Cardiac electrophysiology (EP) is a specialized area within cardiology that focuses on the heart's electrical activity. It involves diagnosing, managing, and treating heart rhythm disorders, known as arrhythmias, which can affect the heart's ability to pump blood effectively. 

What is the cardiac electrical system?

The cardiac electrical system consists of two essential elements: the heart's electrical impulse generator and conduction network. This system generates electrical impulses from the sinoatrial node (SA node) in the right upper heart chamber, where it automatically emits electrical impulses at a regular rate of 60 to 100 times per minute. These impulses travel through specialized conduction pathways, first to the right and left atria and then through the atrioventricular node (AV node), which delays the signal slightly to allow ventricular filling and then moves through the bundle of His and the right and left bundle branches to activate the corresponding ventricles, causing the coordinated contraction of the heart muscle and efficient pumping of blood into the arteries, delivering oxygen and nutrients throughout the body.

 Usually, the flow of these electrical signals is well-coordinated throughout the heart chambers. However, any disruption or short circuit in the system can result in arrhythmias or abnormal heart rhythms, such as tachycardia (an abnormally fast heart rate) or bradycardia (an abnormally slow heart rate). If severe and left untreated, these conditions can be life-threatening.

How do cardiac electrophysiologists treat patients?

Cardiac electrophysiologists act as the "heart electricians," specializing in identifying electrical irregularities through electrophysiology studies and devising strategies to prevent future occurrences. Treatment plans are individualized and may involve medications, catheter ablation to correct abnormal heart rhythms or implantable devices such as pacemakers and defibrillators. The primary goal is to enhance the patient's quality of life, allowing them to confidently carry out daily activities, free from the fear of recurring arrhythmias. 

What is a cardiac electrophysiology study?

A cardiac electrophysiology study (EPS) is a minimally invasive procedure. During the procedure, the doctor inserts a catheter with electrodes through a tiny incision into a large vein in the groin and threads it up to the heart. The procedure can effectively identify the cause, type, and precise location of the origin of abnormal heart signals. Immediate treatment through radiofrequency ablation targets and destroys the tissue responsible for the arrhythmia, yielding significant recovery and notable improvement in patients' quality of life. 

Why choose MedPark for your cardiac electrophysiology study?

• Our highly experienced electrophysiologists specializing in complex arrhythmias perform the procedures.

• We collaborate with specialists from related fields to determine the most appropriate treatment plan tailored to each patient.

• Our Cardiac Electrophysiology Lab (EP Lab) is equipped with advanced medical instruments and technology to enhance the effectiveness of treatments.

• Our cardiac and thoracic surgeons, with over 15 years of experience, are available for immediate care when necessary.

• Our professional nurses and multidisciplinary team, skilled in cardiac electrophysiology, provide attentive care throughout the treatment procedure.

• We offer continuous support from cardiovascular rehabilitation specialists and physical therapists to help patients regain optimal health and quality of life.

Electrophysiology disorder and abnormalities

Heart arrhythmia could be one of the following types:

• Tachycardia is a condition where the heart rate exceeds 100 beats per minute and is classifiable into:

  1. Atrial fibrillation

  2. Atrial flutter

  3. Supraventricular tachycardia

  4. Ventricular tachycardia 

  5. Ventricular fibrillation

• Bradycardia: A condition where the heart rate is below 60 beats per minute. It is classifiable into:

  1. Sick sinus syndrome

  2. Conduction blocks such as atrioventricular block (AV block) and bundle branch block

• Premature heartbeats: Early heartbeats originate from either the atria or ventricles, causing a sensation of irregular heart rhythms. Generally, this condition is not life-threatening.

Signs and indicators you should see a cardiac electrophysiologic

Heart arrhythmias often do not present clear warning signs and are commonly detected incidentally during routine exams or when abnormal heart rhythms cause symptoms.

Noticeable signs include:

• Chest tightness

• Palpitations 

• Shortness of breath or difficulty breathing

• Abnormally rapid or slow heartbeats

• Excessive sweating

• Easy fatigue or feeling of a racing heart

• Weakness 

• Dizziness or fainting

• Sudden loss of consciousness

If you experience any of these symptoms, it is crucial to consult a physician promptly. In cases of syncope, irregular pulse, or cessation of breathing and pulses, call emergency services immediately and perform CPR or use an AED to increase the chances of survival.

Who is at risk?

• Individuals with a family history of heart disease

• Individuals with heart conditions such as coronary artery disease, cardiomyopathy, or heart failure

• Individuals with chronic illnesses, including diabetes, hypertension, high cholesterol, or hyperthyroidism

• Individuals with obstructive sleep apnea (OSA) 

• Individuals who smoke, use recreational drugs, and consume excessive alcohol or caffeine.

• Individuals who experience high levels of stress, anxiety, and insufficient sleep.

Medical services by cardiac electrophysiologists.

• Cardiac catheterization

• Treatment modalities for arrhythmias include:
  
  

  1. Medication to regulate heart rhythms

  2. Radiofrequency ablation (RF ablation) 

  3. Permanent pacemaker

  4. Implantable cardioverter defibrillator (ICD)

  5. Cardiac resynchronization therapy (CRT) 

Cardiac electrophysiology device and equipment

Diagnostic tools

• Holter monitor

• Cardiac event recorder

Treatment devices

• Radiofrequency ablation (RF ablation)

• Permanent pacemaker

• Implantable cardioverter defibrillator (ICD)

• Cardiac resynchronization therapy (CRT)

Challenges and limitations of a cardiac electrophysiology study

Limitations of cardiac electrophysiology studies may arise from factors such as age, anatomy, or certain medical conditions. Physicians can effectively manage most of these challenges. Cardiac electrophysiology studies are highly effective in diagnosing and treating arrhythmias, involving tiny incisions, offering quick recovery, and significantly improving patients' quality of life.

Risks and complications of a cardiac electrophysiology study

• Bleeding or hematoma at the catheter insertion site

• Pain, swelling, or infection at the groin area (catheter entry point) 

• Formation of blood clots in other areas of the body (less than 1% risk)

• Catheter perforation of the heart wall, leading to bleeding around the heart (1% risk)

• Tachycardia or bradycardia (1% risk)

• Death (less than 1% risk)

Frequently Asked Questions

• Is there a chance of recurrence after radiofrequency ablation (RF ablation)?
  Depending on the specific type of heart condition, there is a 2-10% chance of recurrence.

• What should I do if there is bleeding from the catheter insertion site?
  Lie flat, apply continuous pressure to stop the bleeding, and immediately notify your doctor or nurse.

• Can I resume normal activities or exercise after RF ablation?
  Yes, you can. However, if you experience recurrent arrhythmia, please feel free to seek immediate medical attention.

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