This week I went to electrophysiology (EP) lab in cardiology. In this laboratory, I mainly observed two procedures: implantation of a artificial pacemaker and Electrophysiology study.
The artificial pacemaker is a programmable device that generates electrical impulse to the heart to regular heart beats. The electrical signal is delivered by electrodes contacting the heart muscles. Usually people need a pacemaker when their own natural pacemaker is not working properly. When I first entered the EP Lab, they made me wear this 60 pounds lead to prevent radiation from the x-ray. It is quite tiring even wearing it for an hour, I must say quite admired these doctors are able to wear them all day long and perform operations.
The procedure itself is actually quite simple. The physician made a small incision on the right side of the upper chest, and then he threaded two special wires (in which the proximal tip contains an electrode) into the body and place the electrode near the heart muscle. Then he asked the assistant to generate different electrode signals through the wires and watch the pattern on the ECG. Then he adjusted the placement of the wires and repeated the signal generation several time till he got the desired ECG signals he wanted. Finally, he obtained a pacemaker and connected the wires into it and put the small device near the incision area. Then he secured the device under the skin and sewed up the wound. After the implantation is done, the physician went to a computer and remotely programmed the device.
From talking with the physician, I found out that these peacemakers generally last 5 to 10 years depending on the condition of the patient. Some patients like the one he just operated on only require pacing at certain time, but some other patients require the artificial pacemaker to work all the time.
The second type of procedure is an electrophysiology (EP) study. Normally, electricity flows throughout the atria first and then pause for a moment before the electric signal is propagate to the ventricles through the atria-ventricular (AV) node. The electrical signal brings about heart muscle contraction. The orderly pattern guarantees that the heart pumps blood efficiently. Whenever something wrong along the electrical conduction system, it causes a heart rhythm disturbance (termed arrhythmia), which will leads to inefficient pumping of the blood out to the body. The reason for an EP study is to find out the cause of such arrhythmia. Usually during an EP study, wires are placed on the sinus node (natural pacemaker), one on the AV node and one on the bundle of His (which is the wire that sends signal from AV node to the rest of ventricles). They also place several wires on the ventricles and atriums depending on situation. Then they will generate electrical signal on different places, and observed the corresponding signal recorded elsewhere to try to figure out the cause of the arrhythmia.