Clinical Programs and Services
Atrial Fibrillation Ablation
Atrial fibrillation (AF) is an arrhythmia, or abnormal heart rhythm. Arrhythmias are disruptions in the rate or rhythm of the electrical system of the heart, which controls how the heart contracts and pumps blood. While many arrhythmias are harmless, others can be serious or even life threatening. AF is a common cause of stroke and congestive heart failure. In fact, people with AF are 5 to 7 times more likely to have a stroke than people who do not have AF.
Ablation is a procedure to treat cardiac arrhythmias, including AF, performed by one of our electrophysiologists. In this procedure, muscle fibers in the chambers of the heart that trigger and maintain abnormal rhythms are disrupted or eliminated. The procedure is often done with minimally invasive techniques that require only a limited hospital stay. Ablation can provide relief for patients for whom medication was not effective or would prefer not to, or cannot take, medication.
Our Electrophysiology Center was established in 1989, and our 11 board-certified electrophysologists do a large volume of these procedures every year. You can find more information about the Electrophysiology Center here.
Cardiac Catheterization and Cardiac Intervention
Cardiac catheterization is a medical procedure used to diagnose and treat some heart conditions, including:
• Coronary artery disease – Clogging of the arteries by fatty materials in the blood stream
• Valvular heart disease – Malfunction of one or more of the heart valves that can affect blood flow within the heart
• Congestive heart failure – A condition where the heart muscle has become too weak to pump efficiently
• Certain congenital heart conditions – Defects in one or more heart structures that are present from birth
• There may be other reasons for your doctor to recommend a cardiac catheterization
In cardiac catheterization (cath), a very small, hollow tube or catheter is sent through a blood vessel in the groin or arm through the aorta into the heart. Once the catheter is in place, certain diagnostic techniques can be used. The catheter can be advanced into the arteries of the heart, and contrast dye can be injected. A special x-ray called fluroscopy allows the doctor to see blockages in the arteries as the dye moves through the arteries. In a different procedure, the tip of the catheter can be placed into different parts of the heart to measure the pressures and blood flow inside the chambers of the heart.
Angioplasty, percutaneous coronary intervention, and stenting may be done as part of, or following, a catheterization. These interventional procedures are also done in the cardiac cath lab.
Your doctor can provide you with more in-depth information about these procedures and explain about the risks associated with them.
Cardiac Resynchronization Therapy
Cardiac resynchronization therapy (CRT) is a new technology that we are using for some patients with congestive heart failure. Another name for CRT is biventricular pacing. Normally, both ventricles (chambers) of the heart beat together. For some people with congestive heart failure, they beat out of order, one after the other. This places extra stress on an already-damaged heart.
CRT uses specialized pacemakers and implantable defibrillators that can pace both the left and right ventricles of the heart. When the 2 ventricles are resynchronized, the heart’s efficiency is improved. CRT helps to improve pumping ability and overall functioning of the heart. Many patients say that they have improvement in symptoms of shortness of breath, increased energy and exercise tolerance, and generally feel an improved sense of wellness after CRT.
CRT is performed by our specialists in electrophysiology in our Electrophysiology Center.
When you need heart surgery, you want the best possible care from experts who have years of experience, and a compassionate, friendly environment that is close to home.
Heart & Vascular hospital cardiac surgeons are experts in the surgical treatment in the surgical treatment of conditions of the heart. Our experienced surgeons are leaders in many areas, including
coronary artery bypass surgery, transcatheter aortic valve replacement (TAVR) , valve surgery, and ventricular assist
device implantation. Our surgeons have extensive experience in minimally invasive heart surgery, combination open-heart procedures, and many complex surgical procedures. Our physicians are on the front lines of fighting heart and vascular diseases. Many of them are developing techniques and treatments that are setting standards in cardiac care all over the world.
Because we take a team approach to care, you will be seen by your surgeon and a cardiologist, along with our specially-trained nurses, social services, and other healthcare professionals. Every member of the care team shares the same goal: to provide you with the best possible outcomes and to see you return to health as quickly as possible. That dedication pays off in our outstanding results and in our satisfied patients.
Chronic Total Occlusion
When an artery of the heart is completely blocked for 30 or more days, it is called a chronic total occlusion (CTO). CTO is caused by a buildup of the fatty substance called plaque on the walls of the artery. This can lead to a decrease in blood flow to the heart, which prevents it from working correctly. When one or more of the coronary arteries is completely blocked, it can cause a heart attack. If the blockage occurs more slowly, it can cause chest pain (angina).
Some people will require coronary artery bypass graft surgery, which may clear the blockage. Another option for some people is percutaneous (through the skin) intervention. In this innovative technique, interventional cardiologists gently steer special guide wires and catheters through blockages. If you have been diagnosed with CTO, your doctor will discuss treatment options with you based on your individual case.
Coronary Artery Bypass Graft Surgery
When a fatty substance called plaque builds up on the walls of the arteries of the heart (coronary arteries), the arteries narrow. Blood flow to the heart can slow down or stop, and this can cause chest pain (angina), shortness of breath, heart attack, or other symptoms. This is known as coronary artery disease.
In coronary artery bypass graft surgery (CABG), the surgeon creates a detour or bypass around the blocked part of a coronary artery to restore the blood supply to the heart. In this surgery, the doctor uses arteries or veins from a different part of the body, such as the forearm or leg, to create the bypass segment. Sometimes the surgery requires the use of a heart-lung machine. The surgery is done under anesthesia. In some cases, the surgeon can use a minimally invasive approach that is done through a small incision. Your surgeon plans the best approach based on the specifics of your individual condition. All of our Heart & Vascular Hospital surgeons have years of experience in performing cardiac artery bypass surgery and have outstanding results.
Since our establishment in 1989 by Dr. John Zimmerman, we have been dedicated to providing high quality and compassionate care for the diagnosis and treatment of abnormal heartbeats, also known as arrhythmias. Since that time, we have performed these procedures on thousands of patients, with an outstanding record of safety and results. We currently have 11 experienced heart rhythm specialists in our Center. Known as electrophysiologists, they are experts at diagnosing and treating many types of rhythm disorders.
Our advanced facility includes the latest in equipment and technology, including a robotic navigation system, and we are capable of handling many types of ablation cases and devices. Procedures that do not require surgery are performed in an electrophysiology lab.
Our highly experienced team of doctors, nurses, and technicians performs 2000 procedures every year, including: implantation of permanent pacemakers, implantable defibrillators, cardiac resynchronization devices, and ablation of abnormal atrial and ventricular arrythmias, supraventricular tachycardias, and atrial fibrillation. Our active lead extraction program for removal of pacemaker and defibrillator leads utilizes the latest extraction techniques and technologies.
Heart Failure and Pulmonary Hypertension Program
Heart failure, also known as congestive heart failure, is a condition in which the heart does not pump as much blood as the body needs. Each side of the heart is composed of 2 chambers: the atrium, or upper chamber, and the ventricle, or lower chamber. The atrium receives blood into the heart, while the ventricle pumps it out. Heart failure occurs when any of the four chambers—atriums or ventricles—lose their ability to keep pace with the amount of blood that should normally flow through the circulation. The term “failure” does not mean that the heart has stopped, only that it is not pumping blood effectively. When you have heart failure, you may feel tired, short of breath, and have fluid accumulating in your body.
Although heart failure cannot be permanently cured, there is still reason for optimism. With the right treatment and lifestyle changes, you can lead a long, active, and enjoyable life.
Our award-winning Heart Failure program combines both inpatient and outpatient care to provide you with the comprehensive care that leads to improved outcomes. We have had the lowest heart failure mortality in the country for the last 10 years, making our program the gold standard. In fact, programs at other hospitals are compared to ours. In addition, the staff has additional expertise in diagnosing and treating pulmonary hypertension—one of only 2 such programs in New Jersey.
Our collaborative approach offers you access to the latest diagnostics and treatment options, as well as to research studies evaluating new therapies. When you are referred to the Program by your physician, you will receive a comprehensive treatment plan that is designed to meet your individual needs and condition, and will be refined as needed. For patients with advanced heart failure, we offer cutting-edge treatment that may include both pharmacologic and mechanical options, as well as evaluation for transplant and a bridge to transplant services when indicated.
Our multidisciplinary team is led by Dr. Robert L. Berkowitz, who founded the Heart Failure Program in 2000. He is joined by nurses, social workers and other counselors, specialists in physical rehabilitation, dietary counselors, and other professionals, who all have extensive specialized experience in working with people with heart failure. We are dedicated to providing all our patients with state-of-the art and compassionate care from the onset of congestive heart failure symptoms through the long-term management of living with chronic heart failure or receiving a heart transplant.
Lead Extraction Program
Your doctor will check your pacemaker or implanted defibrillator regularly to make sure that it is working well. He or she will also check the leads, the thin wires that are coated with insulation that connect implantable device to the heart. Sometimes, we have to remove the leads in a special extraction procedure that is performed by an electrophysiologist who has had additional training and experience. Like any surgery, a lead extraction has risks. However, this is generally a safe procedure when performed by an experienced doctor and specially trained team using the latest extraction techniques.
Left Atrial Appendage
Non-invasive Cardiology Services
Patients who require non-invasive diagnostic studies are referred to the Cardiovascular Laboratory. Our doctors use many tools to diagnose and treat heart and vascular disease. Advanced imaging technologies have improved our ability to detect and treat cardiovascular disease at an early stage. This is of particular benefit to patients who are at risk for heart disease—either because of genetics or lifestyle choices. The Heart & Vascular Hospital’s cardiac imaging and non-invasive cardiology team uses the most sophisticated equipment available. Non-invasive techniques such as nuclear imaging, Doppler ultrasound and PET-CT scans provide our cardiologists with fast, accurate visualization and analysis of the heart and surrounding structures. Non-invasive cardiology techniques are typically safe and painless, and allow you to return to your regular activities almost immediately.
Our board-certified cardiologists and technologists are all extremely experienced and have had years of advanced training. Their experience and expertise means that they are superior at diagnosing and treating heart problems. Our Echocardiology Laboratory is accredited by the Intersocietal Accreditation Committee of Echocardiology, an honor that is granted only to facilities that meet, or exceed, the highest standards of patient care.
If your heart cannot maintain a normal rhythm on its own (arrhythmia), you may need to have a pacemaker implanted. There are different kinds of arrhythmias. A pacemaker has 2 main parts: a generator and wires, which are also called leads. The generator contains a battery and electrical circuitry. A pacemaker can have 1 to 3 leads, which are attached to the generator and thread through the veins leading to the heart. The leads carry your heart’s signals to the generator and send electrical pulses—or pacing—to the heart—to help normalize its rhythm. The number of leads depends on the individual condition. Your doctor implants the pacemaker under a pocket of tissue under the skin of the left upper chest.
The Pacemaker Center was created to follow and manage patients with pacemakers after they are implanted. It is managed by Dr. Glauco Radoslovich, the Chief of the Pacemaker Center. Dr. Radoslovich and his colleagues provide a range of sophisticated services, including remote monitoring by telephone and clinic visits to ensure that each pacemaker is programmed correctly for each individual patient. The staff of the Pacemaker Center also serves as a resource for patients and their families, offering education and reassurance.
The Pacemaker Center is one of busiest in the country. We have over 2220 patient visits per year and perform over 7300 remote transtelephonic monitoring procedures. Our experience and expertise ensures that you are getting the highest-quality care that is available.
Peripheral Vascular Disease
Peripheral vascular disease (PVD) is a slow, progressive circulation disorder. It can involve disease in any of the blood vessels outside the heart or the arteries, veins, or lymphatic vessels. If you have PVD, the organs that get blood from these vessels—such as the brain, legs, and heart—may not receive enough blood flow. PVD most commonly affects the legs and feet. People who have coronary artery disease often have PVD. Trauma or infection can also cause PVD, and so can irregular anatomy.
In PVD, we often see a narrowing of the vessels that carry blood to the leg and arm muscles. The most common cause is atherosclerosis—the buildup of plaque inside the artery wall. Plaque reduces blood flow and decreases the amount of oxygen and nutrients available to the tissue. Clots may form on the artery walls, which decrease the size of the vessel and threaten the major arteries.
Some of the conditions associated with PVD that affect the veins include varicose veins, chronic venous insufficiency, and deep vein thrombosis (also known as DVT). An example of PVD that affects the lymphatic vessels is lymphedema. When PVD occurs in the arteries outside the heart, it may be called peripheral arterial disease (PAD), though the terms are often used interchangeably.
Our comprehensive treatment program for people with PVD includes a complete assessment and development of an individualized treatment plan. Your plan is based on individual factors such as age, general health and medical history, your symptoms, extent of the disease and its expected course, your preferences regarding treatment. There are a variety of treatment options ranging from lifestyle modifications, to medications, to aggressive treatment of certain conditions that may make your PVD worse (such as diabetes, hypertension, or high cholesterol), to surgical procedures. For some people, we might be able to create a prevention plan to help lessen the progression of PVD once it has been diagnosed. You and your doctor will decide together what is the best path to follow.
Transcatheter Aortic Valve Replacement Program
The aortic valve controls blood flow from the heart to the body. In some people, the valve becomes stiff and has trouble opening. This condition is called aortic stenosis. It is a progressive disease. In aortic stenosis, the heart has to work harder to push blood through the valve to the rest of the body. Over time, the extra stress can cause the heart muscle to get weaker. People who have aortic stenosis can feel tired and short of breath and have chest pain and fainting.
TAVR is a new option for some patients with aortic stenosis. It is a minimally invasive procedure that allows us to repair a valve without removing it. If you have aortic stenosis and your doctor feels that traditional open-heart surgery is too big a risk, TAVR may be an option. TAVR is sometimes recommended for people who are older, have a weaker heart, had previous heart surgery or radiation to the chest, history of stroke, or have chronic conditions such as diabetes, kidney disease, or chronic obstructive lung disease.
TAVR is done through a catheter, which is a thin flexible tube. The catheter is usually placed in the femoral artery in your groin. Sometimes it is placed through a small incision on the left side of your chest instead. Your surgeon brings the new valve to your heart through the catheter. Because this is a minimally invasive procedure, most patients leave the hospital within 4 – 6 days and can resume normal activities within 10 days after the procedure. Many patients report feeling much better after TAVR. That is because a new heart valve can help ease the symptoms you may have had.
Our TAVR team includes highly trained physicians and healthcare professionals with considerable experience. Our 2 cardiac surgeons have performed hundreds of aortic valve operations and our 2 interventional cardiologists have years of experience doing catheterizations and performing diagnostic studies. A specially-trained cardiac anesthesiologist participates in all procedures, and our TAVR coordinator ensures continuity of care from your initial referral through your discharge.
The Heart & Vascular Hospital was the first hospital to perform TAVR in northern New Jersey and we continue to be the most experienced in the procedure.
There are 4 valves in your heart: aortic, mitral, pulmonary, and tricuspid. The valves direct the blood flow in a proper direction. Valvular heart disease is any disease that involves 1 or more of the heart’s valves. Treatment can help relieve symptoms such as shortness of breath and weakness and may help prolong life.
Sometimes valve disease can be treated with medication, but depending on the severity of the problem, valve repair surgery or replacement surgery (insertion of an artificial heart valve) is necessary. Our surgeons are experts in performing all types of valve surgeries with excellent outcomes, including aortic valve repair and replacement and complex mitral valve repairs.
If possible, your valve will be repaired. Some valve repair procedures include: resection, commissurotomy and decalcification. If repair isn’t possible, the valve will be replaced. There are 2 types of replacements: tissue and mechanical. Tissue valves (also known as biological valves) are usually made from pig or cow tissue. Blood does not clot as easily on tissue valves, so you may only need warfarin or aspirin for a short time. Tissue valves can wear out faster than mechanical valves. Mechanical valves are made of metal or hard carbon. There are many different designs. These types of valves require therapy for life with an anticoagulant such as warfarin, which is used to help prevent blood clots.
Although traditional open heart surgery is still the standard for many patients, in certain patients with isolated valve disease, a minimally invasive approach can be taken. Using this approach, the surgery is performed through a small incision, providing access to the heart and lungs for surgical procedures such as aortic valve replacements, and mitral valve repairs and replacements. Your surgeon will determine what is the best approach for your surgery and discuss that with you.
In patients who may not be appropriate candidates for traditional or minimally invasive valve surgeries, percutaneous options allow a replacement valve to be delivered and placed through a catheter that is threaded through blood vessels rather than performing open heart surgery. Our interventional cardiologists and surgeons have extensive experience with percutaneous treatments for valvular heart disease. Transcatheter aortic valve replacement (TAVR) is a new alternative for some patients with aortic valve stenosis. This minimally invasive procedure allows us to repair a valve without removing it. Look here for more information about TAVR.
Schedule an appointment today by calling 855.424.WELL (9355)