What is a Cardiac Electrophysiologist?
A cardiac electrophysiologist is a more specialized type of cardiologist. Cardiologists are doctors that focus on all cardiac issues in a more generalized sense of heart related issues. A cardiac electrophysiologist is specialized specifically on the rhythm of the heartbeat itself to determine why a heartbeat is irregular. A cardiologist is generally focused on issues concerning the overall cardiovascular system. The areas of care for cardiologists can include blood vessels, the heart itself, blockages, and other general heart related issues. Cardiologists also try to prevent and treat more serious health issues related to the heart such as heart attacks and heart disease. A cardiac electrophysiologist can treat those same issues but they have extended training and education to treat the basic electrical impulse that causes a heart to beat.
To further explain the difference between a cardiologist and a cardiac electrophysiologist it is best to understand that the heart only has two major functions. The only two functions that a heart has is to pump blood throughout your entire body and the other function is for the heart to remember to pump blood throughout your entire body. A cardiac electrophysiologist is specialized in the area of making your heart remember to pump blood for circulation into your body. This includes the entire electrical network of the heart, the heart’s timing, and treating symptoms associated with irregular heartbeats and arrhythmias. In order for a cardiologist to become a cardiac electrophysiologist, they must complete additional education and training.
Cardiac Electrophysiologist training and education
A general cardiologist will typically have around 10 years of education and experience before they can begin practicing medicine in the field. These 10 years of education required to become a cardiologist can further be broken down by the first four years of being in medical school. After those four years are complete cardiologists must then complete an additional three years of training concentrated on internal medicines. Following the years of training in internal medicine, an additional three years must be undertaken for special training with a specific focus on cardiovascular disease. Once all of this training and education has been completed a cardiologist must then pass a test. The test is administered by the American Board of Internal Medicine and upon successful completion, a cardiologist can then begin practicing medicine.
After a cardiologist has become board certified they must complete additional training in order to become a cardiac electrophysiologist. A certified cardiologist must then complete three extra years of training focusing on electrophysiology. Following those three years of specialized training, a cardiologist can become certified in the subspecialty of clinical cardiac electrophysiology. This field of medicine specifically focuses on diagnosing, treating, and testing irregular heart rhythms. The additional specialized training that cardiologists undergo to become a cardiac electrophysiologist gives them the training and experience needed to handle more advanced testing and technologies. They are also able to subsequently review the data from test results and interpret what that data means.
History and Evolution of Cardiac Electrophysiologists
The study of the arrhythmia and electrophysiology within a heart can be dated all the way back to the 5th century. The first study was actually conducted by the ancient Chinese as they laid the groundwork for future research with a theory called the pulse theory. It was from the pulse theory that cardiac electrophysiology evolved into what it is today. One of the earliest contributors to the field was Hippocrates. He was a legendary founder of scientific-based medicine in his time era and was the first person to ever notice sudden death due to cardiac arrest. Hippocrates made a statement in one of his Aphorisms that “those who are subject to frequent and severe fainting attacks without obvious cause die suddenly.” This statement was the to describe sudden cardiac arrest. Hippocrates’s observations of such events would later be linked to electrical disease of the heart.
Many years later another major contributor to modern electrophysiology began to document occurrences such as a premature or irregular heartbeat. Etienne-Jules Mary contributed to electrophysiology throughout his lifespan from 1830-1904. Etienne was an inventor of many scientific medical devices and made significant contributions to the understanding of how a heart works. He made the discovery that one side of the heart would beat in a coordinating an alternating fashion with the other side of the heart. His most original work was conducted in the year of 1875. That year he was able to make the first ever electrogram recording on the heart of animals.
Following on the heels of Etienne-Jules Mary was a man by the name of Carl Friedrich Wilhelm Ludwig. Ludwig’s lifespan was from 1816-1895 during which he was a professor at a physiology university. The university at which Ludwig was a professor had the most advanced experimental laboratory during the time period all around the world. Ludwig’s main focus was the physiology of the heart itself. This focus on physiology led to an interest in the entire circulatory system of the body which led to him inventing a medical instrument that recorded hemodynamics and other physiological events. By 1847 he was able to simultaneously observe and record a pulse wave and respiratory pattern to identify arrhythmia within the heart. This was the first ever recording of ventricular fibrillation. His work and understanding of the circulatory system was a major contribution to the field of electrophysiology.
It wasn’t long after this significant discovery in 1847 by Mary that a man by the name of Augustus Desire Waller would make a major breakthrough in developing a piece of technology that we still use in modern medicine. Building from the foundation that Ludwig had put into place, Waller was able to develop the first-ever electrocardiogram (ECG). This electrocardiogram was done on the body surface of a human using an invention that EJ Marey had developed many years before known as the Lippmann capillary electrometer. Waller would later go on to the discovery that if the capillary electrometer electrodes were placed on the human chest that it would record electrical currents generated by the heart. This type of technology was crucial in laying the foundation for the tools available for the modern cardiac electrophysiologist.
Advanced medical methods used by Cardiac Electrophysiologists
A modern cardiac electrophysiologist has a range of advanced testing they are able to conduct depending on the symptoms a patient is experiencing. There are really two different types of testing that cardiac electrophysiologists can use in diagnosing any type of arrhythmia. These types can be broken down into actual testing and monitoring.
Cardiac Electrophysiologist Testing Methods and Devices
The most common test is called an Electrocardiogram or an EKG. An Electrocardiogram is a device that uses electrodes that are connected to a machine. The electrodes are then placed on a patient’s chest. The electrocardiogram then monitors and records the electrical activity of the patient’s heart so a cardiac electrophysiologist can better determine if there are any issues. Another test used by a cardiac electrophysiologist is an echocardiogram. An echocardiogram is also a device used externally that gives a better idea of a patient’s heart structure. This method involves a machine that will send sound waves into a patient’s chest cavity to produce an image of the heart and its structure. These two forms are typically not as intensive as other forms of testing used by a cardiac electrophysiologist.
One of the more intensive tests that cardiac electrophysiologists use is called stress testing. This form of testing typically involves a patient is hooked up to a machine and exposed to vigorous exercise. This typically involves a patient being made to run on a treadmill while wearing numerous wires that relay readings of a heartbeat when exposed to stress. There is also another less intensive test that cardiac electrophysiologists may use called a tilt table test. This method involves a patient being wired up to a machine very similar to the way a patient is wired up for a stress test. Patients are placed in a lying position on a table then the table tilts into an upright position. The tilt table tests allow cardiac electrophysiologists to see how well a heart performs when a patient switches from a lying position into a standing position. A cardiac electrophysiologist can perform tests that are not just intensive, but they also have some that are invasive.
Invasive testing is a more involved method of testing that typically includes a surgical procedure. One type of invasive testing is called an electrophysiology study. This test is conducted by inserting a wire into a patient’s body and putting the wire inside the heart itself. This test will provide the cardiac electrophysiologist with information about the heart’s surrounding electrical system and alert the doctor to any problems concerning abnormalities. Another type of invasive procedure is also a type of monitoring. The implantable loop recorder is a device used to record heart activity. It is especially useful in patients that suffer from frequent dizziness and feeling faint. The device itself is small and is actually inserted under the skin on the patient’s chest. There are other monitoring devices that are often used that are less invasive.
Cardiac Electrophysiologist Monitoring Methods and Devices
Monitoring devices are often used in patients that have chronic cardiac complications. The implantable loop recorder is one such device, but there are a couple others that do not require a medical procedure to be used on a patient. An example of a less invasive monitoring device used by cardiac electrophysiologists is a Holter monitor. A Holter monitor is a small device that a patient will need to wear for a period of time between 24 to 48 hours. The device measure and stores medical data comparable to an electrocardiogram. The Holter monitor will record heartbeats during the time it is worn and will provide cardiac electrophysiologists with valuable data about a patient’s heart health.
Another monitoring device is called an event recorder. Cardiac electrophysiologists use this device in conditions that involve arrhythmia in patients. This small device can also be worn over a period of time determined by a doctor and it will detect any abnormal rhythms in a patient’s heartbeat. This information can then be reviewed by a cardiac electrophysiologist to determine a diagnosis and treatment.
A cardiac electrophysiologist’s available treatment options
Once a cardiac electrophysiologist has determined that a patient is experiencing an abnormal heartbeat they can proceed with a suitable treatment. Treatment options available for arrhythmias range from life-saving technology to simple suggestions for a lifestyle change made by a cardiac electrophysiologist. Treatment options available fall into two different categories which are procedures or prescriptions and implanted devices.
Cardiac Electrophysiologist procedures and prescription treatments
In most cases, patients will be treated with certain medications. There are a variety of prescriptions that can be issued by a cardiac electrophysiologist that helps control the rhythm of a patient’s heartbeat. These prescriptions can also be used to prevent and treat potentially life-threatening conditions such as blood clots. In addition to certain prescriptions, a cardiac electrophysiologist may also suggest that a patient make a lifestyle change. This lifestyle change may consist of a healthier diet or more daily exercise. In other situations involving arrhythmia problems, a more drastic or invasive option may be needed for treatment.
One of the most commonly heard of procedures that treat arrhythmia is actually cardiopulmonary resuscitation or CPR. This emergency procedure is actually a life-saving technique that presses on a patient’s chest cavity that will simulate a heartbeat in conditions in which the heart is no longer beating. Another emergency procedure that can be life-saving involves the use of a device called a defibrillator. Defibrillators are used in situations that involve patients with a heart that has stopped completely. This technology utilizes two paddles that can be applied to the chest cavity and deliver a high voltage shock directly to the heart. A high voltage shock delivered directly to the heart can often times make the heart start beating regularly again.
Another type of procedure used by cardiac electrophysiologists to treat arrhythmia is a more invasive procedure. This invasive procedure is called catheter ablation. This catheter ablation procedure uses a radiofrequency technology that can treat the issue within the heart causing arrhythmia. The procedure itself uses a small thin tube similar to a catheter. The tube itself is inserted inside of a blood vessel located in the patient’s groin. Once the catheter-like tube has been inserted into the blood vessel a cardiac electrophysiologist will then place a wire inside the tube and send the wire up through the vessel and into the heart. After the wire has reached the location of the heart responsible for causing the arrhythmia it will emit a radiofrequency energy to destroy that particular part. This procedure can prevent ongoing complications with arrhythmia, but in some situations, a more long-term treatment may need to be implemented.
Cardiac Electrophysiologists and Implanted Devices
Chronic arrhythmia in some patients may require around the clock observation and on the spot treatments. These types of conditions are commonly treated by a cardiac electrophysiologist with implanting a device inside the patient’s chest cavity to control arrhythmia. One of the most commonly used implanted devices is called a pacemaker. This implanted device is actually implanted under the skin of the chest. A pacemaker is commonly used in the elderly because their heart starts to actually slow down over time. Pacemaker technology is used to prevent slow heartbeats by emitting a small electrical shock to the heart that will speed up the heartbeat.
There is also another type of pacemaker that cardiac electrophysiologists use to treat arrhythmia. Some patients have conditions in which the two lower chambers of the heart no longer beat in synchronization with the two upper chambers. A cardiac electrophysiologist has the ability to implant a device called a biventricular pacemaker under the skin similar to that traditional pacemaker implant. The biventricular pacemaker can detect when the lower chambers are no longer in sync and emit a shock that will help the chambers to beat in sync again. This particular procedure is also referred to as cardiac resynchronization therapy.
A third device that cardiac electrophysiologists can implant inside a patient is called an implantable cardioverter-defibrillator or ICD. This defibrillator can actually be implanted in two different spots depending on conditions. This device can be implanted under the skin of the chest the same way a pacemaker is implanted, but it can also be installed within the patient’s abdomen. The implantable cardiovascular-defibrillator is used to reset the heartbeat. This device can detect dangerous arrhythmias and send a jolt of electricity to the heart and reset the heart’s rhythm.
When is it time to see a cardiac electrophysiologist?
There are several conditions that would require patients to be treated by a cardiac electrophysiologist. A normal and healthy heart is made up of upper and lower chambers that alternately contract and expand pumping the blood into circulation. When anything hinders or alters this rhythm it may be time to visit a cardiac electrophysiologist. There are many conditions and factors that could lead patients into needing treatment such as the speed at which the heart is beating.
A heartbeat that is too fast may indicate that a patient has Bradycardia. This condition can often be diagnosed when the heart is beating more than 100 times per minute. There is also a condition that is the exact opposite of Bradycardia. When a patient is experiencing a slower heartbeat, they could have a condition known as Tachycardia. Tachycardia is a condition in which a patient’s heart beats less than 60 times per minute. Both of these conditions are common and can be treated with the right combination of medication.
The most common type of arrhythmia is called atrial fibrillation. Atrial fibrillation is a condition that involves the two upper chambers within the heart. This condition brings on fast and irregular heart rhythm in those two chambers resulting in the top two chambers quivering instead of their contractions coordinating with the lower chambers. In order to treat and control a-fib, atrial fibrillation, a cardiac electrophysiologist may prescribe a combination of blood thinners and beta blockers. Other treatment options that may need to be used involve the use of electric shock called cardioversion or a catheter ablation. In some situations, there are two surgeries that could be conducted to correct a-fib in a patient. These surgeries are called the Maze and modified Maze procedures. This type of surgery consists of a surgeon cutting a pattern into a patient's upper heart chambers to create a maze that is followed up with stitches. The resulting scars from the stitches create a type of barrier that can stop electrical impulses that stray. Atrial fibrillation is a manageable arrhythmia condition which isn’t very often a serious condition. Some arrhythmia conditions can be fatal if left untreated.
The most common serious form of arrhythmia is a sudden cardiac arrest. Once a patient has gone into cardiac arrest their entire heart stops beating. If immediate medical attention is not administered it can often be fatal. The most effective treatment for sudden cardiac arrest is to apply a defibrillator as soon as possible. The defibrillator can send shocks to the heart until the rhythm is restored and it beings to contract and expand by itself again. Another fatal but less common arrhythmia condition is ventricular fibrillation. This condition can be fatal because the heart no longer beats at a regular pace, but instead begins to flutter. This fluttering can be dangerous because it does not allow the heart to pump blood.
Other arrhythmia conditions could be an ongoing condition as a result of a previous heart attack. Arrhythmia can also occur in patients that are recovering from a heart surgery. If the arrhythmia is chronic without prior operations or surgeries it could indicate a patient has a coronary artery disease or a valve disorder. Other factors could play a part in unexplained arrhythmias such as an imbalance of sodium or potassium. A range of treatment options for these conditions includes prescription medication, invasive therapies, or a simple change in lifestyle.