Electrophysiology is widely used in both research and clinical settings. Often referred to as the science of life, physiology is a branch of biology that focuses on understanding the intricate workings of living things. Electrophysiology, in particular, focuses on electrical mechanisms. The subjects can range from cellular function at the ionic or molecular level to the integrated behavior of the entire body in response to its external environment.

A cardiac electrophysiologist is a cardiologist who has completed extensive training focused on the heart’s cardiac conduction system, which controls the rate and rhythm of the heartbeat. With each beat, an electrical impulse travels through the heart from top to bottom, causing it to contract and pump blood throughout the body.

Normally, the heart’s electrical signals follow a predictable pattern that causes it to beat in an efficient and orderly manner. However, if something causes the signals to go awry, the heart may begin to beat irregularly (arrhythmia). Not all arrhythmias are a cause for concern, but some can damage or weaken the heart muscle and interfere with its ability to pump blood. A cardiac electrophysiologist can investigate the source of the electrical issue, determine if the resulting arrhythmia is harmless or problematic, and suggest a treatment plan to address it if necessary.

What Does a Cardiac Electrophysiologist Do?

A cardiac electrophysiologist specializes in diagnosing and treating heart rhythm disorders, including:

• Atrial fibrillation (AFib) – Faulty electrical signals can make the heart’s two upper chambers (atria) contract irregularly and much faster than normal, causing the atria to drift out of sync with the heart’s two lower chambers (ventricles). Blood may then pool in the atria, which can potentially lead to the formation of blood clots and stroke.
• Atrial flutter – Faulty electrical signals can make the atria contract too quickly, causing the heart to beat faster, but in a rhythm that is more organized and less chaotic than that typically caused by AFib.
• Bradycardia – Faulty electrical signals can cause the heart to beat unusually slowly, typically fewer than 60 beats per minute depending on the patient’s age and physical condition. As a result, the heart may not pump enough blood to the rest of the body.
• Tachycardia – Faulty electrical signals can cause the heart to beat much faster than normal, typically more than 100 beats per minute depending on the patient’s age and physical condition. The rapid heartbeat can prevent the heart’s chambers from filling completely between contractions, which may compromise blood flow to the rest of the body.
• Ventricular fibrillation (VFib) – Faulty electrical signals can cause the ventricles to contract in a rapid and uncoordinated manner. As a result, the heart does not pump enough blood to the rest of the body. VFib is a medical emergency that may require cardiopulmonary resuscitation (CPR) and/or shocks delivered to the heart via an automated external defibrillator (AED).

What Are Some Common Cardiac Electrophysiology Procedures?

A cardiac electrophysiologist may use several tests and procedures to better understand and treat an arrhythmia. Some common examples include:

Electrocardiogram (EKG)

Several small self-adhesive pads (electrodes) are temporarily placed on the skin of the chest, arms, and legs. Connected to an EKG machine via lead wires, the electrodes monitor, track, and record the heart’s electrical activity. To capture infrequent arrhythmias, a portable EKG (Holter monitor) may be worn for 24 to 48 hours.

Tilt-Table Testing

Several electrodes are temporarily placed on the skin of the chest, arms, and legs. While the patient lies comfortably on a special table, an electrophysiologist will gradually change the angle of the table from flat to upright. During the test, the electrodes will monitor, track, and record the heart’s electrical activity, allowing the electrophysiologist to evaluate how it adapts to the changes in body position.

Electrophysiology Studies

After making a needle puncture in the groin, arm, or neck, an electrophysiologist will thread one or more special catheters into the heart via a blood vessel, then send small electrical impulses through the catheters. The electrical signals produced by the heart in response will be picked up by the catheters and recorded. Known as cardiac mapping, this process can help the electrophysiologist locate the source of an arrhythmia.

Cardiac Ablation

After threading special catheters into the heart, an electrophysiologist will deliver hot or cold energy to the precise spot where an arrhythmia originates. The goal is to create tiny scars to block irregular electrical signals and restore a normal heartbeat.

Electrophysiologists also insert, replace, and program cardiac implantable electric devices (CIEDs) such as pacemakers, implantable cardioverter defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices.

Talk With an Expert

If you experience an irregular heartbeat, a racing heart, a fluttering feeling in your chest, or a sensation that your heart has skipped a beat, your primary care provider may refer you to a cardiac electrophysiologist. You may also benefit from a consultation with this type of specialist if you experience unexplained fatigue, dizziness, fainting, or excessive sweating.

You can talk with an experienced electrophysiologist in the cardiology department at Florida Medical Clinic Orlando Health. We see patients at several locations in the Tampa Bay area, including 14320 Bruce B. Downs Blvd. in North Tampa, 7760 Curley Rd. in Watergrass, and 2352 Bruce B. Downs Blvd. in Wiregrass. To request an appointment at any of these offices, please click here.

About Paul Z. Gerczuk, MD

Dr. Gerczuk is a graduate of St. George’s University School of Medicine. He completed his internal medicine residency at the University of Southern California Keck School of Medicine, a Cardiovascular research fellowship at The Heart Institute at Good Samaritan Hospital, a General Cardiology fellowship at Allegheny General Hospital, and a Cardiac Electrophysiology fellowship at the University of South Florida. As a cardiac electrophysiologist, he has extensive knowledge about the heart’s electrical system, and he specializes in diagnosing and managing abnormal heart rhythms.