Cardiac electrophysiology is a branch of

cardiology Cardiology () is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart d ...

and

basic science Basic research, also called pure research or fundamental research, is a type of scientific research with the aim of improving scientific theories for better understanding and prediction of natural or other phenomena. In contrast, applied resear ...

focusing on the electrical activities of the

heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...

. The term is usually used in clinical context, to describe studies of such phenomena by invasive (intracardiac) catheter recording of spontaneous activity as well as of cardiac responses to

programmed electrical stimulation A cardiac electrophysiology study (EP test or EP study) is a minimally invasive procedure using catheters introduced through a vein or artery to record electrical activity from within the heart. This electrical activity is recorded when the hear ...

clinical cardiac electrophysiology {{unreferenced, date=February 2009 Clinical cardiac electrophysiology (also referred to as cardiac electrophysiology, arrhythmia services, or electrophysiology), is a branch of the medical specialty of cardiology and is concerned with the study and ...

. However, cardiac electrophysiology also encompasses

basic research Basic research, also called pure research or fundamental research, is a type of scientific research with the aim of improving scientific theories for better understanding and prediction of natural or other phenomena. In contrast, applied resear ...

and

translational research Translational research (also called translation research, translational science, or, when the context is clear, simply translation) is research aimed at translating (converting) results in basic research into results that directly benefit humans. ...

components. Specialists studying cardiac electrophysiology, either clinically or solely through research, are known as cardiac electrophysiologists.

Description

Electrophysiological (EP) studies are performed to assess complex

arrhythmias Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...

, elucidate symptoms, evaluate abnormal

electrocardiograms Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity. It is an electrogram of the heart which is a graph of voltage versus time of the electrical activity of the hear ...

, assess risk of developing arrhythmias in the future, and design treatment. These procedures include therapeutic methods (typically

radiofrequency ablation Radiofrequency ablation (RFA), also called fulguration, is a medical procedure in which part of the electrical conduction system of the heart, tumor or other dysfunctional tissue is ablated using the heat generated from medium frequency alternat ...

, or

cryoablation Cryoablation is a process that uses extreme cold to destroy tissue. Cryoablation is performed using hollow needles (cryoprobes) through which cooled, thermally conductive, fluids are circulated. Cryoprobes are positioned adjacent to the target in ...

) in addition to diagnostic and prognostic procedures. Other therapeutic modalities used in this field include

antiarrhythmic drug Antiarrhythmic agents, also known as cardiac dysrhythmia medications, are a group of pharmaceuticals that are used to suppress abnormally fast rhythms ( tachycardias), such as atrial fibrillation, supraventricular tachycardia and ventricular tac ...

therapy and implantation of

pacemakers An artificial cardiac pacemaker (or artificial pacemaker, so as not to be confused with the natural cardiac pacemaker) or pacemaker is a Implant (medicine), medical device that generates electrical impulses delivered by electrodes to the Heart ...

implantable cardioverter-defibrillators An implantable cardioverter-defibrillator (ICD) or automated implantable cardioverter defibrillator (AICD) is a device implantable inside the body, able to perform defibrillation, and depending on the type, cardioversion and pacing of the ...

and cardiac resynchronisation therapy devices. Fauci, Anthony, et al. ''Harrison's Textbook of Medicine''. New York: McGraw Hill, 2009.

Electrophysiological study

The cardiac electrophysiology (EP) study typically measures the response of myocardium to programmed electrical stimulation (PES) on specific pharmacological regimens in order to assess the likelihood that the regimen will successfully prevent potentially fatal sustained ventricular tachycardia (VT) or ventricular fibrillation VF (VF) in the future. Sometimes a ''series'' of EP study drug trials must be conducted to enable the cardiologist to select the one regimen for long-term treatment that best prevents or slows the development of VT or VF following PES. Such studies may also be conducted in the presence of a newly implanted or newly replaced cardiac pacemaker or ICD.

Physician specialists

A specialist in cardiac electrophysiology is known as an electrophysiologist, or "heart electrician" in layman' terms. Cardiac electrophysiology is a subspecialty of

in most countries and usually requires two or more years of EP

fellowship A fellow is a concept whose exact meaning depends on context. In learned or professional societies, it refers to a privileged member who is specially elected in recognition of their work and achievements. Within the context of higher education ...

training after a general cardiology residency. In early 2011, the

Centers for Medicare and Medicaid Services The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...

promoted cardiac electrophysiology to its own specialty category in the United States. Cardiac electrophysiologists are trained to perform interventional cardiac electrophysiology studies and cardiac rhythm management device implantations.

Research cardiac electrophysiologist

Cardiac electrophysiologists specialize in a sub-area of

electrophysiology Electrophysiology (from Greek , ''ēlektron'', "amber" etymology of "electron"">Electron#Etymology">etymology of "electron" , ''physis'', "nature, origin"; and , '' -logia'') is the branch of physiology that studies the electrical properties of b ...

, which in turn is a sub-area of

physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...

. This specialization usually requires education at the doctoral (PhD, DSc, or MD/DO) level to become a

principal investigator In many countries, the term principal investigator (PI) refers to the holder of an independent grant and the lead researcher for the grant project, usually in the sciences, such as a laboratory study or a clinical trial. The phrase is also often us ...

for research projects. The area of research is often multi-disciplinary involving chemistry, bioelectrics, biology, and biomedical engineering. The flagship tools used by cardiac electrophysiologists overlap with the toolbox of the neuroscientist including

patch clamp The patch clamp technique is a laboratory technique in electrophysiology used to study ionic currents in individual isolated living cells, tissue sections, or patches of cell membrane. The technique is especially useful in the study of excitabl ...

and

optical mapping Optical mapping is a technique for constructing ordered, genome-wide, high-resolution restriction maps from single, stained molecules of DNA, called "optical maps". By mapping the location of restriction enzyme sites along the unknown DNA of an orga ...

Allied professionals

Mapping specialists (EP techs, EP physiologists) are typically educated up to the Bachelor's or Master's level and are employed by either a cardiac electrophysiology company or department. Often international certification such as Certified Electrophysiology Specialist (CEPS) by the International Board of Heart Rhythm Examiners (IBHRE) or EHRA Certified Electrophysiology Specialist (ECES) or equivalent is required.

Subdiscipline

Cardiac electrophysiology is a relatively young subdiscipline of cardiology and internal medicine. It was developed during the mid-1970s by Hein J. J. Wellens, professor of medicine at the

University of Maastricht Maastricht University (abbreviated as UM; nl, Universiteit Maastricht) is a public research university in Maastricht, Netherlands. Founded in 1976, it is the second youngest of the thirteen Dutch universities. In 2021, 22,383 students studied at ...

in the

Netherlands ) , anthem = ( en, "William of Nassau") , image_map = , map_caption = , subdivision_type = Sovereign state , subdivision_name = Kingdom of the Netherlands , established_title = Before independence , established_date = Spanish Netherl ...

and attending cardiologist at the Academic Hospital in

Maastricht Maastricht ( , , ; li, Mestreech ; french: Maestricht ; es, Mastrique ) is a city and a municipality in the southeastern Netherlands. It is the capital and largest city of the province of Limburg. Maastricht is located on both sides of the ...

. In 1980 the first microprocessor based stimulator was developed there.

Textbook

The author of the definitive textbook in the field is by the late Mark E. Josephson, former Robinette Professor of Medicine and chief of cardiology at the

University of Pennsylvania School of Medicine The Perelman School of Medicine, commonly known as Penn Med, is the medical school of the University of Pennsylvania, a private research university in Philadelphia, Pennsylvania. Founded in 1765, the Perelman School of Medicine is the oldest medi ...

Philadelphia, Pennsylvania Philadelphia, often called Philly, is the largest city in the Commonwealth of Pennsylvania, the sixth-largest city in the U.S., the second-largest city in both the Northeast megalopolis and Mid-Atlantic regions after New York City. Sinc ...

, professor of medicine at

Harvard Medical School Harvard Medical School (HMS) is the graduate medical school of Harvard University and is located in the Longwood Medical Area of Boston, Massachusetts. Founded in 1782, HMS is one of the oldest medical schools in the United States and is consi ...

, and attending cardiologist at

Beth Israel Deaconess Medical Center Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts is a teaching hospital of Harvard Medical School. It was formed out of the 1996 merger of Beth Israel Hospital (founded in 1916) and New England Deaconess Hospital (founded ...

in Boston, Massachusetts. The most recent published edition of ''Clinical Cardiac Electrophysiology: Techniques and Interpretations'' is the 6th edition in 2020.

Professional societies

The

Heart Rhythm Society The Heart Rhythm Society is an international non-profit organization that promotes education and advocacy for cardiac arrhythmia professionals and patients. The society was founded in 1979 and counted over 7,100 members from over 70 countries as o ...

, founded in 1979, promotes education and advocacy for cardiac arrhythmia professionals (including cardiac electrophysiologists) and patients. European Heart Rhythm Association, a part of

European Society of Cardiology The European Society of Cardiology (ESC) is an independent non-profit, non-governmental professional association that works to advance the prevention, diagnosis and management of diseases of the heart and blood vessels, and improve scientific un ...

, is active in Europe.

Certification

Founded in 1985 as NASPExAM, the International Board of Heart Rhythm Examiners (IBHRE) offers knowledge based board exams for physicians and allied health professionals working in the field of cardiac electrophysiology and cardiac rhythm device management. European Heart Rhythm Association (EHRA) provides knowledge and practical competency based certification to physicians and allied health professionals as well as accreditation of cardiac electrophysiology training centres in Europe and neighbouring countries.

Mapping systems

Carto

Biosense-Webster, a subsidiary of

Johnson & Johnson Johnson & Johnson (J&J) is an American multinational corporation founded in 1886 that develops medical devices, pharmaceuticals, and consumer packaged goods. Its common stock is a component of the Dow Jones Industrial Average and the company i ...

, produces a cardiac electrophysiology system called CARTO. The system is designed to visualise the real-time calculated position and orientation of a specialised RF ablation

catheter In medicine, a catheter (/ˈkæθətər/) is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. Cath ...

within the patient's heart in order to minimise

radiation exposure Radiation is a moving form of energy, classified into ionizing and non-ionizing type. Ionizing radiation is further categorized into electromagnetic radiation (without matter) and particulate radiation (with matter). Electromagnetic radiation con ...

during

fluoroscopy Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal structure and functio ...

, increase the accuracy of targeted RF ablation and reacquisition of pacing sites for re-

ablation Ablation ( la, ablatio – removal) is removal or destruction of something from an object by vaporization, chipping, erosion, erosive processes or by other means. Examples of ablative materials are described below, and include spacecraft materi ...

. Its navigation system calculates the position and orientation of the catheter tip, using three known magnetic sources as references. The system uses static magnetic fields that are calibrated and computer controlled. Due to the nature of magnetic fields, the orientation may also be calculated while the tip is stationary. By calculating the strength and orientation of the magnetic fields at a given location, the x,y,z position may be calculated along with the roll, pitch, yaw orientation.

Ensite

St. Jude Medical, now a part of Abbott, manufactures EnSite family of cardiac mapping systems, the latest edition being EnSite Precision, which allows speedy heart mapping during catheter ablation with better accuracy to be able to treat cardiac rhythm disturbances.

Notable cardiac electrophysiologists

Mark Josephson Mark E. Josephson (1943-2017) was an American cardiologist and writer, who was in the 1970s one of the American pioneers of the medical cardiology subspecialty of cardiac electrophysiology. His book titled ''Clinical Cardiac Electrophysiology: T ...

(1943-2017), American * Hein Wellens (1935-2020), Dutch * George Klein, Canadian *Kenneth Ellenbogen, American *Eric Prystowsky, American * Michel Haïssaguerre (born 1955), French *

Michel Mirowski Michel Mirowski (October 14, 1924 – March 26, 1990) was a physician who helped develop the implantable cardioverter-defibrillator (ICD). Born in Warsaw, Poland, he practiced medicine in Israel before coming to Sinai Hospital in Baltimore, Mar ...

(1924–1990), Polish-Israeli-American * Richard N. Fogoros, American *

Bruce Lerman Bruce B. Lerman is a cardiologist. He is the Hilda Altschul Master Professor of Medicine at Weill Cornell Medical College, and is chief of the Division of Cardiology and director of the Cardiac Electrophysiology Laboratory at Weill Cornell Medicin ...

, American *

Amiran Revishvili Amiran Shota Revishvili (russian: Амиран Шотаевич Ревишвили, ka, ამირან რევიშვილი), born February 11, 1956, is a cardiac electrophysiologist, president of Pan-Russian Scientific Society of Cl ...

(born 1956), Russian

References

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