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Electrophysiology (Heart Rhythm) Services

John R. Burg MD Cardiac Center

For an appointment or for more information


Cardiac arrhythmias are disturbances in the rate or rhythm of the heart’s electrical system. These disturbances can range from inconvenient to life-threatening.

Our electrophysiology specialists specialize in electrical conduction in the heart. Billings Clinic Cardiovascular Services has two electrophysiologist and two nurse practitioners. This team is recognized as a leader in diagnosing and treating cardiac arrhythmias.

Electrophysiology services provided at Billings Clinic include:

  • Ablation
  • Lead extraction
  • Permanent pacemaker
  • Tilt table testing
  • Pacemaker telephone checks (in-office checks)

Atrial Fibrillation

Atrial fibrillation is the most common heart rhythm disorder, affecting millions of people in the United States. Symptoms between patients may vary considerably, ranging from completely asymptomatic to having palpitations (fast, irregular or pounding heartbeats), chest pain, shortness of breath, weakness, or light-headedness among others. Episodes in most patients tend to be progressive, with more frequent and longer-lasting episodes of atrial fibrillation occurring over time. Early treatment in many patients is important to halt this progression, whether it be with anti-arrhythmic medications or procedures called ablation. Anticoagulation (treatment with "blood thinners") is important for most as atrial fibrillation is a significant risk factor for stroke, with atrial fibrillation-related strokes tending to be larger and more severe than non-atrial fibrillation-related strokes.

Risk factors for developing atrial fibrillation are many, with advancing age and underlying heart disease being the most common but other chronic medical conditions such as lung or thyroid disease amongst others also predispose to the condition. Risk factors such as obesity, a sedentary lifestyle, alcoholism, and untreated sleep apnea contribute considerably to the development of atrial fibrillation.

Lifestyle modifications, such as regular exercise (30 minutes of walking or equivalent 5x per week), sustained weight loss, alcohol moderation or even complete elimination, and treatment of obstructive sleep apnea if applicable is of paramount importance in limiting atrial fibrillation recurrences.

Heart Devices

Many heart conditions are benefited by implanted devices and pacemakers. A wide variety of devices are offered at Billings Clinic to meet the unique needs of our patients. Each is supported by the largest heart rhythm team in Montana included a team dedicated specifically to supporting our patients with heart devices. For more information about devices Billings Clinic offers, please call (406) 238-2000.

Bradycardia (slow heart rates)

A slow heart rate can happen when the body’s natural pacemaker (the sinus node) begins beating too slowly. This is often called “sick sinus syndrome” or “sinus node dysfunction”.It can also come when the signal from the sinus node is blocked from reaching the lower portion of the heart where the pumping of blood primarily occurs. This is often called “heart block”. Bradycardia can lead to symptoms such as passing out, lightheadedness, dizziness, fatigue, low energy.

The primary treatment for many people suffering from a slow heart rate is a pacemaker. Having a pacemaker placed typically requires less than a day in the hospital and minimal restrictions during recovery.

Billings Clinic implants and supports a full array of pacemakers including:

  • Transvenous pacemakers: a small pacemaker implanted under the skin on the upper chest and connected to the heart through wires (called leads) in the blood vessels
  • Leadless pacemakers: a pacemaker small enough to fit entirely within the heart
  • Cardiac resynchronization devices: Specialized pacemakers which can help strengthen the heart and treat symptoms of heart failure

Tachycardia (fast heart rates)

Many abnormal heart rhythms can make the heart go fast. Some of these such as ventricular tachycardia and ventricular fibrillation are potentially dangerous. A heart device called a defibrillator can monitor for dangerous rhythms and provide treatment which could be lifesaving. Having a pacemaker placed typically requires less than a day in the hospital and minimal restrictions during recovery.
Billings Clinic supports all types of defibrillators including:

  • Transvenous defibrillators: This combines the function of a defibrillator with a pacemaker and sits under the skin on the upper chest and is connected to the heart through wires in the blood vessels
  • Subcutaneous defibrillators: This sits under the skin on the left side of the rib cage and is connected to a wire (called a lead) which travels under the skin to the front of the chest, no wires in the blood vessels required
  • Wearable defibrillators: Used for temporary protection from dangerous fast heart rhythms, this is a vest that monitors the heart through the skin and can treat dangerous heart rhythms

Heart Failure

When the heart weakens, it is sometimes caused by unbalanced electrical activation of the heart. A special form of pacemaker called a cardiac resynchronization device can help strengthen the heart by adding an additional pacing site on the backside of the heart. This can lead to improvement in symptoms and longer life in appropriate patients.

Unknown Heart Rhythms

Heart devices can be used to monitor the electrical activity of the heart and assist in the diagnosis of heart conditions. Devices worn on the outside of the skin can be worn for up to a month. When longer monitoring is needed, a small implantable monitor can be placed under the skin of the chest for monitoring over several years.

Pacemaker telephone checks

After you have your pacemaker implanted, we will be providing dedicated,

Pacemaker Support

We would be happy to answer any questions and provide you with any information about your pacemaker.


thorough follow up services. The staff members who will be talking with you periodically include Cheryl Cummings,RN; Chris Severson, RN; and our electrophysiology technical staff. Dr. Alan Thometz supervises the clinic.

It is important to have your pacemaker checked regularly to ensure it is functioning properly and to keep track of the battery. We recommend the following pacemaker phone check schedule:

  • Implant date: 2 checks in the first month
  • 1 month - 3 years: 1 check every three months
  • 3 years - 6 years: 1 check every two months
  • 6 years - battery depletion: 1 check per month

All routine pacemaker checks are done by appointment. After each telephone check, we will schedule you for your next appointment.

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