DEVICE THERAPY

Our physicians provide device therapy for both diagnostic and therapeutic purposes. With over 700 invasive cases performed each year, we have had experience and success with the most technically challenging procedures. But procedural excellence is just one part of the puzzle. The biggest challenge in device therapy is identifying patients who truly benefit from implantation. Too often, patients who may not benefit from devices receive them while patients who do need devices are never offered them. We believe in being as meticulous and deliberate in the office as we are in the operating suite.

	Injectable Loop Recorder (IRL) In some patients, heart rhythm problems occur so infrequently that conventional investigations can't seem to explain what is going on when someone's heart starts to pound, or when they pass out suddenly. In these patients, the new injectable loop recorder is smaller than the older inplantable and may helpful. These devices can be placed under the skin in the chest in a procedure that takes about 15 minutes. These loop recorders can monitor the heart beat continuously for up to three years, making recordings of any arrhythmias during that time and help secure a diagnosis.
	Pacemakers Patients who experience slow heart rates are said to have bradycardia. Not all bradycardia is bad, but in some people, slow heart rates can cause lethargy, shortness of breath, easy fatigueability, and passing out. On occasion, bradycardia can be life threatening. A pacemaker is a device designed to correct slow heart beats. In a procedure that takes about 45 minutes, a pacemaker is placed under the skin in the chest with wires which extend into the heart. The pacemaker senses your body's level of activity and ensures that your heart beats fast enough to provide you with the energy you need.
	Defibrillators Patients with weak hearts or genetic abnormalities in the way in which electrical impulses are generated in the heart may develop rapid and life threatening arrhythmias know as ventricular tachycardia or ventricular fibrillation. An implantable cardiac defibrillators treats these fast heart beats. In a procedure that takes about an hour, an ICD is placed under the skin in the chest with wires which extend into the heart. After the device is in place, it is tested to ensure that it can correct the fast arrhythmias. Of note, every implantable cardiac defibrillator also has built in pacemaker capabilities.
	Cardiac Resynchronization Therapy (CRT-P, CRT-D) In patients with congestive heart failure, or who are at high risk for congestive heart failure, the main pumping chamber of the heart may beat in a disorganized way. When the heart beats in this way, it does a poor job of delivering blood and oxygen to the body. In cardiac resynchronization therapy, a special pacing wire is advanced through a small vein called the coronary sinus to the lateral wall of the left ventricle. In conjunction with pacing wires placed in the right side of the heart, these leads help the heart beat in an organized and efficient way and can reverse many of the symptoms of heart failure.
	Lead Management/Extraction On rare occasions, patient require removal of an implanted cardiac device. The decision whether to remove a devices and leads is often complex. The cardiac electrophysiologists at Island Cardiac Specialists have experience and special training in lead management and extraction. We perform laser lead extractions in concert with our cardiac surgeons in order to provide the safest possible procedure.