Cardiac Electrophysiology

Cardiac electrophysiologists are cardiologists who have special training and expertise in the diagnosis and treatment of cardiac arrhythmias and syncope (fainting spells). Cardiac electrophysiologists have trained in Internal Medicine and Cardiology prior to spending an additional one to two years in a formal clinical cardiac electrophysiology training program. The American Board of Internal Medicine has separate Board Certifications for Internal Medicine, Cardiology and Clinical Cardiac Electrophysiology. It is perhaps surprising that physicians only recently began to specialize in the diagnosis and treatment of arrhythmias since these disturbances represent the most common single cause of death in most industrialized countries. However, recent advances in electronics and in the biology of arrhythmias have empowered Electrophysiologists to treat patients with a wide range of abnormal heart rhythms and syncope.

Persons who have had a cardiac arrest from any cause. Persons at risk to have a cardiac arrest. This includes but is not limited to persons with coronary artery disease, persons who have had a myocardial infarction, persons with congestive heart failure or poor heart function, and persons with intrinsic heart muscle disease such as hypertrophic cardiomyopathy, sarcoidosis or amyloidosis. Persons with documented arrhythmias. Persons with familial heart disease such as Wolff-Parkinson-White syndrome or a family history of cardiac death at a young age. Persons who have palpitations or fluttering in their chest. Persons who have had a loss of consciousness that has not been explained. Persons with congestive heart failure or poor heart function of any cause.

Many electrophysiologists restrict their activity to clinical cardiac electrophysiology alone. The physicians of the Texas Arrhythmia Institute take a more global and holistic approach to clinical cardiac electrophysiology and consider the whole patient when assessing their cardiac electrical problems. Although cardiac electrical problems must be addressed separately from other problems, solutions to the problems often depend upon the other health problems the person may have. Therefore, our physicians are capable of and do evaluate general internal medicine and cardiology in addition to clinical cardiac electrophysiology. The cardiac electrophysiologists of the Texas Arrhythmia Institute use a variety of sophisticated skills and procedures to diagnose and treat arrhythmia disorders in the context of other medical conditions may aggravate the electrical problems. All evaluations start with a thorough history and physical examination and often will include standard cardiac tests such as an echocardiogram, stress test, or cardiac catheterization. Electrophysiologists may then use special tests to diagnose and treat disorders of the cardiac electrical system or blood pressure reflexes. These tests will be discussed in a separate section.

Several factors have contributed to the rapid growth of cardiac electrophysiology:

The failure of antiarrhythmic drugs to control arrhythmias. The failure of antiarrhythmic drugs to decrease the recurrence of sudden cardiac death (SCD) brought non-drug therapy to center stage. The development of minimally invasive techniques for localizing and selectively eliminating abnormal cardiac tissue giving rise to arrhythmia have made catheter-based ablation an effective non-surgical cure or palliation of arrhythmias in many patients. Implantable cardioverter-defibrillators (ICD) have proven remarkably effective in preventing sudden cardiac death (SCD). Increased miniaturization of defibrillators and development of electrodes inserted through superficial blood vessels under local anesthesia reduced implantation from major surgery to a simple surgical procedure. Advances in pacemaker technology have allowed device therapy to supplement or even supplant drugs for difficult to control atrial arrhythmias.

For the growth to continue it is important to develop precise understandings of the mechanisms of cardiovascular diseases and to facilitate the delivery of technologically sophisticated medical procedures in a cost effective and caring manner. In the past, new and expensive techniques have been developed and widely used in many seemingly appropriate situations before any scientific evidence of their advantages or effectiveness was demonstrated. Examples of such procedures are MRI scans, percutaneous balloon angioplasty or coronary artery bypass surgery. A clear understanding of the effectiveness of procedures in different situations is necessary for prudent usage. PTCA can relieve chest pain from coronary artery disease and sometimes improve the overall function of the heart, but PTCA has not been shown to save lives or prevent heart attacks except when used in the early hours of a heart attack. In this day of mushrooming health care costs, prudence must be exercised in utilization of relatively shrinking resources.

Procedures in clinical cardiac electrophysiology have already been shown in numerous studies to make real differences in the health and welfare of persons, to save lives and to make the quality of living better. Appropriate therapies can be curative and life saving but inappropriate therapies can be fatal. This is why a precise understanding of the cardiac electrical system and the myriad of sometimes very technologically sophisticated and expensive therapies needs to be firmly in hand before treating one person or whole societies. The physician who has the knowledge, understanding and experience to accomplish this complex task now is the cardiac electrophysiologist.