The Clinical Cardiac Electrophysiologist

A clinical cardiac electrophysiologist (cardiac EP) is a healthcare provider who treats heart rhythm problems. A cardiac EP is a type of cardiologist. A cardiologist is a healthcare provider who has had 3 or more years of extra training beyond internal medicine to treat problems of the heart and blood vessels.

What training does a cardiac EP have?

A cardiologist has at least 10 years of medical training. This includes 4 years of medical school, 3 years of training in internal medicine, and 3 or more years in other special training, specifically in cardiovascular disease. They must then pass a test from the American Board of Internal Medicine.

A cardiac EP is a cardiologist who then completes 2 years of extra training beyond that required for board certification in cardiology. They are first certified by the American Board of Internal Medicine in the specialty of cardiovascular disease . This focuses on caring for patients with diseases of the heart and blood vessels, including heart attack, valve disease, and some arrhythmias. After becoming board certified in cardiovascular disease and finishing the extra 2 years of EP training, the provider then is certified in the subspecialty of clinical cardiac electrophysiology. This cardiac subspecialty focuses on testing and treating the heart for rhythm problems. A clinical cardiac electrophysiologist has the specialized education and experience needed to do advanced cardiac-related procedures and interpret their results.

When would I see a cardiac EP?

A cardiac EP isn't your primary healthcare provider. This healthcare provider works only with people who need special heart-related care. Your provider may refer you to a cardiac EP if you have symptoms of heart rhythm problems. These may include dizziness, fainting, and fluttering feelings in your chest. Or you may see a cardiac EP if you have risk factors for a dangerous arrhythmia, such as heart disease. You would likely see a cardiac EP in a hospital or cardiac clinic.

What does a cardiac EP do?

Cardiac EPs test for, diagnose, and treat abnormal heart rhythms. Abnormal heart rhythms are called arrhythmias. EPs need know how the heart works, what kind of arrhythmias there are, and what may cause them. They also know how to do different kinds of tests. They know how to implant special devices in the body to regulate the heartbeat. They also do special procedures such as cardiac ablation to fix heart rhythms problems. And they can prescribe medicine and lifestyle changes, and give other advice. They often work with a general cardiology practice or at a cardiac hospital.

A cardiac EP can diagnose and treat conditions such as:

• Atrial fibrillation. This is an irregular, fast heart rhythm in the upper chambers of the heart.

• Bradycardia. This is a heartbeat that is too slow.

• Tachycardia. This is a heartbeat that is too fast.

• Ventricular tachycardia. This is a dangerous type of very fast heartbeat.

• Supraventricular tachycardia. This is a sudden, very fast heartbeat from the top chambers of the heart

• Ventricular fibrillation. This is a dangerous fluttering of the heart muscle that doesn’t let the heart pump blood. This condition can be fatal.

• Sudden cardiac arrest. This is when the heart suddenly stops beating.

• Long QT syndrome. This is a disorder of the heart that can cause sudden arrhythmias.

• Wolff-Parkinson-White (WPW) syndrome. This is a condition that may cause episodes of a fast heartbeat due to an extra electrical pathway in the heart.

• Other arrhythmias. Arrhythmias can be caused by pregnancy, medicine interactions, or metabolic problems.

Testing for arrhythmias

To help diagnose an arrhythmia, a cardiac EP can order or perform tests such as:

• Electrocardiogram (ECG or EKG). This uses electrodes attached to your chest to record your heart’s electrical activity.

• Blood tests. These are done to check the levels of certain minerals, enzymes, and other chemicals in your blood.

• Echocardiogram. This uses sound waves to show images of your heart structure and gives information about the heart's function.

• Stress testing. This looks at how your heart performs when you stress it with exercise.

• Holter monitor. This is a device you wear for 24 to 48 hours. It records your heartbeats using ECG.

• Event recorder. This is a device you wear that records any abnormal rhythms of your heart. Typically this is worn for 7, 14, or 30 days consecutively.

• Electrophysiology study. This is an invasive test in which a special thin tube (catheter) is placed into a large vein usually in your groin or neck and threaded into the heart. It shows problems with the heart’s electrical system.

• Tilt table testing. This looks at how the heart is affected when your body is moved from a lying position to a standing position on a tilting table.

• Implantable loop recorder. This is a small device put in the chest under the skin. It records your heartbeat all the time and has a battery life of about 3 years. The device records your heart rhythm and sends it to the EP automatically. You can also write down in a diary when you have symptoms, such as dizziness or feeling faint.

Treating arrhythmias

A cardiac EP can do certain procedures and prescribe treatments. These include:

• Cardioversion or defibrillation. This is the use of a device to send a shock of electricity to the heart and restore normal electrical activity.

• Catheter ablation. In this procedure, a thin tube (catheter) is put into a blood vessel in the groin and sent up to the heart. A small part of the heart that is causing arrhythmia is destroyed with radiofrequency (heat) or cryoablation (cold) energy.

• Medicines. These can help control heart rhythm and prevent blood clots.

• Lifestyle changes. Changes in diet or exercise can help with some heart rhythm problems.

A cardiac EP can also implant devices in the body to help reset or control heart rhythm. These include:

• Pacemaker. This is a small device that’s put under the skin of the chest. It sends out electrical signals to help the heart beat at a normal rate.

• Implantable cardioverter defibrillator (ICD). This is a small device that is put under the skin of the chest or in the abdomen. It can reset the heart rhythm when dangerous arrhythmias occur.

• Biventricular pacemaker. This is a small device that is put under the skin of the chest. It helps the lower chambers of the heart beat at the same time. This is known as cardiac resynchronization therapy.

A cardiac EP isn't a heart surgeon. But they're trained in the above surgical procedures. If a cardiac EP thinks you need heart surgery, they'll refer you to a heart surgeon.