Afib Doctor - The Electrophysiologist
What in the world is The Electrophysiologist?
I had just gotten over the shock of having to go see a Cardiologist for my Atrial fibrillation and now he says I
need to see the Electrophysiologist.. While most heart doctors are lumped into the category "Cardiologist"
Electrophysiologists are heart-rhythm specialists.
The other doctors call them "EPs." I will try to refer to them as EP's as "Electrophysiologist" is too long to type and spell, EP is
much simpler.
In a nutshell Electrophysiology is a branch of cardiology that deals with the diagnosis and
treatment of heart rhythm disorders. They do an extra year (or two) of training after the standard cardiology
fellowship.
EP doctors do mostly just three things:
1. Ablate (They burn).
2. Implant and manage cardiac devices (They install). Pacemakers and
such.
3. Take care of patients (They talk to us).
Burning:
Catheter ablation is a procedure in which a small catheter is placed inside the
heart (via a leg vein). The catheter has a 4-8 mm metal tip through which radio-frequency energy is skillfully
delivered to selected parts of the heart from the inside. The area to ablate is found primarily by two simple
strategies: vector analysis of the how the arrhythmia activates the heart (ie…north-south, east-west) and secondly,
by moving the ablation catheter in a "warmer-colder" trial-and-error manner.) The 4-8 mm ablation lesions can
eliminate rogue cells that have electrically run amok, or in the case of Atrial Fibrillation, isolate entire areas
of the heart into quadrants with lines of scar tissue in order to "block" the unwanted stimuli causing the weird
"Afib" rhythm.
Catheter ablation is the only
cardiac procedure that can be correctly called curative. (No, stents are not curative.)
Ablation started to become available the mid-1990s but did not start getting wide
use for atrial fibrillation until some time later. Over the past few years, Atrial Fibrillation ablation has
emerged as electrophysiology’s most exciting therapy, and it is now the focus of much interest as a possible "cure"
for Afib.
Installing:
The other procedures EP's do is implantation of cardiac devices. Pacemakers,
Defibrillators, and Cardiac Resynchronization Devices that are placed under the skin in the upper chest and are
connected to wires that are snaked through veins and positioned into the heart for sensing, pacing and shock
delivery.
It takes time to learn the surgical installation process, and attention to detail
is essential to do it well, the far greater challenge in device management is skillfully applying these complex
therapies in the management of patients–the judgment part. The EP Doctor must know the latest procedures and
techniques in this fast changing specialty. New drugs and better methods of ablation are being developed almost
daily.
Doctoring:
Electrophysiologists don't just do procedures and install stuff. They are real
medical doctors.
In many cases, a heart rhythm problem results from a random event–a fluke.
Supra-ventricular tachycardia , lone Atrial Fibrillation in a young healthy person, and congenital AV-block are
just three examples of many such hiccups of nature. These non-acquired (congenital) problems comprise a substantial
portion of the EP's work. EP doctors are fortunate because they get to treat a wide range of patients: from the
very young, with congenital disease, to the aged with the disease of excessive birthdays, and everywhere in
between.
But in other cases, the heart’s rhythm is affected by environmental factors, both
cardiac and non-cardiac. For instance, hardening of the arteries and heart attacks cause heart rhythm problems. So
does long-standing high blood pressure, diabetes, sleep disorders and bad lifestyle choices.
Understanding whether to use a catheter, a device, a medicine, or in some cases,
none-of-the-above, requires The EP to listen to, exam, and talk with their patients. In other words…be a doctor. My
EP is a great doctor but it pays to do your homework to know what questions to ask.(see - THIS
WEBSITE)
Electrophysiology is a mix of pharmacology, procedures, and surgery all meshed
together with doctoring with the goal being to "fix" your heart rhythm.
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