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 hea ...

and basic science 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 to ...

. 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 -

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 researc ...

and translational research 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 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 medical device that generates electrical impulses delivered by electrodes to the chambers of the heart eit ...

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 h ...

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 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 bi ...

, which in turn is a sub-area of physiology. 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.

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 and attending cardiologist at the Academic Hospital in Maastricht. 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 ...

in Philadelphia, Pennsylvania, professor of medicine at Harvard Medical School, 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, 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, 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 ...

, 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, 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, erosive processes or by other means. Examples of ablative materials are described below, and include spacecraft material for a ...

. 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 St. Jude Medical, Inc. was an American global medical device company headquartered in Little Canada, Minnesota, U.S., a suburb of Saint Paul. The company had more than 20 principal operations and manufacturing facilities worldwide with products s ...

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

Michel Haïssaguerre Michel Haïssaguerre (October 1955) is a French cardiologist and electrophysiologist. His investigations have been the basis for development of new markers and therapies for atrial and ventricular fibrillation. Biography Haïssaguerre was born ...

(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, ...

(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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