The Clinical Cardiac Electrophysiologist

A clinical cardiac electrophysiologist, or cardiac EP, is a doctor who treats rhythm problems of the heart. A cardiac EP is a type of cardiologist. A cardiologist is a doctor 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. He or she must then pass a test from the American Board of Internal Medicine.

A cardiac EP is a cardiologist who completes 3 years of extra training beyond that required for board certification in cardiology. He or she is 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 such as include heart attack, valve disease, and some arrhythmias. After becoming board certified in cardiovascular disease and finishing the extra 3 years of EP training, the doctor then is certified in the subspecialty of clinical cardiac electrophysiology. This cardiac sub-specialty focuses on testing and treating the heart for rhythm problems. A clinical cardiac electrophysiologist has the specialized education and experience needed to perform advanced cardiac-related procedures and interpret their results.

When would I see a cardiac EP?

A cardiac EP is not your primary healthcare provider. This doctor only works with patients who need special heart-related care. Your healthcare 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 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 to know about 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 heartbeat. And they can prescribe medicine, lifestyle changes, and make other recommendations. They often work in a cardiac care unit, emergency room, or intensive care unit.

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.

• Ventricular fibrillation. This is a dangerous fluttering of the heart muscle that doesn’t let it pump blood and 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 causes episodes of a fast heartbeat. These are caused by 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.

• Electrophysiology study. This is an invasive test in which a wire is put into the heart. It shows problems with the heart’s electrical system.

• Echocardiogram. This uses sound waves to show images of your heart structure.

• 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.

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

• 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.

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

• Implantable loop recorder. This is a small device put in the chest under the skin. It records heart activity when a person feels dizzy or faint.

Treating arrhythmias

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

• Defibrillation. This is the use of a device to send a shock of electricity to the heart and make it pump regularly.

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

• Cardiopulmonary resuscitation (CPR). This includes pressing on the chest and breathing into the mouth of someone with cardiac arrest. It helps send blood through the body and can be life saving.

• 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 prevents the heart from beating too slowly.

• 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 is not a surgeon. But if a cardiac EP thinks you need surgery, he or she will refer you to a cardiac surgeon.