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Cardiac Electrophysiology-Pacemaker

Cardiac Electrophysiology-Pacemaker

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Overview

The diagnosis and treatment of abnormal electrical activities of the heart is called cardiac electrophysiology. The doctors who specialise in this field are known as cardiac electrophysiologists. Depending on the patient's condition, they diagnose and treat these rhythm disorders with medications, ablation procedures or devices.

Symptoms of Arrhythmia

Arrhythmia is a condition in which the cardiac rhythm of the heart changes. As a result, it may become too slow, fast, uncoordinated, or irregular. Further, it results in palpitations, breathlessness, light-headedness or syncope, anxiety, fatigue and rarely cardiac arrest (sudden death).

Types of Arrhythmia

Bradycardia
A slow heart rate or bradycardia occurs due to delay or blockage of the heart conduction pathways. A mild form may require no treatment compared to severe bradycardia, which may need the implantation of an electrical device termed a pacemaker within the heart.

Tachycardia
Tachycardia is a rapid heart rate due to ventricular tachycardia or supraventricular tachycardia. Mild forms do not require treatment. However, severe tachycardia often needs medical therapy to slow the heart rate. If not managed with medications, it may require a radiofrequency ablation procedure to correct the problem. Alternatively, some patients with ventricular tachyarrhythmias may require an implanted defibrillator to restore the heart rhythm.

When to see a Cardiac Electrophysiologist?

People who are experiencing the following must immediately seek medical attention; they may then be referred to a cardiac electrophysiologist for further investigation:

  • People experiencing heart palpitations, light-headedness and fainting.
  • Have abnormal heart rhythm, either slow or fast on ECG
  • A person with atrial fibrillation on EKG
  • A person who has survived sudden cardiac arrest
  • A patient with low heart function who might benefit from a combo device to improve heart function or an implantable cardiac defibrillator to prevent sudden death

Diseases Treated by Cardiac Electrophysiologist

Cardiac Electrophysiology and Pacing specialists look after patients having difficulty with heart rhythm and electrical signalling. An electrophysiologist manages conditions such as:

  • Bradycardia: Slow heartbeat-like heart blocks and sick sinus syndromes
  • Supraventricular tachycardia, atrial tachycardia, AV nodal re-entrant tachycardia, AV re-entrant tachycardia, and Wolff-Parkinson-White syndrome
  • Ventricular arrhythmias - ventricular fibrillation, ventricular tachycardia
  • Syncope
  • Heart Failure patients for cardiac resynchronisation therapy
  • Cardiac Arrest survivor
  • Familial arrhythmia syndromes such as arrhythmogenic right ventricular dysplasia, early repolarization, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, idiopathic ventricular fibrillation, long QT syndrome, and short QT syndrome
  • Postural orthostatic tachycardia syndrome

Diagnosis & Test Recommended by Cardiac Electrophysiologists

Apart from advising the standard diagnostic tests, electrophysiologists recommend the following tests:

  • Electrocardiogram: This quick and painless test measures the heart's electrical activity. During an ECG, sensors are placed on the chest, arms, and legs. Some latest personal devices like smartwatches also can monitor heart activity but are not as accurate as EKG.
  • Holter monitoring: Continuous monitoring of the heart rhythm can be done using this portable device for upto 3 days.
  • Event monitoring: Event monitoring is advisable when long-term heart rhythm needs recording.
  • Cardiac magnetic resonance imaging (MRI): This test helps assess cardiac structure abnormalities that may be responsible for arrhythmias.
  • Electrophysiological (EP) testing and mapping: This test, also called an EP study, helps patients with slow or fast heart rates, confirm the diagnosis, and helps in treatment planning.
  • Tilt table test: This test helps patients with syncope.

Cardiac Rhythm Treatment Procedures

Electrophysiologists treat rhythm disorders with various procedures, like

  • Antiarrhythmic drug therapy
  • Catheter procedure may include either radiofrequency ablation or cryoablation, where abnormal focus causing heart rhythm disorders is ablated.
  • Pacemakers for slow heart rate
  • Implantable defibrillators for ventricular tachycardia
  • Cardiac resynchronisation therapy for weak heart function

Last Update

Reviewed by Dr. Ripen Gupta, Senior Director & Unit Head, Cardiac Sciences, Cardiology, Cardiac Electrophysiology-Pacemaker on 19-Oct-2022.

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