Electrophysiology

If you've been diagnosed with an arrhythmia or have symptoms such as heart palpitations, chest discomfort, a racing heart, lightheadedness, dizziness, or fainting, you should talk to your doctor. AU Health sees patients for:

• Atrial fibrillation
• Atrial flutter
• Bradycardia
• Congenital-related arrhythmias
• Heart blockages
• Sick sinus syndrome
• Supraventricular tachycardia (SVT)
• Syncope
• Ventricular tachycardia
• Wolff-Parkinson-White syndrome

We do a broad range of tests to identify abnormal rhythms, these include cardiac imaging and angiograms, short/long-term monitoring, and stress testing. If needed, we also offer more in-depth diagnostic electrophysiology studies.

Typically, the first step is to do non-invasive testing to identify heart rhythm issues, these tests include:

• Electrocardiography (ECG/EKG): To record the electrical activity of your heart.
• Holter monitor: You wear a monitor that records your heart's electrical activity over 24-72 hours.
• Event recorder: You wear a monitor that provides a long-term recording of your heart rhythm. Usually worn up to a month at a time. 
• Implantable loop recorder (ILR): A small device is implanted under the skin on your chest. It will record your heart rate and rhythm continuously for up to 3 years. Recordings are regularly transmitted to a monitoring center and reviewed by your care team. ILP is most often used in patients with suspected, but intermittent, abnormal rhythms.
• Echocardiogram: An ultrasound that provides pictures of the hearts valves, chambers, and pumping function of your heart.
• Cardiac CT: A radiology test that uses intravenous dye to obtain high resolution, three dimensional (3D), pictures of the moving heart and vessels surrounding the heart.
• Cardiac MRI: Magnetic resonance imaging (MRI) to evaluate the heart’s structure and function; no radiation is involved in this test.
• Exercise stress testing: Helps to determine abnormal heart rhythms during exercise.
• Tilt table testing: A procedure performed to evaluate causes of light-headedness or fainting; a table starts in a horizontal condition and tilts up at different angles while your blood pressure and heart rate are monitored.

These non-invasive procedures are helpful in identifying the abnormal rhythm of your heart, but it may be necessary to map the elective activity of the heart, if so, an electrophysiology study may be necessary.

Electrophysiology study

An electrophysiology study may need to be done to pinpoint where an abnormal heart rhythm begins. Finding out this precise information helps electrophysiologists determine which treatments would be the most effective for your problem.

What to expect

During this study, one of our electrophysiologists will reproduce your abnormal heart rhythm and give you medications to determine which one controls your rhythm best. They will insert small catheters into a vein in your arm, neck, or groin and guide them to your heart. The catheters will sense the electrical activity and help analyze the activity in your heart.

The goal of an electrophysiology study is to find out what is causing your heart rhythm issues. In addition, it can pinpoint where your abnormal heart rhythm begins so our electrophysiologists can determine what treatment would be the most effective for you.

Depending on your diagnosis, antiarrhythmic medications can be very successful treatment options. However, for more serious problems, we do a number of regulatory procedures that are preformed by highly trained and experienced electrophysiologists. Procedures include:

• Cardiac ablation: A minimally-invasive procedure that involves a thin catheter inserted into a vessel in your groin and threaded up into your heart. A cooling agent or heat will be sent through the catheter to stop the electrical triggers and circuits which lead to arrhythmias.
• Cardiac resynchronization therapy: This special permanent pacemaker/implantable cardioverter defibrillator (PPM/ICD) was designed for patients with heart failure whose heart strength is weakened and whose lower chambers (ventricles) are not contracting in "synchrony". A small device resynchronizes the contractions by pacing both ventricles at the same time to improve the efficiency and strength of the heart.
• Cardioversion: A procedure performed in the hospital with the patient under sedation in which an electrical shock is used to convert an abnormal rhythm back to a normal rhythm.
• Implantable cardioverter defibrillators (ICD): Intended to prevent sudden cardiac death, ICDs contain pacing functionality and can help find a balanced heart rhythm.
• MAZE procedure: A surgical procedure to treat atrial fibrillation by creating a "maze" of scar tissue to control abnormal electrical signals in the heart. It can be done either during open heart surgery or though minimally invasive surgery.
• Pacemaker insertion: A pacemaker may be inserted to monitor and regulate the rhythm of your heart and transmit electrical impulses to stimulate it if it’s beating too slowly. Pacemakers are typically used to treat bradycardias.