Clinical Electrophysiology Service

The Clinical Electrophysiology Service performs in- and outpatient evaluation and management of cardiac arrhythmias. A multidisciplinary approach is used to provide care for patients with ventricular arrhythmias, supraventricular tachycardias, preexcitation syndromes, atrial fibrillation/flutter, derangements in sinus node automaticity, disturbances in atrioventricular conduction, syncope, and other abnormalities. The Stony Brook University Hospital Heart Institute includes two dedicated electrophysiology laboratories with state-of-the-art equipment, as well as telemetry units in which computer-assisted automated equipment is used to monitor patients with complex arrhythmias.

Therapies for specific cardiac arrhythmias include investigational and conventional antiarrhythmic drugs, implantable pacemakers and defibrillators, and catheter ablation procedures for complex atrial and ventricular arrhythmias. Because of its unique stature as a clinical and investigational unit, the Arrhythmia Service offers patients the opportunity to participate in cutting-edge trials that evaluate new applications for approved devices as well early access to the latest developments in device technology.

Accurate diagnosis of electrophysiologic abnormalities is crucial to the success of therapy. A combination of programmed electrical stimulation, multichannel catheter mapping and tilt table testing is used to identify arrhythmogenic mechanisms, assess which therapies are likely to be effective, locate sites of abnormal tissue for ablation, and assess the efficacy of therapy. A major focus of interest is ablation of atrial fibrillation and ventricular tachycardia. Fellows will be exposed to the latest technology to facilitate these procedures, including 3D mapping systems with image integration, intracardiac ultrasound, and remote catheter navigation.

The Arrhythmia Service also evaluates patients who may be at high risk for life-threatening ventricular arrhythmias. These include patients recovering from myocardial infarction or those with nonischemic cardiomyopathy who may later develop sustained ventricular tachycardia or fibrillation. Risk assessment involves conventional tests of cardiovascular function as well as the interpretation of ECGs with advanced signal-processing techniques.

Arrhythmia Service attending personnel make daily teaching rounds that focus on management strategies for patients with or at risk for development of tachyarrhythmias or bradyarrhythmias. ECG rhythm strips and recordings from Holter monitors are reviewed during these rounds. In addition, several regular clinics are conducted for patients with arrhythmias and for those with pacemakers or implantable defibrillators. Analysis of pacemaker function and programming are performed in the arrhythmia clinic, with additional pacemaker surveillance available through a telephone monitoring service. Trainees have a broad exposure to indications for and effects of various antiarrhythmic drugs, radiofrequency ablation, high-resolution electrocardiography, sophisticated pacemakers, and the newest technology in implantable cardioverter-defibrillators.

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