The Mount Sinai Heart arrhythmia treatment program offers a full range of therapeutic services for simple and complex arrhythmias. We offer a number of ways to return an irregular heart to normal electrical function: medication, electronic control devices, and treatments to destroy or remove damaged tissue.

Our electrophysiologists offer individualized treatment and take into account medical, personal, and cultural factors as they make decisions. "Mount Sinai offers world-class, personalized care in a setting that feels more like a community hospital," says Nicholas Skipitaris, MD, Senior Faculty of Cardiology.

Factors that influence arrhythmia treatment decisions include:

• Frequency and seriousness of the irregular heartbeat
• Underlying cause of the electrical problem
• Other heart problems, such as coronary artery disease, heart failure, or valve disorders
• Overall health
• Age
• Use of incompatible medications taken for other conditions
• Patient preferences

A Comprehensive Atrial Fibrillation Treatment Center

Atrial fibrillation affects millions of people every year and is a leading cause of stroke. No single treatment works for every patient. Some do best with medications, some benefit from procedures such as catheter ablation, and others need pacemakers to control extreme heart rates.

Mount Sinai Heart doctors have extensive experience in cutting-edge procedures to reduce the risk of stroke and recurrent irregular heartbeats. The addition of Vivek Y. Reddy, MD, in August 2009 as Director of Electrophysiology will further establish Mount Sinai Heart as a national leader in comprehensive care for atrial fibrillation.

Atrial fibrillation is the most common abnormal heart rhythm that is often caused by "short circuits" within the heart muscle. Until recently, treatments for atrial fibrillation used medications or electrical shocks called cardioversions to bring the heart back to its normal rhythm. Such treatments are usually temporary and are not cures.

Mount Sinai cardiologists offer the most comprehensive atrial fibrillation treatment in the region. Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Professor of Cardiology, and Jonathan L. Halperin, MD, Director of Clinical Cardiology Services and Professor of Cardiology, are among the select group of physicians who wrote the current national treatment guidelines for atrial fibrillation.

Medications for Arrhythmia

For uncomplicated abnormal heart rhythms, a mainstay of treatment is anti-arrhythmia medication. These drugs work on different parts of the electrical pathway to slow, speed, or regulate heartbeats.

Dedicated medications, alone or in combination, treat abnormal rhythms in the upper or lower chambers. It may take several changes in medication to arrive at the best solution. Atrial fibrillation patients at high risk for blood clots may also take anti-clotting medications or anticoagulants.

Mount Sinai Heart physicians participate in clinical trials to test promising arrhythmia medications.

Catheter Ablation Therapy

This procedure finds the specific area of the heart responsible for an arrhythmia and permanently fixes it. The procedure usually takes less than two hours, and patients go home either the same day or the next morning. Mount Sinai Heart cardiologists perform more than 350 catheter ablation procedures every year.

Catheter ablation therapy involves threading catheters into the heart's blood vessels. A computer records signals from multiple areas of the heart to produce a detailed map of its electrical flow. The map pinpoints the area causing the abnormal signals. Doctors then send a barely noticeable burst of low-voltage radio waves through the wires to destroy the tissue.

Read more about Mount Sinai Heart's advances in catheter ablation using a revolutionary robotic system.

Cardioversion

In some instances, brief bursts of electricity can correct abnormal heart rhythms. While the patient is sedated, cardioversion physicians use a cardioverter machine to deliver electrical pulses to the heart. This procedure can treat different types of abnormal rhythms but is not a cure.

Electronic Devices

Mount Sinai Heart implants more than 700 pacemakers a year, with that number growing annually. These small implantable electronic devices regulate or guard against certain arrhythmias.

Mount Sinai Heart has received international recognition for its work in assessing the risk for sudden cardiac death following a heart attack. "We monitor patients after a heart attack to determine their level of risk for sudden death," says J. Anthony Gomes, MD, Director of Consultative Services and Professor of Cardiology. "Once we know where patients stand, we can lower their risk by implanting a defibrillator."

After patients receive a new device, they are enrolled in a follow-up care database for periodic evaluations. Between visits, heart rhythm data may be transmitted to our doctors as needed. "We have set up remote monitoring capability to send device information via the Web," says Davendra Mehta, MD, PhD, Professor of Cardiology. "Patients have complete confidence that they will be continually monitored by a dedicated device team at Mount Sinai Heart."

Pacemakers

Implanted pacemakers prevent the heart from beating too slowly. These tiny electronic devices are composed of a battery, electronic circuits, and a computer and can take over the work of the heart's natural pacemaker cells.

To implant a pacemaker, doctors make a small incision near the collarbone and thread wires into the heart through a large vein. Sensors placed throughout the heart's electrical pathway link the timing of atrial and ventricular contractions.

Since their introduction more than 50 years ago, the devices have become increasingly sophisticated and effective. Their battery life is as long as 10 years.

Biventricular Pacemakers

Mount Sinai Heart electrophysiologists are experts in the placement of biventricular pacemakers. This treatment saves lives and improves the health of many heart failure patients.

These particular patients' hearts send electrical signals to different parts of the ventricle at different times, making each heartbeat less effective. Biventricular pacemakers bring electricity simultaneously to opposite walls of the left ventricle and allow them to contract together.

Read more  about cardiac resynchronization therapy for heart failure patients.

Implanted Cardioverter Defibrillators

Certain arrhythmias are so dangerous that even one occurrence is too many. The result is sudden cardiac death. The best hope is to stop the threatening rhythm as soon as it happens. Implantable cardioverter defibrillators deliver life-saving jolts to reorganize the heart's electrical system.

Mount Sinai Heart patients receive extensive education about living with the devices and make regular monitoring appointments.

In the 1980s, implantable cardioverter defibrillators were limited to survivors of previous episodes of arrhythmia. Today, our physicians implant the defibrillator in many more people, thereby saving more lives.

Transtelephonic Monitoring

For patients with pacemakers and defibrillators, this type of monitoring records intermittent problems that may not be detected with 24-hour monitoring. Electrocardiographic recordings are transmitted over the telephone for evaluation by a Mount Sinai Heart physician.