Electrophysiology

Cardiac electrophysiology is a discipline that explains the problem of rhythms and their treatment. Electrophysiology has been marked by various advancements in the diagnosis and management of cardiac arrhythmia. Being one of the best hospitals in India, the Department of Electrophysiology at Fortis Healthcare is well-equipped with vibrant and skilled electrophysiologists who perform electrophysiological studies using advanced technology and the latest treatments to treat cardiac arrhythmic conditions.

What is Electrophysiology?

Electrophysiology refers to the evaluation of electrical signals or impulses, generated in the heart chambers. The electric impulses generated ensure that the chambers of the heart contract at the right time to pump the blood through the body and the circulatory system properly. The pattern, rate, and timing of generating these electric impulses are called heart rhythm.  Let us understand in detail how electric impulses are generated.

Steps to understand the generation of heart rhythm

• Roots of the Beat: The heart’s rhythm starts with the sinoatrial (SA) node, a natural pacemaker in the right atrium. SA node takes the initiation of generating electrical impulses.
• Conduction Pathway: These impulse pass through the atria and promote contraction and push blood into the ventricles. Serving as an intermediator between the atria and ventricles, the atrioventricular (AV) node delays the impulse with a view of allowing enough time for the ventricles to fill to capacity.
• Ventricular Performance: These impulses move across the atria and create contractions, which circulates the blood through the ventricles. These impulses travel across the atria, prompting their contraction to propel blood into the ventricles.

Electrophysiology studies in diagnosing abnormal heart rhythm 

The heart rhythm is said to be abnormal when generated impulses are irregular in nature. These conditions of abnormal heart rhythm are called cardiac arrhythmia. The symptom of this condition includes palpitations, chest pain, dizziness, shortness of breath, etc. When one experiences such symptoms, it’s high time to consult a cardiologist for an initial consultation. The cardiologist may advise basic investigations such as electrocardiograms and echocardiograms. In the event of abnormalities in heart rhythms, the patient may be referred to an electrophysiologist for further evaluation of cardiac valves.

The cardiac electrophysiologist is a cardiologist who has additional training in diagnosing and treating of problems in heart or cardiac rhythms.  When patient is referred to electrophysiologist, they may advise anti-arrhythmic medication and conduct a Electrophysiology Study (EPS) for further evaluation of cardiac arrhythmia.

Procedure:

The electrophysiological studies entail the specialized procedure to evaluate the electrical system of heart. Here is the stepwise breakdown of the procedure.

• The patient is taken to a procedure room where electrophysiological study is performed. The patient vitals are monitored for safety evaluation. They may receive sedative to help them relax.
• The Cardiac Electrophysiologist inserts thin, flexible wires called catheters into blood vessels, usually through the groin. These catheters are guided into the heart using fluoroscopy (X-rays).
• The catheters are positioned in various locations within the heart. Each catheter has electrodes at its tip to acquire and display cardiac electrical signals in real-time.
• The electrodes on the catheters receive electrical signals from the heart, which are displayed on a monitor. These signals help the electrophysiologist understand the heart’s electrical activity.
• To induce abnormal heart rhythms, the electrophysiologist stimulates the heart using the electrodes or administers cardiac medications through the blood vessels.
• Once an arrhythmia is induced, the electrophysiologist diagnoses its cause using the signals obtained from different cardiac locations. A series of moves are performed using the electrical signals delivered through the catheter electrodes.
• After the study, the catheters are removed, and the insertion site is bandaged. The patient is monitored for a short period before being allowed to go home.

Therapeutic Procedures in Electrophysiology:

Electrophysiology studies are used in various therapeutic applications apart from diagnosis. Some of them include.

Cardioversion: This procedure involves passage of synchronized electric shock to the chest with a intention of restoring the normal heart rhythm to treat conditions of such as atrial fibrillation or ventricular tachycardia.

Catheter Ablation: A catheter with an electrode is inserted into the heart; this is used to regulate either heat or cold energy to the affected area of the heart muscle. This energy interferes with the electrical signals that result in the development of the arrhythmia, in a way a seal or scar is created so that the abnormal signals do not propagate further. Usually, it is used in the treatment of atrial fibrillation, supraventricular tachycardia and ventricular tachycardia.

Clinical Significance of Electrophysiology:

• Electrophysiology is the central component in the diagnosis and grouping of cardiac arrhythmias and management of patients dealing with such condition’s disorders. By deeply understanding the electrical characteristics the doctor decides treatment options either with medication, pacemakers, implantable cardioverter-defibrillators, and catheter ablation therapies for diagnosed condition.
• The electrophysiology study is also used for determining the appropriate conditions in patient suffering from tachycardia (Increase in heart rate) especially when the non-invasive test should no clarity or does not provide a definite  answer about what causing a problem or how severe is. In addition, EPS is also recommended for patients who had history of heart attack.

Electrophysiology is continuously evolving field with significant implications in diagnosis and treatment of conductions disorders of heart. Understanding the procedure, risk and clinical significance makes the individual to empower themselves and make informed decisions about the health and treatment options.