Who is Electrophysiologist?

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Who is Electrophysiologist ?

A cardiac electrophysiologist also known as cardiac EP, is a doctor who treats heart rhythm problems. Cardiac EP is a type of cardiologist. A cardiologist is a doctor who has had 3 or more years of extra training after MD medicine to treat problems of the heart.

cardiac Electrophysiologist

How much training is required to become a cardiac EP?

A cardiologist has 12 years of medical training. This includes 6 years of medical school, 3 years of training in general medicine, and 3 or more years of special training in cardiovascular disease.

A cardiac EP is a cardiologist who completes 1-2 years of extra training in electrophysiology after finishing Cardiology training. Cardiologist focuses on caring for patients with diseases of the heart including heart attack, valve disease, and some arrhythmias. After becoming cardiologist and finishing the extra 1-2 years of EP training, the doctor then is certified in the subspecialty of cardiac electrophysiology. This cardiac sub-specialty focuses on testing and treating the heart rhythm problems. A clinical cardiac electrophysiologist has the specialized education and experience needed to perform advanced procedures for heart rhythm problems and interpret their results.

Who needs treatment with cardiac EP?

Cardiac EP works with patients who need special heart-related care. Your physician or cardiologist will refer you to a cardiac EP if you have symptoms of heart rhythm problems or you have risk factors for dangerous cardiac arrhythmias. Symptoms of heart rhythm problems include dizziness, fainting, breathing difficulty, and fluttering feelings (palpitations) in your chest.

What is the role of cardiac EP?

Cardiac EPs do diagnosis and treat abnormal heart rhythms. Abnormal heart rhythm is also known as arrhythmia. Cardiac EPs will do exact diagnosis of arrhythmia types and identify exact mechanism of arrhythmias. Cardiac EPs implant special devices in the body to regulate the heartbeat. They also do special procedures such as catheter ablations to treat heart rhythm problems (abnormal fast heart beats).

Diagnosis and Treatment of following conditions:

  • Atrial fibrillation (Irregular and fast heart beats from the upper chambers of the heart)
  • Bradycardia (Slower heart beats)
  • Tachycardia (Faster heart beats)
  • Supraventricular tachycardia (SVT) (Sudden, regular and very fast heart beats from the upper chambers of the heart)
  • Ventricular tachycardia (VT) (Dangerous type of very fast heart beats from the lower chambers of the heart)
  • Ventricular fibrillation (VF) (Dangerous fluttering of the heart muscles of the lower chambers that doesn’t let the heart pump blood. This condition can lead to immediate death of the patient)
  • Sudden cardiac arrest (SCA/SCD) (This is when the heart suddenly stops beating which leads to immediate death of the patient)
  • Long QT syndrome, Brugada syndrome, Short QT syndrome and other genetic channelopathies (Genetic problems associated with heart rhythm abnormalities which can cause sudden cardiac death)
  • Wolff-Parkinson-White (WPW) syndrome (Episodes of a fast heartbeat caused by an extra electrical connection in the heart)
  • Sick Sinus Syndrome (SSS) (Abnormally slower heart beats due to SA Node disease which is a natural pacemaker of heart)
  • Complete Heart Block (CHB) (Abnormally slower heart beats due to AV Node disease which is very vital structure for normal electrical activity of lower chambers of heart)

Investigations and analysis for the diagnosis of arrhythmia:

  • Electrocardiogram (ECG)

    Very important for diagnosis of heart rhythm abnormalities

  • Blood tests

    Thyroid function tests, Serum Electrolytes, other blood investigations

  • Genetic analysis

    Diagnosis of various genetic channelopathies like Long QT syndrome, Brugada syndrome, CPVT, ARVCs

  • 2D Echocardiogram (Ultrasonography of Heart)

    To look for heart function, valves, size of heart, heart muscle thickness, congenital heart defects

  • Treadmill test (TMT)

    To look for exercise related heart rhythm abnormalities, risk stratification of asymptomatic WPW pattern, diagnosis of long QT syndrome

  • Holter

    Recording of heart beats for 24 to 48 hours by using ECG. Used for diagnosis of heart rhythm abnormalities which are lasting for few minutes and occur almost daily.

  • ELR (External loop recorder/Event recorder)

    Recording of heart beats for 7, 14, or 30 days by using ECG. Used for diagnosis of heart rhythm abnormalities which are lasting for few minutes and do not occur daily.

  • HUTT (Head Up-Tilt Table testing)

    This looks at how the heart is affected when your body is moved from a lying position to a standing position on a tilting table. This test is used for diagnosis of vaso-vagal/neuro-cardiogenic syncope.

  • ILR (Implantable loop recorder)

    This is a small pen-drive size device which can be inserted in the chest under the skin. It records heartbeat all the time and has a battery life of about 2-3 years. The device records heart rhythm which can be analysed by cardiac EP periodically. Patient can also note down date and time in a diary when they have symptoms, such as dizziness or feeling faint. ILR is used for diagnosis of serious heart rhythm abnormalities which occur only few times in a year and can be life threatening.

  • EP study (Electrophysiology study)

    This is an invasive test in which special thin wires (catheter) are placed into a large vein usually in groin and threaded into the heart. It is used for testing heart’s electrical system and for confirmation of type of arrhythmia.

Treatment of cardiac Arrhythmias

  • Medicines : Special medicines for controlling heart beats (Anti-arrhythmic drugs)
  • Lifestyle changes : Changes in diet and regular exercise can help with some heart rhythm problems.
  • Cardioversion or defibrillation : Use of electric current/ electric shock to treat abnormally fast heart beats due to serious heart rhythm problem
  • Catheter ablation (EP study & RF ablation) : Catheter ablation is done for treatment of fast heart beats. In this procedure, a thin tube is put into a blood vessel in the groin and sent up to the heart. A small part of the heart muscle that is causing electric short-circuit and arrhythmia is destroyed with radiofrequency energy.
  • Pacemaker : Pacemaker is used for treatment of slow heart beats. It is a small device which is put under the skin of the chest. It supplies electric current to the heart muscles and helps to maintain normal heart rates.
  • Implantable cardioverter defibrillator (ICD) : ICD is used for treatment of serious fast heart beat problems. This is a small device that is put under the skin of the chest. It supplies electric current to the heart muscles and helps to maintain normal heart rates by resetting the heart rhythm whenever dangerous arrhythmias occur.
  • Biventricular pacemaker (CRT-P, CRT-D, Combo therapy) : CRT is a type of special pacemaker which is used for heart failure patients. This is a small device that is put under the skin of the chest. It is used in heart failure patients having conduction problems especially Left bundle branch block (LBBB). It improves electric current supply of left ventricle which is the main pumping chamber of heart. It improves heart failure related symptoms. This is known as cardiac resynchronization therapy (CRT).