In the United States, heart disease is the leading cause of death for most racial and ethnic groups, contributing to about a fourth of US deaths every year. Every 40 seconds, someone in the US has a heart attack.
While a cardiologist is equipped to deal with most cardiovascular disease, sometimes the input of a cardiovascular subspecialist is required. Electrophysiology is one such subspecialty.
An electrophysiologist, also known as a cardiac electrophysiologist or cardiac EP, is a cardiologist who focuses on testing for and treating problems involving irregular heart rhythms, also known as arrhythmias. They examine your heart’s electrical system, which sends an electrical signal through your cells in order to regulate heart rate and rhythm.
What Does an Electrophysiologist Do?
Electrophysiologists generally work at a larger cardiac practice or hospital where they test for, diagnose, and treat abnormal heart rhythms. They are trained in the use of highly specialized tests, devices, and procedures in order to do so. They also may prescribe medication or make lifestyle recommendations.
An electrophysiologist may diagnose and treat conditions such as:
- Bradycardia. A heartbeat that is too slow.
- Tachycardia. A heartbeat that is too fast. There are three main types, according to where the problem originates in the heart.
- Atrial Fibrillation. A quivery, fluttery heartbeat.
- Cardiac Arrest. The sudden stop of your heartbeat.
- Other arrhythmias and heart disorders.
Education and Training
Electrophysiologists are cardiologists who have further training in the specialty of electrophysiology. After getting their bachelor’s degree, they go through a process that involves completing:
- An average of four years in medical school
- A three-year residency in internal medicine
- Three to five years additional training in cardiovascular disease fellowship(s)
- An exam to become certified as a cardiologist by the American Board of Internal Medicine or the Advisory Board for Osteopathic Specialists of the American Osteopathic Association
- Two years additional training in electrophysiology
- An exam to become certified as an electrophysiologist by the American Board of Internal Medicine
Reasons to See an Electrophysiologist
Your primary care doctor or another cardiologist may refer you to an electrophysiologist if you:
- Have an abnormal heart rhythm
- Are undergoing or being considered for cardiac ablation, a procedure that creates scar tissue in order to block erratic signals
- Experience syncope, i.e., a sudden loss of consciousness
- Have a risk of sudden cardiac death
- Are undergoing heart surgery
- Might benefit from a pacemaker or implantable cardiac defibrillator (ICD)
Electrophysiologists are generally seen by referral and not through direct appointment.
What to Expect at the Electrophysiologist
Electrophysiology studies (EPS) test the electrical activity of your heart in order to locate sources of arrhythmia. The doctor will insert a thin tube called an electrode catheter into a blood vessel that leads to your heart. This insertion is usually in the groin but may be in the arm or neck. They will then send electrical signals to your heart and record its activity.
Electrophysiology studies usually take place in a specialized laboratory within a clinic or hospital. This room may be called the electrophysiology laboratory (or EP lab) or the catheterization laboratory (or cath lab). The test should last about 1-4 hours.
Before undergoing EPS, you should:
- Not eat or drink anything for 6-8 hours before
- Tell your doctor about any supplements or medications you take and follow their instructions
- Have someone drive you to your appointment and take you home
The doctor will then review your test results and make recommendations for your course of treatment.