It is the science and study of the electrical activity of the heart.
The heart is a muscle that pumps blood around the circulation. To initiate the process of pumping the heart has electrical channels that spread the electricity in an organized manner to its cells. This electrical impulse originates at the sinus node, the natural pacemaker of the heart. Arrhythmia is the disturbance of the electrical activity of the heart. Being a human organ and not a machine the heart occasionally goes out of rhythm. This is called an arrhythmia. Arrhythmias can cause symptoms, usually palpitations that commonly let people visit a Cardiologist or an Electrophysiologist.
Most arrhythmias are benign but can be unpleasant so we tend to treat them for symptomatic relief. Unfortunately, some rhythm disturbances are potentially dangerous and should be diagnosed early to avoid disastrous consequences.
There are a vast number of arrhythmia substrates and there is a specific treatment for each and every one of them. The General Cardiologist can manage most of the arrhythmias but some aspects of the treatment require a specialist opinion by an Electrophysiologist.
A considerable number of investigations are available to discover the specific rhythm problem and the skill is to decide which is the correct one to avoid wasting patient’s time and unnecessary expenses. This often depends on the experience of the electrophysiologist.
Diagnosis and Treatment of:
- Atrial Fibrillation (AF)
- Congenital Channellopathies
- Sudden Cardiac Death Syndromes
- Supraventricular Tachycardia (SVT)
- Ventricular Extrasystoles-Ectopic Beats
- Wolff-Parkinson White Syndrome (WPW)
Non-invasive procedures offered:
- 24-hour Ambulatory Electrocardiogram (Holter) Monitoring
- Pharmacological Infusion Tests
- Pacemakers/Defibrillators- Regular Check-ups
Pharmacological Infusion Tests:
The infusion of some intravenous medication can help identify certain arrhythmia substrates. Other infusion tests can assist in diagnosing inherited, potentially lethal electrical abnormalities. These procedures are performed by an experienced specialist in cardiac arrhythmias.
Pacing and Defibrillator Clinic:
Following implantation of a pacemaker or defibrillator, the device should be checked on at least an annual basis. The check involves testing the parameters of the wires, the battery and the programmed settings and fine-tuning the device function. No operation is needed for these tests as the pacemaker communicates with the programmer equipment via radio waves.
Invasive procedures offered:
Ablation of Atrial Flutter
Ablation of Atrial Fibrillation (AF) Ablation of Supraventricular Tachycardia (SVT)
Ablation of Ventricular Tachycardia
Direct Current Cardioversion
Electrophysiological Study (EP Study)
Implantation of Internal Loop Recorder (ILR)
Implantation of Biventricular Pacemakers
Implantation of Cardiac Defibrillators
Implantation of Permanent Pacemakers
Pacemaker Battery Replacement
An electrophysiological study is an invasive procedure that is undertaken to determine the cause of the abnormal heart rhythms, or to exclude the presence of an abnormal substrate. A number of catheters are introduced into the heart via small punctures in the veins of the leg, shoulder or neck. Various measurements are taken of the electrical conducting system of the heart. In most cases the abnormal heart rhythms are initiated by various pacing maneuvers. After the problem is identified with the electrophysiological study an ablation procedure can performed at the same time. These procedures are done with sedation or a general anaesthetic.
Ablation is the process that modifies small parts of the heart muscle that are responsible for the abnormal heart rhythms or palpitations. This is done by heating the area using radiofrequency electric current at the end of a catheter that is placed in contact with the heart muscle.
Once that part of the heart muscle is modified it no longer conducts electrical impulses so the palpitations that originate from that area stop. The procedure is performed with heavy sedation and strong pain relief. Sometimes a general anaesthetic can be used.
Implantation of a cardiac pacemaker:
The heart has its own natural pacemaker called the sinus node, which produces regular electrical impulses. This keeps the heart beating regularly throughout life.
If the heart rate is too slow a pacemaker may be needed to speed it up. An artificial pacemaker is a small electronic box about the size of a cigarette lighter, which can generate electrical impulses. The pacemaker is connected to pacing wires, which have been placed inside the heart via some veins, usually under the collarbone.
The pacemaker monitors the heart rate continuously and when it detects that the pulse has slowed down it generates an electrical signal which travels through the pacing wires to make the heart beat.
A specialist in cardiac devices and arrhythmias, under sterile conditions, using local anesthetic, pain relief and sedation, performs the procedure. The device is placed under the skin leaving a small scar on the left side under the collarbone. The recovery is quick with the majority of patients being discharged the day following the procedure.
Implantation of a Cardiac Defibrillator (ICD)
Sudden cardiac death is caused by life-threatening arrhythmias. Implantable cardiac defibrillators continuously monitor the heart rhythm, automatically function as pacemakers for heart rates that are too slow, and deliver life-saving shocks if a dangerously fast heart rhythm is detected.
The implantation is similar to a pacemaker by gently positioning wires in the heart and connecting them to the defibrillator box sitting below the left collarbone. A specialist in cardiac devices and arrhythmias performs the procedure.
Direct current cardioversion
Cardioversion is a brief procedure where an electrical shock is delivered to the heart to convert an abnormal heart rhythm back to a normal rhythm. The procedure simply resets the heart and is commonly performed to treat atrial fibrillation. This done under heavy sedation or an anaesthetic.
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