The Role of a Cardiac Electrophysiologist

by admin | March 17, 2022 11:05 am

The heart is the most vital organ of the body, as oxygen-rich blood pumped by the heart is what sustains us. The pumping of blood involves contracting of the atria (upper chambers of the heart) and the ventricles (lower chambers of the heart) in a sequence. This sequence happens in a particular rhythm which is controlled by electrical signals that originate from within the heart. The origin of the signals lies in the Sino Atrial Node (SAN) which is the ‘pacemaker’ of the heart.

Like several other natural processes that happen in the body round the clock, the heart’s electrical activity also can undergo disruption. While an occasional disruption is well – tolerated by a healthy heart and body, frequent disruptions that become chronic can lead to several short and long-term health problems. These disruptions require a detailed study so that necessary action can be taken. These are carried out by cardiologists who are specialists in the field, called Cardiac Electro-Physiologists or ‘CEP’ for short. A CEP is not somebody that a patient would meet on their own. They are often referred to by a Cardiologist[1], and participate in the treatment plan for the patient.

Education and training received by a cardiac electrophysiologist

Cardiac Electrophysiology is an intricate science of its own, so a CEP requires appropriate education and training to become a qualified expert in the field. Both in India and worldwide, a CEP would have gone through all of these:

• An average of four to five years in medical school (MBBS in India)
• A three-year residency in internal medicine
• Three to five years of additional training or fellowships in cardiovascular diseases
• An exam to become certified as a cardiologist by the concerned Medical body in the country
• Two years additional training in electrophysiology
• An exam to become certified as an electrophysiologist by the concerned Medical body in the country

Conditions that require a CEP

Arrhythmias[2] is a generic term for any condition that involves irregular heart-beat. But there are several variations of the same and a qualified CEP would be aware of this. A CEP would get involved if the patient is suffering from any of the below:

• Atrial fibrillation: An irregular or fast heart-rhythm that originates in the upper chambers of the heart.
• Ventricular fibrillation: An irregular or fast heart-rhythm that originates in the lower chambers of the heart, which does not let the heart pump blood. This can be a fatal condition.
• Tachycardia: A heartbeat that is too fast.
• Ventricular tachycardia: This is a dangerous type of very fast heartbeat that originates in the ventricles of the heart.
• Supraventricular tachycardia: This is a sudden and very fast heartbeat that originates from above the ventricles.
• Bradycardia: A heartbeat that is too slow.
• Sudden cardiac arrest: This is when the heart suddenly stops beating or there is no rhythm
• Long QT syndrome: In this disorder, the heart suddenly develops arrhythmias due to abnormal conduction of electrical signals within the heart.
• Wolff-Parkinson-White (WPW) syndrome: In this condition, an extra electrical-pathway is present in the heart. This causes episodes of fast heartbeat.
• Other kinds of arrhythmias: Arrhythmias can be a temporary condition caused by infections, inflammation, pregnancy, drug interactions, or any other metabolic problem.

Tests conducted by a CEP

Once Arrhythmias is detected in a patient, it’s important to know the type and cause for the same. For this, various tests are undertaken by a CEP.

• Electrocardiogram (ECG or EKG): In this test, electrodes are attached to the patient’s chest to record the heart’s electrical activity.
• Echocardiogram: In this, sound waves are used to show images of the structure of the heart that  give information about the heart’s function.
• Blood tests: These look for the level of certain chemicals, minerals and enzymes in the blood.

• Stress testing: This looks at how the heart performs when the patient is stressed with exercise.
• Holter monitor: This device is worn by the patient for 24 to 48 hours. It records the heartbeats using an ECG.
• Event recorder: This device which is worn by the patient records any abnormal rhythms of the heart. Typically, it is worn for 7, 14, or 30 days consecutively.
• Implantable loop recorder: This small device is put in the chest under the skin. It records the patient’s heartbeat all the time and has a battery life of around 3 years. The heart rhythms so recorded are sent to the CEP automatically. The patient will also be asked to write down their symptoms such as dizziness or feeling faint, in a diary.
• Tilt table testing: This looks at how the heart is affected when the patient is moved from a lying position to a standing position on a tilting table.
• Electrophysiology study: This is covered in detail in another article.

Treatment and Interventions undertaken by a CEP

In an earlier section, we have examined the education and training that a CEP receives. This puts him/her in a unique position to understand most cardiac ailments. He/she is then qualified to undertake certain procedures and prescribe medication. And, in the eventuality that the patient requires to undergo a surgery to resolve the condition, the CEP will refer the patient to a cardiac surgeon.

• Lifestyle changes: Depending on the patient’s condition, the CEP may recommend changes in diet or exercise which can help overcome some of the heart-rhythm issues.
• Medication: The CEP will prescribe medicines that help regulate heart rhythm and prevent blood clots.
• Catheter ablation: As the name implies, a thin tube called a catheter is put into a blood vessel in the groin and pushed all the way up to the heart. Electrodes are inserted through them that help to search and detect a site or a focus in the heart that is suspected to be causing arrhythmias that are then “ablated”, using radio frequency energy.
• Cardioversion or defibrillation: In this procedure, a device sends pulses of electricity to the heart in an attempt to restore normal electrical activity.
• Cardiopulmonary resuscitation (CPR): This is the first line of support to somebody who has had a cardiac arrest (no breathing and no heart beat). It involves applying pressure on the chest and breathing into the mouth of someone or delivering air or oxygen through appropriate masks and tubes. This has the effect of sending blood through the body and can be life-saving.
• Pacemaker implant: Pacemaker is a small device that is put under the skin of the chest and connected to heart through leads. It sends out electrical signals which help the heart to beat at a normal pace.
• Implanting a Biventricular pacemaker: Cardiac resynchronization therapy is one in which the lower chambers of the heart are made to beat in sequence and synchrony with the upper chambers. This requires a small device called Biventricular pacemaker to be put under the skin of the chest.
• ICD implant: Implantable Cardioverter Defibrillator is a small device that is put under the skin of the chest or in the abdomen. It is used when dangerous arrhythmias occur, which the pace maker senses and fires (cardioverts/ defibrillates), to help reset the heart rhythm.

Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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