Clinical cardiac electrophysiology


Clinical cardiac electrophysiology (also referred to as cardiac electrophysiologyarrhythmia services, or electrophysiology), is a branch of the medical specialty of cardiology and is concerned with the study and treatment of rhythm disorders of the heart. Cardiologists with expertise in this area are usually referred to as electrophysiologists. Electrophysiologists are trained in the mechanism, function, and performance of the electrical activities of the heart. Electrophysiologists work closely with other cardiologists and cardiac surgeons to assist or guide therapy for heart rhythm disturbances (arrhythmias). They are trained to perform interventional and surgical procedures to treat cardiac arrhythmia.

The training required to become an electrophysiologist is lengthy and requires seven to eight years after medical school (in the U.S.), entailing three years of internal medicine residency, three years of clinical cardiology fellowship, and one to two (in most instances) years of clinical cardiac electrophysiology.

An electrophysiology study is any of a number of invasive (intracardiac) and non-invasive recording of spontaneous electrical activity, as well as of cardiac responses to programmed electrical stimulation. These studies are performed to assess arrhythmias, elucidate symptoms, evaluate abnormal electrocardiograms, assess risk of developing arrhythmias in the future, and design treatment.

In addition to diagnostic testing of the electrical properties of the heart, electrophysiologists are trained in therapeutic and surgical methods to treat many of the rhythm disturbances of the heart. Therapeutic modalities employed in this field include antiarrhythmic drug therapy and surgical implantation of pacemakers and implantable cardioverter-defibrillators.

Diagnostic testingAmbulatory electrocardiographic monitoring - Holter and event monitor recording and interpretation;

  • Tilt table testing;
  • T-wave alternans testing;
  • Signal-averaged electrocardiogram (SAECG) interpretation, also referred to as "late potentials" reading;
  • Electrophysiology study (EPS) consists in the insertion of pacing and recording electrodes either in the esophagus (intra-esophageal EPS) or, through blood vessels, directly into the heart chambers (intra-cardiac EPS) in order to measure electrical properties of the heart and, in the case of intra-cardiac EPS, to electrically stimulate it in the attempt to induce arrhythmias for diagnostic purposes ("programmed electrical stimulation").

Medical treatment

Initial administration and monitoring of the effect of drugs for treatment of heart rhythm disorders. Electrophysiologists are often involved when severe or life-threatening arrhythmias are being treated, or when multiple drugs must be used to treat an arrhythmia.

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John Mathews
Journal Manager
Current Trends in Cardiology