Clinical cardiac electrophysiology

From Wikipedia, the free encyclopedia

Clinical cardiac electrophysiology (also referred to as cardiac electrophysiology or electrophysiology), is a branch of the medical specialty of cardiology 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).

An electrophysiologic study is a term used to describe 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 methods to treat many of the rhythm disturbances of the heart. Therapeutic modalities employed in this field include antiarrhythmic drug therapy and implantation of pacemakers and implantable cardioverter-defibrillators.

1 Scope of practice, tests and procedures
2 Related articles
3 External link

[edit] Scope of practice, tests and procedures

[edit] Diagnostic testing

Ambulatory electrocardiographic monitoring - Holter recording and interpretation, loop recording and interpretation
Tilt table testing
Signal-averaged electrocardiogram interpretation
Electrophysiologic study - insertion of pacing and recording electrodes in the heart to measure electrical properties of the heart and conduction system and to electrically stimulate the heart in an attempt to induce arrhythmias for diagnostic purposes (programmed electrical stimulation - as described above)

[edit] Medical treatment

Initital 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.

[edit] Catheter ablation

Ablation therapy - Catheter based creation of lesions in the heart (with radiofrequency energy, cryotherapy (destructive freezing), or ultrasound energy) to cure or control arrhythmias (see radiofrequency ablation). Ablation is usually performed during the same procedure as the electrophysiology study which induces and confirms the diagnosis of the arrhythmia for which ablation therapy is sought.

"Non-complex" ablations include ablation for arrhythmias such as: AV nodal reentrant tachycardia, Accessory pathway mediated tachycardia, atrial flutter. These procedures are usually performed using intracardiac catheters (as are used during an electrophysiologic study), fluoroscopy (a real-time X-ray camera), and electrical recordings from the inside of the heart.

"Complex" ablations include ablation for arrhythmias such as multifocal atrial tachycardia, atrial fibrillation, and ventricular tachycardia. In addition to the apparatus used for a "non-complex" ablation, these procedures often make use of sophisticated computer mapping systems to localize the source of the abnormal rhythm and to direct delivery of ablation lesions.

[edit] Pacemaker and Defibrillator implantation and follow up

Implantation of single and dual chamber pacemakers and defibrillators
Implantation of "biventricular" pacemakers and defibrillators for patients with congestive heart failure
Implantation of loop recorders (implanted ECG recorders for long term monitoring of ECG to allow for diagnosis of an arrhythmia)
Clinical follow up and reprogramming of implanted devices