Atrial Fibrillation and Other Arrhythmias

When you have atrial fibrillation, ventricular tachycardia, or other forms of arrhythmia, prompt treatment is key to your heart health.

Medications

Slow your heart rate, stabilize irregular heartbeats, and reduce the effects and risks of an abnormal heartbeat. Blood-thinning (anticoagulants) medications may be prescribed to reduce stroke risk following atrial fibrillation. Two of the three newer anticoagulants were studied at Duke, which gives us the knowledge and expertise to reduce stroke risk in people with atrial fibrillation while minimizing potential bleeding complications.

Catheter Ablation

A minimally invasive procedure that uses energy to cauterize the exact heart regions where irregular heartbeats originate. We perform the full range of standard and investigational ablation techniques in our four catheterization labs.

Surgical Ablation

Performed through incisions in the chest. Often offered with other heart surgeries such as coronary bypass surgery or surgery to repair leaky or narrowed heart valves.

Lead Extraction for Implanted Cardiac Devices

Leads from implanted devices that malfunction, fracture, or are linked to infection are removed by electrophysiologists and surgeons who work together in our hybrid operating rooms. As a result of our experience, nearly 95 percent of leads are removed without open heart surgery.

Implanted Cardiac Devices

Stimulate and reset your heart's rhythm. We implant more than 1,000 pacemakers, defibrillators, and arrhythmia management systems annually. Many times we use a nonsurgical approach, during which leads are inserted into the heart through a vein under the collarbone, to minimize risk and shorten recovery time. 

Left Atrial Appendage Closure Devices

Newly approved devices are implanted during a minimally invasive procedure to close off or block the area of the heart where blood clots that cause stroke are most likely to form.

Various types of tests and imaging will accurately diagnose your arrhythmia. Your doctor will determine which tests are appropriate for you.

Electrocardiogram

Small electrodes placed on the skin record your heart’s electrical activity and help diagnose arrhythmia.

Echocardiogram

Uses ultrasound to capture images of your heart to measure its size, shape, and function.

MRI Scan

Uses a strong magnetic field to capture images of your heart to measure size, shape, scar tissue, and function. It may be used to image your pulmonary veins before an atrial fibrillation ablation procedure or the ventricles in your heart in the case of ventricular arrhythmia.

CT Scan

Uses X-ray and computerized reconstruction to image your heart or other structures in different slices and angles. It may be used to image your pulmonary veins before an atrial fibrillation ablation procedure.

Holter or Event Monitors

Monitor your heart rhythm over a period of time. A Holter monitor records your heart rhythm continuously for 24-hours (or longer). An event monitor may be used to record information about when you have abnormal heart rhythms. Some types use electrodes placed on the surface of your skin; others are implanted underneath your skin. Some cardiac event monitors have a device for you to activate recording when you feel symptoms.

Stress Test

A motorized treadmill or bicycle is used to increase the workload on your heart to study your heart rhythm, reproduce symptoms or arrhythmias, or diagnose coronary artery disease.

Tilt Test

Recording of heart rate and rhythm and blood pressure while you are tilted to an upright (near standing) position to try to diagnose causes of fainting.

Electrophysiology (EP) study

A thin, flexible wire is inserted through an artery or peripheral vein to stimulate your heart and pinpoint the origin of irregular or infrequent abnormal electrical signals.

Catheter Mapping

Performed during an EP study before ablating any tissue, this involves manipulating catheters inside or outside the heart to collect electrical signals and often uses computerized systems to help interpret the recordings in order to pinpoint the origin of the arrhythmia. 

Setting the Standard for Arrhythmia Treatment
Our specially trained cardiac electrophysiologists treat nearly 1,700 arrhythmia patients each year -- among the highest number in the Southeast. We continually evaluate new treatment approaches and have achieved some of the lowest complication rates associated with catheter ablation, a common treatment for atrial fibrillation (Afib) and ventricular tachycardia. Our research and expertise help set the standard for arrhythmia treatment nationwide.

Sophisticated Mapping Techniques
Your catheter ablation will be performed by electrophysiologists trained in the most advanced ablation techniques available, including heart mapping for spiral waves and focus beats, which can shorten procedure time. Computer-guided treatments stabilize the catheter and more accurately guide its movement within the heart. As a result, the problem area is treated and the likelihood of repeat procedures is reduced. Over the past two years, fewer than ten percent of our patients have needed a repeat ablation, a rate less than half the average.

Specialized Procedures for Less-Common Arrhythmia
Duke is among a handful of centers with substantial expertise in epicardial catheter ablation, which treats ventricular tachycardia that occurs on the heart’s outer surface.

Skilled Geneticists
Our genetic heart disease program is one of the only centers in the Southeast with adult and pediatric experts who can interpret the complex tests required to identify inherited heart rhythm disorders such as the long QT and Brugada syndromes. Pinpointing the cause of your arrhythmia helps us take a proactive approach to treatment, prevents the possibility of sudden cardiac death, and ensures your family is well-informed of any increased risk.

Specialists at Removing Pacemakers
Our team includes specialists skilled in removing pacemakers and defibrillator leads when necessary. This complex procedure is performed alongside heart surgeons who can provide surgical support. Nearly 95 percent of our patients have their leads removed without the need for open-heart surgery.

Expertise in Optimizing Devices
Cardiac resynchronization therapy can be very beneficial for patients with heart failure and arrhythmia, but some patients do not respond to the therapy at first. We use cardiac MRI to help identify problems and optimize pacing treatment.

Long-Term Care for Implanted Devices
If you have an implanted device, we provide comprehensive, long-term care to ensure it functions properly and is not subject to device recalls.

Options for High-Risk Patients
We assess and care for patients with a prior unsuccessful catheter or surgical ablation. We provide hope to people with complex heart rhythm conditions.

New Ways to Manage and Reduce Stroke Risk
Our colleagues led the research studies that resulted in the FDA approval of new "blood-thinning" drugs (or anticoagulants) designed to reduce stroke risk. We are also implanting newly approved devices designed to prevent blood clots that can cause a stroke. The devices eliminate the need for anticoagulant medications in patients who are at risk for bleeding complications.