Cardiac electrophysiology is a fairly new entry in cardiac subspecialties focusing most on rhythm dysfunction of the heart. In the second half of the 20th century, heart arrhythmias gained attention as disorders that could be effectively treated through a variety of interventions. Since its development, the field has seen numerous improvements and innovations, and many cardiology medical programs now offer fellowships of two to three years in length that take place after a cardiology specialty has been completed. There are both adult and pediatric electrophysiologists who employ many diagnostic and interventional tools, in addition to relying on treatments like drugs or pacemaker implantation to cure or reduce likelihood of serious dysrhythmias (any abnormal changes to rhythm).
Study of both normal and abnormal heart rhythms and their treatment, from an electrical perspective, are part of cardiac electrophysiology. The heart has an internal electrical system that regularly sparks or creates signals, which regulate its contractions and periods of relaxation. These are complex, and as with any electrical system, errors of these impulses can lead to dysfunction. This may be extremely minor and pose few problems or it can be very serious and impact the way the heart functions as a whole unit. Understanding exactly where these signals arise and what they control is part of this field, and this understanding can lead to different measures to treat the problem, if necessary.
In clinical practice, cardiac electrophysiology can utilize a number of different tools to diagnose problems. It regularly employs recording devices like electrocardiograms (EKGs) that can take a quick reading of the different heart signals. Other monitoring equipment can be used for longer periods of time, like 24-hour holters or event monitors. These help record events that occur sporadically. Additional diagnostic equipment includes the stethoscope, since rhythm errors may be heard, and much more advanced technology like echocardiograms or cardiac catheterization.
Precise tests can be used in a variety of ways to conduct evaluations of the electric functions of the heart. When not enough information exists about causal factors of a dysrhythmia, an option in diagnostic cardiac electrophysiology is to use the cath lab to evaluate the heart’s electrical impulses. Doctors can even induce arrhythmia to determine from where it arises. Techniques like radiofrequent ablation can destroy certain electrical pathways that cause some rhythm problems, and an EP or cardiac electrophysiology study in a catheterization lab can be curative if an abnormal pathway is discovered and destroyed.
Electrophysiologists are quick to state their field is still evolving and can be mystifying, at times. Sometimes radiofrequent ablation doesn’t work when it should, or it becomes very difficult to identify the source of a problem. In these instances, there are other treatments that can be considered. Medications can control some heart rhythms and very serious rhythm issues could be addressed with pacemaker or defibrillator implantation. The diverse possibility for treatment means that cardiac electrophysiology specialists regularly and closely work with standard cardiologists, cath lab interventionists, and cardiothoracic surgeons.
