What Is Electrophysiology?

An electrophysiologist is a cardiovascular physician with special training in treating and managing heart rhythm problems.

Electrophysiologists are specialists in treating problems having to do with heart rhythm, such as if the heart beats too fast, or if the heart beats too slow, or if people experience fainting. Specific problems include conditions like atrial fibrillation, tachycardia, palpitations, ventricular tachycardia, pacemakers, defibrillators, and ablations for abnormally fast heart rhythms.

An electrophysiologist is a cardiologist who has one or two years of extra training and who specializes in treating cardiac rhythm problems. Whereas the cardiologist is trained to treat general heart problems. All electrophysiologists are cardiologists, but not all cardiologists are electrophysiologists.

There are many routes to an electrophysiologist’s office. Sometimes a patient will be referred by their primary care physician. Sometimes patients may see a cardiologist who is not an electrophysiologist and who will refer you to an electrophysiologist, and sometimes patients may have to seek an electrophysiologist out themselves and have a self-referral. If you already have a primary care physician, you can always ask to specifically see an electrophysiologist if you have a heart rhythm problem.

There are many tools and treatments available for electrophysiologists. Initially an electrophysiologist may prescribe medications, some of which are medicines that are highly specialized and are best prescribed and managed by an electrophysiologist. There are also procedures that an electrophysiologist may perform to treat heart rhythm problems. Some of the procedures include pacemakers, which are used to treat heart rhythms that are too slow. Defibrillators are used to prevent cardiac death from abnormally fast heart rhythms, such as ventricular tachycardia or ventricular fibrillation. The most common procedures performed by electrophysiologists are called ablations, which are used to treat fast rhythms that come from certain parts of the heart by finding those abnormal tissues and cauterizing or freezing them so that they do not cause problems anymore.

During the first visit, we would usually take standard vital signs including blood pressure and heart rate. The doctor will then sit down with you to talk about your symptoms, which helps point to the type of heart rhythm problem you are most likely to have. A physical examination and an electrocardiogram (EKG) then help pinpoint where the problem may be.

Most electrophysiology procedures, including pacemaker implants and ablations to treat abnormally fast heart rhythms, are done with the patient sedated. Sometimes it is complete general anesthesia, and sometimes it is mild or moderate sedation depending on the condition of the patient and the condition being treated.

Ablations are done for different types of abnormal heart rhythms.  The success rate depends on the type of heart rhythm being treated. For the most common types of SVT, success rates are in the 90 to 95% range.  For other types of heart rhythm problems, such as atrial fibrillation, success rates can range from 60 to 80%.

It depends on the type of ablation and the type of condition being treated. Some conditions, such as WPW or SVT, have cure rates of 95% to 98%, and once the condition is confirmed cured, multiple follow-up visits may not be needed. For most conditions, however, some follow-up will be required. It really depends on what type of condition it is.