What is an Electrophysiologist and Who Should See One?

If you have an irregular heartbeat or a heart rhythm that’s too fast or too slow, your doctor may refer you to an electrophysiologist for care. Electrophysiologists are specialized cardiologists who receive two additional years of training, beyond general cardiology training, to gain expertise about conditions that are related to the heart’s electrical system.

You may not realize it, but the heart has an electrical system. Every time that your heart beats, electrical impulses within your heart trigger the activity. These electrical signals keep your heart beating normally, but in some cases, they may prompt abnormal heart rates or rhythms.

An electrophysiologist can determine the cause of different problems that arise because of abnormal electrical activity in the heart. They may pinpoint the precise origin of a faulty electrical signal within the heart, and they can offer a variety of treatments to manage different conditions.

Electrophysiologists see a mix of patients with slow heart rates, fast heart rates, irregular rhythms like atrial fibrillation (AFib) and people who are at risk of sudden cardiac death.AFib is probably the most common condition that electrophysiologists treat. It causes chaotic, fast heart rhythms in the top chambers of the heart, and it increases the risk of stroke.

You might seek help for AFib if you have symptoms like heart palpitations, shortness of breath or lightheadedness. If you don’t notice any AFib symptoms, your smartwatch or wearable device might tell you to seek medical care because you may have a possible cardiac problem.

Electrophysiologists often diagnose AFib with an electrocardiogram (EKG), a simple, quick test which measures the heart’s electrical activity. To record the heart’s rhythms, an electrophysiologist would place sticky electrodes on your chest. The test would record the electrical activity of your heart, recording the information in wavy lines that create peaks and valleys on a piece of paper. Each part of the wave shows a different phase of your heartbeat. If you’re diagnosed with AFib, it’s possible that you may need to undergo ablation, a procedure to minimize the sources of the abnormal electrical activity.

An electrophysiologist can perform a minimally invasive procedure known as ablation to treat AFib and other heart-rhythm disorders. During the procedure, you would receive anesthesia. The electrophysiologist would make a small incision in your groin to gain access to a vein in your leg. They would thread wires and catheters through the blood vessels, using X-ray or ultrasound guidance, until they reach the spot in your heart causing the abnormal electrical activity. To eliminate the problem, they perform one form of ablation:

• Cryoablation, which pinpoints, freezes and destroys the problematic tissue within the heart. 

• Radiofrequency ablation, which uses heat to burn and destroy the tissue that triggers abnormal electrical activity. 

• Pulsed-field ablation, a new type of ablation, which uses pulsed energy to electrically isolate these areas from the rest of the heart and minimize atrial fibrillation. Pulsed-field ablation targets specific cells without damaging surrounding tissue. 

Electrophysiologists may recommend an electrophysiologic study if you experience symptoms like heart palpitations, rapid heart rate, fainting or other abnormal heart rhythms. The initial steps in the procedure are similar to the steps during an ablation, threading wires and catheters through blood vessels to your heart from a small incision in the groin. However, you would not be put under general anesthesia during an electrophysiologic study because anesthesia can sometimes mask arrhythmias. You would receive sedation so that you’d be comfortable, but you would be somewhat awake for the procedure.

Wires would be placed in different areas of your heart to record the electrical activity. Then, the electrophysiologist would try to induce the arrhythmia by performing pacing maneuvers or giving you intravenous adrenaline drugs to speed up your heart rate. The information that is recorded during the study helps electrophysiologists diagnose arrhythmias. They may perform ablation at the same time, so that you wouldn’t have to undergo another procedure.

Yes. If you need a pacemaker or implantable cardiac defibrillator (ICD), you could see an electrophysiologist:

• Pacemakers are for patients with dangerously low heart rates. Once you receive a pacemaker and your heart rate returns to a normal range, you should feel better – in terms of your behavior – very quickly after the procedure. 

• ICDs are for patients who are at increased risk of sudden cardiac death, either because you have less than 35% heart function – perhaps after a massive heart attack – or because you previously experienced cardiac arrest. An ICD doesn’t make you feel different afterward; it’s more of a safety net, preventing sudden cardiac death. An ICD also has pacemaker functionality. 

When an electrophysiologist determines that you need a pacemaker or ICD, they are the ones to surgically implant it in your chest. They also monitor your health for the rest of your life.

The procedure to implant pacemakers and ICDs is similar. An electrophysiologist would make a small incision in your chest wall and use X-ray guidance to place the appropriate device in the chest. They would then thread wires from the device to your heart, which they would screw into your heart muscle. The whole procedure takes about an hour or less, and patients often go home the same day. Pacemakers and ICDs are powered by batteries that last about 10 years.