Our Affiliate System

We are building one organization with affiliates in two regions. Our parent company, now known as Prisma Health, supports both affiliates with overall direction and leadership as we continue to align. We will soon share one brand across the entire organization to better reflect this. The rebranded Palmetto Health-USC Medical Group will continue to operate as a joint venture between the Midlands affiliate and the USC School of Medicine.

Learn more
We are becoming Prisma Health in early 2019

What We Treat

Atrial Fibrillation & Atrial Flutter

Atrial fibrillation (AFib)/atrial flutter (AFL) are the most common heart rhythm abnormalities we see. Millions of people have these problems. They are a common cause of an irregular, racing pulse, sometimes with (and sometimes without) symptoms. They are also a risk factor for stroke.

Although two different rhythms AFib and AFL often coexist and act to cause or to support each other. Symptoms, evaluation, and treatment of the two arrhythmias, up to ablation, are overlapping.

  • Racing irregular heartbeat
  • Chest pain
  • Shortness of breath with activity
  • Lightheadedness
  • Often no symptoms at all

AFib and AFL are detected with the use of an EKG or a monitor showing the irregular heartbeat as diagnosed by your doctor. Additional tests may include an echocardiogram, a heart ultrasound, to look at heart and valve function.

Atrial Fibrillation & Atrial Flutter Therapy

Medical therapy is usually the first step to prevent the AFib or AFL from coming back or to keep your heart from beating too fast. If medical therapy fails, then procedures for AFib or AFL are considered, such as cardioversion (shocking your heart back to normal rhythm), pacemaker placement, or cardiac ablation.

Atrial Fibrillation Ablation Therapy

AFib has been shown to start in structures known as the pulmonary veins (brings blood with oxygen in it back to the heart from the lungs). Ablation is a procedure where cautery is placed on the inside of the heart to block these impulses from starting the atrial fibrillation. This procedure is aided by a GPS system that creates a map of the inside of the heart as displayed below.

Ablation for AFib is one of the most frequent procedures performed for AFib at Greenville Health System (GHS), with GHS as one of the highest volume ablation centers in South Carolina.

Atrial Flutter Ablation Therapy

Ablation for AFL is more straightforward with a lower recurrence rate than ablation for AFib. AFL uses one circuit where the electricity gets stuck in a loop around one of the heart valves on the right side of the heart. Similar to AFib ablation, ablation for AFL involves placing catheters into the heart; however, the target of ablation for AFL is a a well-defined circuit that is cut with burning. The procedure is generally shorter with a broadly agreed upon lower complication rate than the more involved ablation for AFib. Ablation is appropriate to consider earlier on after the diagnosis of AFL due to difficulty keeping the heart from racing with medications.

Pacemaker Therapy

A pacemaker or defibrillator (details about the difference can be found in the device section) may be utilized to prevent slow heart rates caused by medications or coupled with an ablation of the heart’s circuitry to prevent heart racing should medications prove inadequate at keeping your heart from racing. Both of these devices can be a part of atrial fibrillation for any AFib patient but in the current era of ablation have become less commonly utilized.

Stroke Prevention

Stroke prevention is the most important element of atrial fibrillation therapy. AFib is the most common cause of stroke within the United States. Your stroke risk will be determined during the visit with your doctor based upon your other medical conditions. If you are at risk, a blood thinner will be prescribed if necessary.

In the event that bleeding is seen when you are on a blood thinner, a stroke prevention device such as a WATCHMAN may be appropriate. Currently, the WATCHMAN (from Boston Scientific) is the only device FDA approved to prevent strokes without blood thinners.

Details surrounding device placement are detailed in the video below. This therapy line provides stoke prevention as if you were on a blood thinner but without the bleeding risk. Major bleeding and the risk of dying were shown to be significantly reduced in major medical studies. Placement of these devices is routinely performed at Greenville Health System.

WATCHMAN is the only FDA-approved implant proven to reduce stroke risk in people with atrial fibrillation not caused by a heart valve problem. It’s the alternative to warfarin for people who need it.

And, GHS is the only facility in the Upstate currently using this new technology.

Learn how a permanent heart implant may replace the need for long-term blood thinners.

Will I be asleep during the procedure?

Yes. It is necessary to use anesthesia for the procedure. You may or may not be on a breathing machine during the procedure but you will be completely asleep and know nothing of the procedural events.

How long is the procedure?

It is variable dependent upon the complexity of the atrial fibrillation and the practitioner performing. The spectrum of duration is from 2-4 hours although it may be longer. We know how hard it can be to be in the waiting room so regular updates are universally performed at regular intervals (expect our nurses to tell you when to expect one). In addition there is a procedural status board in the waiting room that will keep you informed of procedural events outside of regular updates.

What is recovery like? Are there instructions or restrictions?

Initial recovery in the hospital will involve lying flat for 4-6 hours depending upon procedure details and physician preference. After discharge heavy lifting should be avoided for 3-7 days again depending upon physician preference and procedural details. Driving and showering are fine the day after your discharge. Returning to work is dependent upon whether or not you lift during work but is generally reasonable after 7 days. In general patients take 2-7 days off of work but it varies. Soreness both in the chest and where the catheters are inserted are not uncommon but improve on their own.

What are the common complications?

Any time a blood vessel is entered there is a risk of bleeding. This is why bedrest is universal post procedure. When manipulating catheters inside of the heart there is a risk of damage to the heart wall and blood collecting around the heart. This would require drainage and extend the in hospital stay. With ablation on the back wall of the heart being close to the esophagus injury to it is possible. Everything possible is done to avoid this as this is the most serious complication specific to this procedure. Thankfully it is very rare. Narrowing of the pulmonary veins post procedure is also very uncommon and with the AFib ablation approach at GHS is even less common.

Do I stay overnight?

Yes. There are very rare exceptions to this.

Are abnormal rhythms seen early after the procedure? How long does it take for my heart to heal?

Atrial fibrillation after the early time post ablation happens in 25% of patients. These episodes may require a cardioversion or adjustments in medications. Healing period is generally agreed to be 4-6 weeks.

Does ablation damage my heart in a way that is dangerous?

No. Ablation damages the heart in places of the atrium that do not contract or contribute to normal heart function.

Will I ever need to do this again? Can it be done again?

The answer s dependent upon the status of your AFib at the time of the procedure. For patients with little AFib the rate of recurrence is lower and the need for repeat ablation will follow accordingly. For patients with a higher burden of AFib the recurrence rate is higher and thus a repeat ablation is also higher. Multiple repeat ablations are uncommon. It often takes two procedures to gain ideal control of the AFib.

Supraventricular Tachycardia (SVT)

Supraventricular Tachycardia (SVT) is a category of abnormal rhythms that includes multiple different diagnoses (SVT, WPW and atrial tachycardia) with similar diagnostic and therapeutic approaches. SVT can be very difficult to diagnose due to the short, intermittent and generally infrequent nature of the episodes. Often symptoms can start during the second or third decade of life.

However, the arrhythmia can start at any stage of life. The underlying cause for the arrhythmia is a short circuit in the heart that was likely present at birth. The electricity required to coordinate heart contraction can get trapped in the short circuit and cause the heart to race. This characteristic results in the sudden on and off of the symptoms as the electricity finds and loses the circuit suddenly. Over time, the frequency and duration of episodes tend to both increase making early diagnosis and therapy important.

The most difficult element of SVT is its diagnosis. If you notice repeated episodes of sudden on/sudden off heart racing that are generally short lived, particularly those that start early in life, then have a discussion with a medical professional. Once diagnosed, SVT is very treatable.

  • Sudden onset racing heartbeat
  • Chest pain
  • Lightheadedness
  • Passing out (infrequent)
  • EKG or a monitor showing SVT
  • Invasive diagnostic electrophysiology study (EP study) showing SVT (discussed below)
  • Echocardiogram (heart ultrasound) to look at heart and valve function

Medical Therapy

First line in treatment has traditionally been starting medications to prevent and shorten episodes. The difficulty with this approach is the need to take a daily medication (along with its side effects) to prevent something that may only happen a few times per year. In addition, the medications used for SVT are poorly tolerated in younger patients who represent a significant portion of patients presenting with this rhythm.

Electrophysiology and Ablation Therapy

For patients that do not tolerate, desire to try, or fail medical therapy, EP study with ablation is the next step in intervention. Often diagnosis can remain elusive due to the infrequent and brief nature of SVT. Monitoring at home for up to a month is unlikely to capture an episode that happens only a couple of times per year. An EP study can provide a diagnosis and is generally performed first followed by ablation (burning) of the abnormal part of the circuit dependent upon the EP study results.

During an EP study, catheters are advanced through the vein into the heart. The heart is stimulated electrically from these performing maneuvers to identify presence, type and location of the abnormal circuit. Once the arrhythmia is diagnosed, an ablation (burn) is performed with removal of the short circuit. Repeat testing follows to confirm success.

With a successful ablation, the recurrence rate lifelong is less than two percent.

Will I be asleep during the procedure?

Ablation procedures are all performed with sedation. However the nature of the arrhythmia being most often seen with activity and during waking hours makes it sometimes necessary to have patients awake for a portion of the procedure. This is during diagnostic pre and post ablation testing not during uncomfortable parts of the procedure.

How long is the procedure?

It is variable dependent upon the complexity of the abnormal circuit. On average it is about 2 hours. We understand the stress of being in the waiting room and provide regular updates regarding procedure progress. In addition a status board in the waiting room will provide you with information as well.

What is recovery like? Are there instructions or restrictions?

Initial recovery in the hospital will involve lying flat for 4-6 hours depending upon procedure details and physician preference. After discharge heavy lifting should be avoided for 3-7 days again depending upon physician preference and procedural details. Driving and showering are fine the day after your procedure. Returning to work is dependent upon whether or not you lift during work but is generally reasonable after 3 days. In general patients take 2-7 days off of work but it varies. Soreness both in the chest and where the catheters are inserted are not uncommon but improve on their own.

What are the common complications?

Any time a blood vessel is entered there is a risk of bleeding. This is why bedrest is universal post procedure. With ablation for SVT there is a risk of damaging the normal circuitry of the heart. This could result in placement of a pacemaker. Our goal at GHS is a safe and effective procedure, in that order. We control where and how long ablation is performed. Should concerning things be seen ablation will be stopped and that area avoided. Not everything is in our control however and even in the best of hands there exists a 1% chance of pacemaker placement during SVT ablation.

Do I stay overnight?

Almost always no but there are exceptions. Procedures done late in the day may require an overnight stay due to a desire to avoid a very late discharge. In addition events during recovery may also necessitate additional monitoring via an overnight stay.

Are abnormal rhythms seen early after the procedure? How long does it take for my heart to heal?

Skipping or feeling like your rhythm is going to start back up but doesn’t is quite common. This may be present for a month or so which is the arbitrarily agreed upon healing time post ablations.

Does ablation damage my heart in a way that is dangerous?

No. Ablation damages the heart in places of abnormal heart circuits for this rhythm and acts to return your heart to normal. There are no lasting dangers or consequences (except arrhythmia cure) to ablation.

Will I ever need to do this again? Can it be done again?

With a successful ablation determined at the time of procedure, the rate of recurrence is so low that the likelihood that it would need to be repeated is just as low. In the unlikely event of recurrent symptoms or the return of arrhythmia on an EKG post procedure, a repeat procedure is possible and likely to be recommended.

This is an EKG of SVT. Each of the spikes is a heartbeat. On the left part of the picture the spikes are close together indicating that the patient is in SVT. When ablation is performed on the right side of the screen at the appropriate spot the rhythm stops.