Q&A with Ruth Ann Greenfield, MD

Heart rhythm problems are serious, but they need not be scary, says Duke cardiologist and heart rhythm specialist Ruth Ann Greenfield, MD.

Ruth Ann Greenfield, MDHeart rhythms that fall outside of a normal beat are called arrhythmias, and they’re essentially the result of a glitch in the heart’s electrical system. “It’s increasingly common,” Greenfield says, and though it’s also an increasingly common cause of sudden, heart-related death, early detection and treatment can quickly get most hearts back into a reliable rhythm.

Whether a patient’s heartbeat is too slow, too fast, or simply irregular, most arrhythmias can be treated effectively either through medication or through small surgical procedures, such as catheter ablations or implanting a pacemaker or implantable cardioverter defibrillator (ICD).

Because the idea of having a tiny computer inserted in your chest is off-putting to many people, HealthLine caught Greenfield outside of clinic and asked her to explain what it’s like to get a pacemaker or ICD:

First, what’s the difference between a pacemaker and an implantable cardioverter defibrillator (ICD)?

A pacemaker is basically a computer and a battery, about the size of two dollar coins stacked on top of each other. It’s implanted under the skin and connected to wires that go down into the heart. If the heart forgets to beat, it gives a tiny electrical impulse that reminds the heart to beat. ICDs are pacemakers, too -- they have that same function. But ICDs have a much stronger battery in them, and they are capable of shocking the heart back into normal rhythm if a life-threatening arrhythmia happens.

How do you choose between the two?

The choice is based on what the patient needs, and it’s driven very much by information that your doctor will send to us, as well as data from the evaluation that we’ll perform at our clinic. ICDs in particular are used to treat life-threatening fast heart rhythms; we now have ways of identifying certain patients who are at risk for sudden cardiac death -- those who have significant heart damage, people who have weak heart muscles, and people who have symptoms of heart failure. In those patients, these devices are implanted prophylactically -- we call it primary prevention.

Our clinic has a very intensive education program, so that our patients really understand what we’re doing. Because if you do choose ICD or pacemaker therapy, it’s a device you’re going to have for the rest of your life, and we think it’s very important to make sure that it is compatible with the rest of your life.

What is the procedure like?

We generally bring people to stay at the hospital one or two nights. A typical pacemaker or ICD procedure is about an hour, and it’s done under conscious sedation -- that means that the patient is awake, and she can talk a little bit if she wants to; she’s just snoozing in and out. A nurse will be dedicated to taking care of the patient and her comfort during the procedure, and all of the nurses and physicians in our center have specialized experience in these procedures, so they’re available to answer questions and handle the patient’s needs at any other time during his or her stay.

Will I feel different after the procedure?

It depends upon the patient and the indication for the procedure. Some people don’t notice that much, and some people will notice a benefit, depending on what their symptoms were beforehand.

Will I have to come back all the time for follow-up?

We are now able to follow both pacemakers and defibrillators predominantly by phone. If you come to Duke to have these procedures done, it doesn’t mean that you have to come back every three months to have them followed-up.