche has been performing Tilt Table Studies since 2002.

Implantable Cardioverter Defibrillator

What is an AICD?

The implantable defibrillator (AICD) is an electronic device like a large pacemaker that is implanted surgically in a pocket formed in the chest wall. It consists of a pulse generator that can deliver a powerful shock to the heart; electrodes to sense the rhythm of the heart and to deliver the shock to the heart muscle; and a computer and circuitry that tells the AICD when to discharge the shock.

The first implantable defibrillators required open-chest surgery to implant the electrodes. Fortunately, the present units do not require open chest surgery for implantation. The electrodes can be inserted through a large vein that runs beneath the collar bone and directed into the heart under x-ray guidance (fluoroscopy). The pulse generator is then buried under the skin of the chest wall, the electrodes are inserted into the heart through the veins, and the pulse generator is surgically buried under the skin of the abdomen or chest.

Why are AICDs needed and how do they work?

Some people are at very high risk for sudden death. This group includes those whose heart suddenly stops pumping blood due to loss of an organized heartbeat (ventricular fibrillation) or an excessively rapid heartbeat (ventricular tachycardia). These rhythm disturbances can result in loss of consciousness and/or death. When these rhythms occur in a hospital setting with the heart rhythm being monitored, such as in the coronary care unit, an electrical shock can be quickly given, restoring the heart to a normal rhythm. Many episodes, however, occur outside hospitals and the victims can die unless CPR is administered quickly and defibrillation accomplished by a medic unit. Because the resources are not always available in a timely fashion, patients at high risk for these events may receive a defibrillator.

The defibrillator monitors the heart rhythm. When a life threatening rhythm is detected, the device can delived a powerful electrical shock to the heart restoring normal rhythm. A variety of sophisticated electrical therapies can be selected by your cardiologist depending on the type of heart rhythm being treated. The batteries are designed to last approximately 3 to 5 years and deliver about 100 shocks. People with AICDs must continue to follow their doctor's recommendations regarding medication, diet, and exercise.

View more information about Pacemakers and Implantable Defibrillators.

Pacemaker

A pacemaker (or artificial pacemaker, so as not to be confused with the heart's natural pacemaker) is a medical device which uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart. The primary purpose of a pacemaker is to maintain an adequate heart rate, either because the heart's native pacemaker is not fast enough, or there is a block in the heart's electrical conduction system. Modern pacemakers are externally programmable and allow the cardiologist to select the optimum pacing modes for individual patients. Some combine a pacemaker and defibrillator in a single implantable device. Others have multiple electrodes stimulating differing positions within the heart to improve synchronisation of the lower chambers of the heart.

What Is a Pacemaker?

A pacemaker is a small device that's placed in the chest or abdomen to help control abnormal heart rhythms. This device uses electrical pulses to prompt the heart to beat at a normal rate.

Pacemakers are used to treat arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.

A heartbeat that's too fast is called tachycardia (TAK-ih-KAR-de-ah). A heartbeat that's too slow is called bradycardia (bray-de-KAR-de-ah).

During an arrhythmia, the heart may not be able to pump enough blood to the body. This may cause symptoms such as fatigue (tiredness), shortness of breath, or fainting. Severe arrhythmias can damage the body's vital organs and may even cause loss of consciousness or death.

A pacemaker can relieve some arrhythmia symptoms, such as fatigue and fainting. A pacemaker also can help a person who has abnormal heart rhythms resume a more active lifestyle.

Your doctor will want to check your pacemaker regularly. Some pacemaker functions can be checked remotely through a telephone call or a computer connection to the Internet. Your doctor may ask you to come to his or her office to check your pacemaker.

Pacemaker batteries last between 5 and 15 years (average 6 to 7 years), depending on how active your pacemaker is. The wires of your pacemaker also may need to be replaced eventually. Your doctor can tell you whether your pacemaker or its wires need to be replaced.

VVIR pacemaker

A ventricular demand inhibited pacemaker that is responsive to the patient's respiratory rate and thus to exercise and metabolic needs. This device will look for the heart beat in the bottom of the heart and send a tiny impulse from the pacemaker if one is not sensed in a timely manner.