The James Family Heart Center

Heart Surgery

Interventional Cardiology and Interventional Radiology

Cardiac Electrophysiology

    This is a subspecialty – or branch – of cardiology. Cardiac electrophysiologists are specially trained to diagnosis and treat heart rhythm disorders, also called arrhythmia.


    During one of these exams, the cardiac electrophysiologist tests your heart’s electrical activity to diagnose the type of arrhythmia (abnormal heartbeat) and pinpoint its location.

    At YRMC’s James Family Heart Center, these exams generally take place in our state-of- the-art hybrid operating room


    Your doctor will recommend a treatment to address your type of arrhythmia. This may include medication or one of following:
    • Cardiac Ablation
      During this procedure, the electrophysiologist makes a tiny incision in a vein and inserts a long, slender, flexible tube (catheter) that is threaded to the heart. The physician then uses either cold (cryoablation) or heat (radiofrequency ablation) to destroy the tissue that triggers irregular heartbeats.
    • Cardiac Resynchronization Therapy (CRT)
      People with heart failure who develop arrhythmia, may be candidates for cardiac resynchronization therapy (CRT). During CRT, a small pacemaker is implanted, usually just below the collarbone. Three wires, also called leads, are then connected to the pacemaker. The device monitors the heart rate and emits tiny electrical pulses to correct irregular heartbeats.
    • Implantable Cardioverter Defibrillator (ICD)
      Implantable Cardioverter Defibrillators (ICDs) are usually inserted under the skin in the upper chest. An ICD includes a pulse generator and wires, called leads. These devices use electrical pulses to monitor heart rhythm and treat arrhythmias that occur in the heart’s lower chambers. If the ICD detects an irregular rhythm, it uses low-energy electrical pulses to restore a normal rhythm.
    • Pacemaker
      This small device is placed in the chest or abdomen to help control abnormal heart rhythms. Pacemakers use electrical pulses to prompt the heart to beat at a normal rate.


Transcatheter Aortic Valve Replacement

    The heart has four chambers – two upper chambers called the left and right atriums, and two lower chambers called the left and right ventricles. Within these four chambers are four valves that control the flow of blood through the heart by opening and closing: the aortic, mitral, pulmonary and tricuspid valves. When your heart beats and pumps blood through these valves, the valves open and close to allow blood to move forward and prevent backflow.


    Aortic stenosis is when a valve is too narrow to pump blood effectively, due to calcium buildup, high cholesterol or a birth defect. Aortic regurgitation is when a valve cannot close fully, causing blood to leak backward through the valve. Both problems cause your heart to work harder, which can weaken heart muscle. Severe aortic stenosis is usually caused by calcium buildup over time. Without treatment, the heart can quickly deteriorate, increasing the risk for heart failure.


    If the heart has to work harder to pump blood, this can reduce the body’s ability to receive enough oxygen-rich blood. Patients with severe aortic stenosis often feel shortness of breath, chest pain or fatique, or they may feel like they will pass out.


    Severe aortic stenosis cannot be treated with medication. Patients can undergo aortic valve replacement, a surgical procedure that replaces the defective valve with a new mechanical or tissue valve. This procedure is performed through open-heart surgery, which requires patients to have their blood pumped with a heart-lung machine. However, age, a history of heart disease, or other health issues may prevent some patients from being able to undergo open-heart surgery. For those patients, there is a new treatment option called Transcatheter Aortic Valve Replacement (TAVR).


    TAVR is a heart valve replacement procedure for patients with severe aortic valve stenosis who have been determined to be high risk or too sick for open-heart surgery. This less invasive procedure allows a prosthetic valve to be inserted into the diseased valve.

    The TAVR procedure can be performed through three different approaches: transfemoral , through the leg artery, transapical , through the chest between the ribs, or transaortic , through the upper chest. Once in place, the heart valve is intended to function like a normal, healthy valve with proper blood flow. The recovery time is less for patients who undergo a TAVR procedure and usually go home from the hospital within 3-5 days.

    For more information about TAVR or to see if you may be a candidate, please speak with your cardiologist or call The James Family Heart Center’s patient navigator at (928) 771-5609.


    TAVR is a less invasive approach to aortic valve replacement and is an option for people with severe aortic stenosis who may not qualify for open aortic valve replacement surgery.

    For more information about TAVR or to see if you may be a candidate, please speak with your cardiologist or call The James Family Heart Center’s patient navigator at (928) 771-5609.


    After thorough testing, our multidisciplinary team will evaluate your results and determine the best way to treat your aortic stenosis.


    Patients undergoing a TAVR procedure typically stay in the hospital between three and five days.


    TAVR is performed in YRMC's Hybrid Operating Suite by these Heart Center Physicians:
    You will receive detailed instructions after your procedure to guide you through the recovery process. Most patients go back to their lifestyle after a few days and return to normal activities faster than with major surgery.


    For more information about TAVR or to see if you may be a candidate, please speak with your cardiologist or call The James Family Heart Center’s patient navigator at (928) 771-5609.


WATCHMAN™ (Left Atrial Appendage Closure)

    The “WATCHMAN™”, as it is commonly called, is also known as the left atrial appendage closure (LAAC) procedure. During this procedure, the heart’s left atrial appendage is permanently closed using the WATCHMAN™ device. The quarter-sized device – made of very light and compact materials used in many other medical implants – can prevent strokes by keeping blood clots from escaping the left atrial appendage. A large percentage of blood clots that cause strokes originate in the left arterial appendage.


    The WATCHMAN™ is for people with Afib (atrial fibrillation) that is not caused by a faulty heart valve as well as people who cannot tolerate medications for their condition. Afib patients are typically prescribed blood thinning medications – Warfarin or Plavix, for example – to reduce their stroke risk. Some people, however, cannot tolerate blood thinning medications due to bleeding issues, concerns about falling and other problems. For these people, the WATCHMAN™ may be an alternative to reduce stroke risk.


    Your physician will use a scoring method to determine which blood thinning medication would be best for you or if you are eligible for the WATCHMAN™ procedure. This scoring method also helps identify Afib patients for whom blood thinners may not work. The scoring method assigns points to the following:

         • Congestive heart failure
         • Hypertension
         • Age ≥ 75
         • Diabetes
         • Stroke


    The WATCHMAN™ is performed in YRMC’s Hybrid Surgical Suite – regarded as among the finest in the nation – by either Soundos Moualla, MD, FACC, FSCAI, or Nisha Tung-Takher, MD.


    The left atrial appendage closure (LAAC) is a one-time procedure during which a WATCHMAN™ device is implanted into your heart. The WATCHMAN™ is designed to permanently close off the LAA and keep life-threatening blood clots from escaping. This permanent device doesn’t have to be replaced and can’t be seen outside of the body. To implant a WATCHMAN™ device, your James Family Heart Center physician will make a small incision in your upper leg and insert a narrow tube, as is done for a standard stent procedure. The physician then guides the WATCHMAN™ into the left atrial appendage (LAA) of your heart where it is placed. This closes off the LAA and keeps blood clots from escaping. You’ll receive general anesthesia for the LAAC, which takes about an hour. Most likely, you will stay overnight at YRMC.


    Most likely, you will remain overnight at YRMC after your WATCHMAN™ procedure. You’ll return to your normal activities immediately following the procedure. WATCHMAN™ eliminates the need for regular blood tests and food-and-drink restrictions that come with blood thinners. You will continue to take your blood thinning medication for approximately 45 days after the WATCHMAN™ procedure.


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