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Pediatric Cardiology Associates | |||||
| Practice of Congenital Heart Disease | ||||||
Electrophysiology
The electrophysiology service at Pediatric Cardiology Associates and Barbara Bush Children's Hospital at Maine Medical Center provides expert comprehensive care for all rhythm disorders from fetal life through adulthood. All diagnostic and therapeutic modalities are available including ambulatory rhythm and event monitoring, exercise testing, autonomic testing, pacemaker and defibrillator implantation and follow-up (both in person and remotely), transesophageal and intracardiac electrophysiologic testing, electroanatomic rhythm mapping, pharmacologic therapy and both radiofrequency and cryoablation.
"Children are not just small adults," says Michael Epstein, M.D., Maine's first and only pediatric and congenital electrophysiologist. "Issues of small size and patient growth play a vital role in the diagnosis and management of rhythm disorders in kids." In addition to caring for the very young, one of the great challenges faced by the pediatric and congenital electrophysiologist is the care of adults with repaired or palliated congenital heart disease. As more patients with complex congenital heart disease survive into adulthood, rhythm abnormalities have become a common and serious morbidity. Pediatric and congenital electrophysiologists, because of their unique knowledge of structural heart disease, are best equipped to manage these difficult problems.
Dr. Epstein is a graduate of Harvard College and Harvard Medical School and performed his Pediatric, Pediatric Cardiology, and Pediatric and Congenital Electrophysiology training at Children's Hospital, Boston.
Electrophysiology Services provided include:
- Electrocardiography
- Ambulatory Electrocardiology (24 Hour Holter Monitoring)
- Event Monitoring (Memory Loop Recorder)
- Pacemaker and Defibrillator Evaluation and Programming
- Permanent Pacemaker Implantation
- Automatic Defibrillator Implantation
- Electrophysiology Study
- Ablation
Electrocardiography
An essential part of any assessment, electrocardiography provides important information about heart rhythm, heart structure, and the potential for potentially serious rhythm disorders.
topAmbulatory Electrocardiology (24 Hour Holter Monitoring)
24 hour Holter monitoring provides continuous real time rhythm assessment to determine the severity of a known rhythm disorder and/or to correlate daily recurring symptoms with one's heart rate and rhythm.
topEvent Monitoring (Memory Loop Recorder)
Infrequent but recurring symptoms can be correlated to one's heart rate and rhythm with the aid of event monitoring. Event monitors are both portable and easy to use. Implantable monitors are also available for patients with very infrequent but serious symptoms.
topPacemaker and Defibrillator Evaluation and Programming
Pacemaker and defibrillator evaluation and reprogramming can both optimize device function as well as maximize battery longevity. An important consideration of the pediatric and congenital electrophysiologist is to maximize battery longevity in order to minimize the number of pacemaker or defibrillator surgeries required in one's lifetime.
Pacemaker and defibrillator evaluation can also be periodically performed remotely in the convenience of one's own home both for patient and parental reassurance and to minimize the need for travel to our Portland office.
topPermanent Pacemaker Implantation
The treatment of slow heart rhythms (bradycardia) and/or heart muscle dysfunction occasionally results in the necessity for permanent pacemaker implantation. Depending upon patient size and heart structure, permanent pacemakers are implanted with leads attached to either the inside (endocardial) of outside (epicardial) of the heart. To provide the best cosmetic result and maximize patient safety, all pacemaker implantations are performed with Dr. Epstein working side-by-side with Dr. Reed Quinn, Maine Medical Center's congenital heart surgeon.
topAutomatic Defibrillator Implantation
Life-threatening rapid heart rhythms are frequently treated with an implantable defibrillator. Depending upon patient size and heart structure, defibrillators are implanted with leads attached to either the inside (endocardial) of outside (epicardial) of the heart. To provide the best cosmetic result and maximize patient safety, all defibrillator implantations are performed with Dr. Epstein working side-by-side with Dr. Reed Quinn, Maine Medical Center's congenital heart surgeon.
topElectrophysiology Study
Electrophysiology study may be recommended for a variety of reasons including to elucidate the mechanism of a known rhythm abnormality or to assess one's risk for a life-threatening rhythm event. The electrophysiology study may be performed with a single pacing catheter placed within the esophagus, the anatomic feeding tube that connects the mouth to the stomach (transesophageal study) or with one or more pacing catheters threaded into the heart via the veins and/or arteries (intracardiac study). More complex mechanisms of a rapid heart rhythm (tachycardia) are investigated with the use of one of two available electroanatomic mapping systems.
topAblation
Permanent elimination (ablation) of the substrate responsible for certain rapid heart rhythms (tachycardias) can be successfully and safely performed with either heat (radiofrequency ablation) or cold (cryoablation).
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