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Heart Rhythm Center

Heart rhythm problems, or arrhythmias, can be frightening because they are unpredictable. Some arrhythmias can be harmless while others can be life-threatening. Stony Brook's Heart Rhythm Center is here to help you navigate through the fear and uncertainty. We offer comprehensive arrhythmia management that relies on minimally invasive, outpatient procedures to quickly provide the correct diagnosis and the appropriate treatment options. Our electrophysiology team uses a collaborative, multidisciplinary approach to your care. We stress open communication, and will fully discuss your diagnosis and treatment options with you and your family. We also work closely with your cardiologist to ensure you receive the best care possible.



What is electrophysiology?

An electrophysiologist is a physician who specializes in the diagnosis and treatment of heart rhythm disorders (arrhythmias). Your heart has a complex electrical system that keeps it beating at the right speed and in an orderly rhythm. An arrhythmia is a disturbance in the rate (the number of times in which the heart beats per minute) or rhythm (if the heartbeat is orderly or disorderly) of the heart beat. Electrophysiologists use minimally invasive techniques to diagnose and treat heart rhythm problems. Minimally invasive interventions use catheters (thin, flexible tubes) that are inserted through a small incision in your groin area and guided to the place in your heart where the arrhythmia originates. The catheters typically have special tips on them that are used to diagnose and treat arrhythmias. Minimally invasive procedures have largely taken the place of open surgery. The smaller incision means less pain, healing time, and infection risk. Electrophysiologists perform other procedures as well, such as cardiac defibrillator and pacemaker implantations, and cardiac resynchronization therapy for heart failure.


Services

Our highly skilled physicians will work with you and your primary care physician or cardiologist to accurately diagnose your condition and determine the best course of treatment for you. Our services include:

  • Comprehensive arrhythmia consultation: We offer complete arrhythmia consultation, which includes diagnostic procedures and medication management.
  • Electrophysiology study: Ours doctor will use catheters and electrodes (small electrical conductors) to record the electrical activity in your heart.
  • Catheter ablation: Catheters, most frequently with electrodes at their tips, are heated with radiofrequency energy to destroy (ablate) a tiny spot of heart tissue and create an electrical block along the pathway that is causing the arrhythmia. Physicians can use other forms of energy as well, including cold (called cryoablation). Our electrophysiologists use advanced 3D mapping systems such as CARTO and NAVX, intracardiac echocardiography, and pulsed fluoroscopy, to precisely locate the heart tissue that is causing the arrhythmia, while limiting radiation exposure. We are the first and only institution on Long Island to use the Sensei Robotic Catheter System for ablation. The robotic system enables the electrophysiologist greater accuracy and control than traditional ablation methods. We are the only center in Suffolk County that performs ablation procedures for complex arrhythmias such as atrial fibrillation and ventricular tachycardia.
  • Evaluation of syncope (tilt table testing): Syncope (fainting) can be diagnosed by using tilt table testing in which the physician measures blood pressure while positioning the patient at different angles on a tilting examination table.
  • Implantable devices:
    • Implantable cardioverter-defibrillator (ICD): An implantable cardioverter-defibrillator, or ICD, is a small device that is implanted under the skin in the upper chest and connected to the heart with wires called leads. When the device senses an arrhythmia, it delivers a shock to restore the heart's proper rhythm.
    • Pacemaker: Pacemakers are electronic devices that correct or prevent an abnormally slow heartbeat, turning on when the heartbeat is too slow (called bradycardia) and turning off once the heartbeat returns to normal.
    • Biventricular defibrillator (cardiac resynchronization therapy [CRT]): In some people with heart failure, the electrical impulses that travel through your heart are delayed, which can make your heart failure symptoms worse. Physicians can restore the synchronization through CRT, which is the placement of a biventricular ICD. A biventricular ICD differs from a standard ICD in that it has the ability to pace both the left and the right ventricles, which resynchronizes your heartbeat and allows the heart to contract more efficiently.
  • Long-term device monitoring: Remote monitoring enables you to have your ICD checked from home rather than having to travel to Stony Brook for an appointment. The remote monitor is made up of a small battery-powered box with a detachable wand. At a scheduled time, the patient connects the monitor to the home telephone, and places the wand on the skin over the ICD. The wand reads the ICD information and transmits the information securely to our offices. Some devices can communicate with the monitor box wirelessly. After the data are transmitted, the physician can review the data to ensure the device is performing properly.
  • Device lead extraction: In this procedure, electrophysiologists remove nonfunctioning ICD and pacemaker leads assisted by a laser to detach the leads from the blood vessels and the heart. The laser allows the leads to be removed more easily than with manual tools. Common reasons for lead extraction include infection, malfunctioning or fractured leads, and to get access to the vascular system to place new leads when the veins are blocked.


The Stony Brook Difference

Stony Brook's Heart Rhythm Center is a recognized leader in the diagnosis and treatment of heart arrhythmias. Led by Dr. Eric Rashba, our team includes five electrophysiologists, three nurse practitioners, and two physician assistants, who practice in two state-of-the-art electrophysiology laboratories. Our Heart Rhythm team combines medical expertise, state-of-the-art facilities, and personalized care that stresses open communication between us and you, your family, and your cardiologist and your primary care physician. We stay on the cutting edge of electrophysiology through our deep involvement in heart rhythm research. Much of our research is practical and focuses on improvements in treatments that are already available. This means that we can provide you with access to tomorrow's treatments today.


Frequently Asked Questions



Questions about Atrial Fibrillation:







Q: What is atrial fibrillation?

A: Atrial fibrillation is the most common heart arrhythmia in the U.S. It usually involves a rapid heart rate, where the upper heart chambers (atria) are stimulated to contract in a disorganized and abnormal manner. It is most often caused by abnormal electrical firing in the areas where the veins that drain blood from the lungs (pulmonary veins) connect to the left atrium. Atrial fibrillation can be related to high blood pressure, an overactive thyroid, congestive heart failure or diseased heart valves, or can occur in patients with structurally normal hearts who do not have an obvious predisposing condition. It is important to be diagnosed and treated as early as possible. Click here for more information about atrial fibrillation.

Answered by Eric J. Rashba, MD. Dr. Rashba, a cardiologist, is professor of medicine and director of electrophysiology.


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Q: What are the signs and symptoms of atrial fibrillation?

A: There are many. Typical symptoms include a racing heart or palpitations, but some patients have more subtle symptoms such as shortness of breath or fatigue, without palpitations.

Answered by Eric J. Rashba, MD. Dr. Rashba, a cardiologist, is professor of medicine and director of electrophysiology.


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Q: How is atrial fibrillation treated?

A: Initial treatment is medication. If this fails, ablation, which involves cauterization of abnormal heart tissue, is recommended. The goal is to eliminate the electrical connections between the pulmonary veins and the left atrium so that the abnormal impulses from those veins cannot stimulate the rest of the heart, the cause of the atrial fibrillation. Typically, ablation has been done manually by directing a catheter (a thin flexible tube) within the left atrium (left upper chamber of the heart). Although atrial fibrillation is a common arrhythmia, the ablation procedure to fix it is very complex and can only be done at major medical centers with a high level of technical expertise. In Suffolk County, Stony Brook Medicine fills this role.

Answered by Eric J. Rashba, MD. Dr. Rashba, a cardiologist, is professor of medicine and director of electrophysiology.


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Q: What are the advantages of the new robotic catheter system to treat atrial fibrillation?

A: With the Sensei® Robotic Catheter System, the catheter is mounted to a sheath, or hollow tube, in the robotic arm and is manipulated quickly and easily using a joystick. Electrophysiologists, physicians who specialize in the diagnosis and treatment of heart arrhythmias, are able to reach areas in the heart that can be difficult to get to using the traditional manual method. The robotic catheter allows electrophysiologists to manipulate the catheter quickly and easily throughout the left atrium, dramatically reducing the length of time the procedure takes, key because it decreases the risk for the patient. Shorter procedure times also mean that both the patient and the physician have less exposure to radiation. Typically, ablations for atrial fibrillation are repeated in as many as 50 percent of cases because the electrical connection between the pulmonary veins and the left atrium is not completely eliminated. The Sensei System allows us to deliver more effective ablation, reducing the need for repeat procedures.

Answered by Eric J. Rashba, MD. Dr. Rashba, a cardiologist, is professor of medicine and director of electrophysiology.


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Q: Where is this new procedure being done?

A: Currently, Stony Brook Medicine is the only healthcare facility in New York State performing the robotic ablation procedure using the Sensei Robotic Catheter system.

Answered by Eric J. Rashba, MD. Dr. Rashba, a cardiologist, is professor of medicine and director of electrophysiology.


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Q: What other cardiac arrhythmia services are offered at Stony Brook?

A: Our electrophysiology service offers comprehensive care for patients with atrial fibrillation, including the latest diagnostic tools, medication management, and ablation, when necessary. Also offered are the latest treatments for patients with other arrhythmia conditions including:


  • Implantation of pacemakers and cardiac defibrillators
  • Cardiac resynchronization therapy
  • Laser extraction of infected or malfunctioning pacemaker and defibrillator leads
  • Evaluation and management of syncope (fainting)
  • Expert medical management of patients with cardiac arrhythmias

Answered by Eric J. Rashba, MD. Dr. Rashba, a cardiologist, is professor of medicine and director of electrophysiology.


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Our Team

At Stony Brook Medicine, our electrophysiology team focuses on your treatment and comfort. We work collaboratively with each other, your referring physician, and — most importantly — you to develop the best treatment plan for you. We stress a continuum of care as well as care coordination with your cardiologists and primary care physician. Our team offers decades of training and experience, insight from cutting-edge research, state-of-the-art facilities, and a patient-focused environment to provide you with superior outcomes and a positive patient experience.


Ibrahim Almasry, MD

Ibrahim Almasry, MD

Saverio (Sam) Barbera, MD

Saverio (Sam) Barbera, MD

Roger Fan, MD

Roger Fan, MD

Eric J. Rashba, MD

Eric J. Rashba, MD

Stephen C. Vlay, MD

Stephen C. Vlay, MD


Research



The Stony Brook Heart Institute - Electrophysiology

Contact:
Stony Brook Medicine
Nicolls Road and Health Sciences Drive intersection
Stony Brook, NY 11794

Phone: 631-44-Heart



Learn More

Stony Brook Heart Institute now offers the innovative Hansen Sensei Robotic Catheter System to treat atrial fibrillation, when medication has been unsuccessful Click here to learn more.