Electrophysiology
Heart Rhythm management
Heart Rhythm Management is a specialised field of cardiology focused on diagnosing and treating irregular heart rhythms (arrhythmias).
Electrophysiologists use advanced technology to study the heart's electrical activity and may treat issues with medications, catheter ablation, or devices like pacemakers and defibrillators to regulate heart rhythms.
Arrhythmia
An arrhythmia is an irregular heartbeat, where the heart may beat too quickly, too slowly, or with an irregular rhythm. This occurs when the electrical signals that coordinate heartbeats malfunction. Arrhythmias can feel like a racing heart or fluttering. Many are harmless, but some can cause severe symptoms and complications, especially if linked to a weak or damaged heart.
Other Arrhythmias:
Supraventricular Tachycardia (SVT): Rapid heart rate starting in the atria, often over 100 beats per minute.
Atrial Flutter: Fast, sometimes regular, heart rate in the atria, up to 300 beats per minute.
Wolff-Parkinson-White Syndrome (WPW): Causes fast, irregular heartbeats, potentially leading to fainting.
Long QT and Brugada Syndromes: Rare, inherited heart conditions.
Ventricular Tachycardia: Life-threatening fast heart rate originating in the ventricles.
Heart Block: Delayed or blocked electrical signals, causing a slow heartbeat.
Tachybrady Syndrome: Issues with the heart’s natural pacemaker, causing fast or slow heartbeats.
Ectopic Heartbeats: Extra or missed beats, usually not serious unless frequent or causing symptoms.
What are the treatments
Treatment depends on the type and severity of the arrhythmia. Options include:
Medications: Anti-arrhythmic drugs, heart-rate control drugs, and anticoagulants (e.g., Warfarin, Rivaroxaban, Dabigatran, Apixaban.
Lifestyle Changes: Managing diet, exercise, and stress.
Invasive Therapies: Catheter ablation or surgical procedures.
Electrical Devices: Pacemakers or defibrillators.
Atrial Fibrillation (AF)
The most common arrhythmia is atrial fibrillation (AF), where the upper chambers of the heart (atria) beat rapidly, up to 400 times per minute. While not life-threatening, AF can cause palpitations, fatigue, and heart failure.
Electrophysiology Specialists
Assoc Prof Martin Stiles
Dr Dean Boddington
Dr Daniel Garofalo
Pacemaker Implants
Normally the heart is signalled to contract by an electrical impulse that starts in the sinus node in the right atrium (top chamber of the heart). If this system is disrupted and causes a slow heart rate, a pacemaker may be needed to regulate the heartbeat.
A permanent pacemaker is a small device, 3-4 cm across, implanted under the skin just below the collarbone. It includes a computer, a battery, and leads that carry electrical impulses to the heart.
Implantable Cardioverter-Defibrillator (ICD):
A small device placed under the skin near the collarbone. It monitors heart rhythms and delivers shocks via leads if an irregular heartbeat is detected. It’s used for dangerously fast or chaotic heartbeats.
Learn more about ICDs’
Biventricular Pacemakers (Cardiac Resynchronization Therapy or CRT): Used for heart failure to help the ventricles contract in sync. The device, implanted under the skin, has 2 or 3 leads placed in the heart to improve its function. It may also include an ICD to correct dangerous heart rhythms.
Pacemaker Specialists
Dr Robert McIntosh
Dr Spencer Heald
Assoc Prof Martin Stiles
Dr Dean Boddington
Dr Daniel Garofalo
Dr Jonathan Tisch
Rhythm Management
Electrical Cardioversion
Electrical cardioversion also called direct current cardioversion (DCC), is a short procedure that uses a defibrillator to provide an electrical shock to the heart. It is performed under sedation or anaesthetic by an anaesthetist.
The defibrillator sends an electrical impulse through your chest wall, via pads or electrodes which are placed on your chest. This impulse disrupts the abnormal rhythm for a split second, allowing your heart to resume a normal rhythm. The procedure takes a few minutes and because of the sedation, you shouldn't feel any discomfort. Most people can go home from the hospital on the same day.
Electrophysiology Study (EPS)
A diagnostic test assessing the heart’s electrical system. Catheters are used to locate the source of the arrhythmia, and treatment decisions, like catheter ablation, are made based on the results.
Catheter Ablation
A procedure that destroys small areas of heart tissue causing arrhythmia. This can treat supraventricular tachycardias (SVTs) and ventricular tachycardia (VT).
Pulmonary Vein Isolation (PVI)
A specific ablation technique for AF, targeting areas around the pulmonary veins to block abnormal signals.
Monitoring Device Implant – Loop Recorder
A loop recorder is a small heart-monitoring device implanted under the skin of your chest, using local anaesthetic. It continuously records your heart rhythm for up to three years, allowing for remote monitoring. This device is especially useful for diagnosing symptoms like fainting, seizures, palpitations, or dizziness that occur infrequently and might not be caught by short-term monitors.
Unlike standard ECGs that only capture heart rhythms during a brief period, a loop recorder tracks your heart signals over a longer time, increasing the chance of capturing abnormal rhythms during symptoms. This helps your doctor make a more accurate diagnosis and treatment plan.
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