Arrhythmia Associates LLP

Visit Us - Office Procedures

Office Procedures

Exercise Stress Test

The exercise test (on a treadmill) is especially useful for arrhythmias experienced only during exercise. The patient wears several electrodes attached to an ECG machine and walks progressively faster on the treadmill. This is also a way of evaluating whether or not coronary artery blockages are present.

Preparation
Do not eat or drink anything after midnight the evening before your procedure. If you must take medications, drink only small sips of water to help you swallow your pills.

Take all your medications as prescribed. If you are diabetic, check with the office about how to adjust your diabetic medications.

Wear comfortable clothes and shoes for walking. You will wear a hospital gown during the procedure. It is best not to wear any jewelry or valuables. Electrode patches will be attached to your chest and upper back. Men may have their chest hair shaved for electrode placement. A blood pressure cuff will be attached to your arm for monitoring during this test.

Procedure
The nurse will help you to the treadmill machine and the physician or physician's assistant will slowly start the treadmill belt and you will start walking at a comfortable stride. Every three minutes, the treadmill will move faster and the incline of the treadmill will increase. We will encourage you to walk for as long as possible so that we can obtain the maximal amount of information about your heart. When you feel that you can no longer continue, you will notify us and the treadmill will slow down and return to a flat level and then the treadmill belt will stop. We will help you back to the examining table as you may feel slightly dizzy. Your heart rate and blood pressure will continue to be monitored until your heart rate and blood pressure return to normal.

Follow-up care
The results of your treadmill test will be discussed with you and further recommendations will be made. As always, if you have any further questions, don't hesitate to call our office.

Microvolt T-Wave Alternans

There are two methods to perform m-TWA testing: exercise/walking testing and pacing testing. With a walking test, you will walk on a treadmill to slowly raise your heart rate to a rate greater than 100 beats/min. If your resting heart rate is already 100 beats/min, then walking may not be necessary.

A pacing test is generally performed in patients who already have a pacemaker. After the electrodes are correctly placed, the pacemaker is interrogated and we will temporarily program it to a set rate of 110 beats/min.

In either case, the data is obtained and then processed by a machine and the results will be interpreted by your doctors. The testing itself takes approximately 10 minutes. The interpretation of the test can sometimes be hindered by extra heart beats called atrial premature contractions (see APC's) or ventricular premature contractions (see VPC's) and the testing may need to be repeated for another 10 minutes.

Holter Monitor Placement

Holter monitoring is a continuous recording of an ECG for 24 hours. If prescribed by our physicians at the time of your office visit, the nurse will apply electrodes on the skin's surface to continuously record the heart's electrical activity, and the signals are saved and later analyzed. You will wear the monitor for 24 hours continuously and we ask that you do not take off the device during that time so that all of the information is available for our review. You will be given a form to allow you to document any symptoms that occur while you wear the Holter monitor. Please write down the time of your symptoms and try to describe what you are feeling (i.e. "palpitation", "lightheadedness", "dizziness", "heavy beats"). This information will greatly help us interpret the study.

The following day, you will bring back the monitor and the nurse will help you take off the device for analysis. The information will be reviewed by our physician in the office that day and we will contact you by the following day to discuss any further recommendations.

Event Recorder Placement

The event recorder is a kind of Holter that is a continuous loop-recording device. It can be "worn" for a whole month and the patient alerts the device when an arrhythmia symptom appears by pushing a button. The saved signals can be transmitted over a telephone to the doctor's office for analysis. If prescribed by our physicians at Arrhythmia Associates, our nurse will teach you how to apply the device to record the electrical signals of your heart when you have symptoms. This device can be taken off at night and you may take a shower when the recorder is not attached. This device can record for up to 30 days but information will only be obtained if you instruct the device to record. At the end of 30 days, we will ask you to return to our office visit to discuss the results of this testing. Our physicians will then make additional recommendations.