Electrophysiology (EP) is one of the fastest growing specialties in cardiovascular medicine. EP focuses on the heart’s electrical system, which regulates the rhythm and beats to keep blood flowing in, through and out of the heart. Electrophysiologists, or heart rhythm specialists, are cardiologists who specialize in EP. These specialists are experts in diagnosing and treating conditions associated with irregular heart rhythms. Treatment options may include medication as well as the implantation and management of electrical devices, such as pacemakers and internal defibrillators, to keep the heart beating normally.
Electrical Properties of the Heart
Heart beats are triggered by the electrical properties of cells in the heart. Different areas of the heart have different roles to play in the conduction of electrical properties that make the heart beat properly. These areas, called pacemakers, send electrical signals to the rest of the heart, setting the speed or pace of the heartbeat – speeding the heart up during exercise or hard work and slowing it down again during rest. A strong regular heartbeat that is neither too slow nor too fast allows the heart to safely and effectively pump blood to all parts of the body.
A healthy, efficient heart maintains a “normal sinus rhythm” that beats between 60-100 times per minute. A resting heartbeat that is more than 100 beats per minute is referred to as tachycardia; a heartbeat less than 60 beats per minute is called bradycardia; an irregular heartbeat is known as arrhythmia. Any of these conditions can indicate an electrical problem with the heart.
It is fairly easy to figure out beats-per-minute by taking a pulse on the neck or wrist while using a watch with second hand. Determining an irregular heartbeat or arrhythmia may not be as easy.
Identifying Arrhythmias
Most people’s hearts beat in a normal rhythm, ensuring regular healthy blood flow to all parts of the body. Heart arrhythmias can take many forms; many heart arrhythmias are harmless, but some are not. Some irregular beats can indicate a person has heart disease or structural problems within their heart, or can increase the risk of stroke or heart attack.
Many people diagnosed with arrhythmia describe feeling their heart flop, flutter, race, pound oddly or even stop for a few seconds. Sometimes arrhythmia is accompanied by chest pain, dizziness or shortness of breath.
Some irregular heart rhythms can be exacerbated by caffeine, drug or alcohol use, stress, sleeplessness, illness or even a hormonal imbalance. Although some arrhythmias are common with aging and during stressful times, it is important to discuss any irregular heart feelings and episodes with a physician, who may then refer patients to a cardiologist or an electrophysiologist for further testing.
Non-invasive tests to determine the severity of arrhythmia may include an EKG, a test that reads the heart rhythm; a stress test that monitors the heart during exercise or in a stressed stage via medications; or an echocardiogram, which is an ultrasound of the heart. Some people are given heart monitors to wear for up to 30 days to help get a better idea when the heart beats abnormally and possible causes.
Treating Heart Arrhythmias
There are several ways to treat heart arrhythmias. Medications such as calcium-channel blockers and beta-blockers can be used to slow fast heart rhythms. Management of slow rhythms may involve implanting a pacemaker. Implantable defibrillators are used to shock the heart out of dangerous fast rhythms and mostly are used for patients with heart failure. Finally, many fast heart rhythms can be cured with a procedure called catheter ablation. This procedure cauterizes abnormal tissue in the heart and restores a healthy rhythm. FBN
Lynn Otto, M.D., is a board-certified cardiologist and electrophysiologist at the Heart & Vascular Center of Northern Arizona (HVCNA). Dr. Otto specializes in the electrical activities of the heart including diagnosing and treating irregular heart rhythms and implanting and managing heart devices such as pacemakers and defibrillators. HVCNA is a cardiovascular physician practice offering services including general cardiology; rhythm abnormalities; the treatment of chronic heart and vascular conditions; and advanced surgical procedures including traditional and minimally invasive open heart surgery. HVCNA cardiovascular specialists include cardiologists, interventional cardiologists, an electrophysiologist, cardiothoracic and vascular surgeons, and specialty trained physician assistants, nurse practitioners and registered nurses. HVCNA is a partnership between Flagstaff Medical Center and Verde Valley Medical Center, with offices located in Flagstaff, Camp Verde, Cottonwood, Sedona and Winslow. For more information, visit NAHeartCare.com. For more information, visit NAHeartCare.com. To make an appointment in Flagstaff or Winslow, call 928-773-2150; in Camp Verde, Cottonwood or Sedona, call 928-634-1331.