The doctor who specializes in the electrical system of the heart is called a Cardiac Electrophysiologist, often referred to simply as an EP. This highly specialized physician focuses entirely on diagnosing and treating heart rhythm disorders, known medically as arrhythmias. The heart’s electrical system functions as a natural pacemaker, coordinating the contraction of the heart muscle to pump blood effectively. When this electrical signaling goes awry, the heart can beat too fast, too slow, or irregularly.
The Cardiac Electrophysiologist Role
An Electrophysiologist (EP) is a cardiologist who has completed extensive additional training, focusing specifically on the complex “wiring” of the heart. General cardiologists treat structural issues like blocked arteries, high blood pressure, and heart muscle health. The EP, in contrast, is the expert in the heart’s conduction system, managing the speed and regularity of the heartbeat.
To reach this level of specialization, a physician must first complete four years of medical school, a three-year residency in internal medicine, and a three-year fellowship in general cardiology. Following this rigorous path, the doctor then commits to an extra one to two-year fellowship focused exclusively on Clinical Cardiac Electrophysiology. This extensive education allows the EP to expertly interpret intricate electrical signals and perform highly technical procedures.
The EP’s role requires a deep understanding of how electrical impulses move through the heart tissue and what causes them to malfunction. They are skilled in advanced diagnostic techniques and therapeutic interventions to restore a normal heart rhythm.
Conditions Treated by an EP
Cardiac Electrophysiologists treat a wide variety of electrical malfunctions, collectively known as arrhythmias. These conditions can cause the heart to beat too quickly (tachycardia) or too slowly (bradycardia). Tachycardias include atrial fibrillation (AFib), the most common chronic heart rhythm disorder, where the upper chambers of the heart beat rapidly and erratically.
Other rapid heart conditions include atrial flutter, which is similar to AFib but involves a more organized, fast electrical circuit. Supraventricular tachycardia (SVT) refers to a sudden, rapid heartbeat originating in the upper chambers. The most dangerous rapid rhythms are ventricular tachycardias and ventricular fibrillation, which originate in the lower pumping chambers and can cause sudden cardiac arrest.
Patients are often referred to an EP after experiencing symptoms suggesting an electrical problem. Common complaints include palpitations, which feel like a racing, pounding, or fluttering in the chest. Other symptoms that prompt a referral are unexplained dizziness, lightheadedness, or episodes of fainting (syncope). These symptoms indicate the heart’s irregular rhythm may be disrupting the normal circulation of blood.
Common Electrophysiology Procedures
The EP utilizes a range of advanced tools and procedures to diagnose and correct the source of an arrhythmia. One primary diagnostic procedure is the Electrophysiology Study (EPS), often performed in an EP lab. During an EPS, thin, flexible wires called catheters are threaded through a vein, usually in the groin, and guided into the heart.
Once inside, the electrodes on the catheters map the heart’s electrical signals and can safely reproduce the abnormal rhythm by sending small electrical pulses. This mapping allows the EP to precisely locate the source of the electrical short circuit. The EPS is frequently followed by a therapeutic intervention called catheter ablation.
Catheter ablation involves delivering energy, often radiofrequency heat or cryo-freezing, through the catheter tip to destroy the small area of heart tissue causing the faulty electrical signals. This process effectively “cauterizes” the abnormal pathway, restoring a normal heart rhythm. Ablation is an effective treatment for many tachycardias, including AFib and SVT.
For patients with heart rates that are too slow (bradycardia), the EP may implant a pacemaker. This small device is placed under the skin near the collarbone, with wires that deliver electrical impulses to the heart muscle to ensure a steady heart rate. For dangerously fast rhythms or patients at risk of sudden cardiac arrest, an Implantable Cardioverter Defibrillator (ICD) may be used. The ICD constantly monitors the heart rhythm and delivers a life-saving electrical shock to reset the heart if a fatal rhythm is detected.