Many patients diagnosed with arrhythmias (irregular heartbeats) are referred to an electrophysiologist for evaluation and treatment. You may find yourself asking, “What is an electrophysiologist and what do they do?” As an EP—the term commonly used to refer to electrophysiology—I often find myself describing my specialty to patients and explaining to them how I might be able to help resolve their arrhythmias.
Simply put, electrophysiology is the branch of cardiology that deals with the diagnosis and treatment of heart rhythm disorders, or arrhythmias. In more than 35 years of EP practice, I’ve learned the key to successful and effective treatment is carefully listening as you, the patient, describes symptoms, changes in lifestyle due to the irregular heartbeats, fears and concerns.
Really hearing the patient helps me determine the best treatment option—surgery, using a device, prescribing medication, or none of these. Basically, EPs have three treatment paths: ablation using a catheter, implanting an automatic defibrillator, or prescribing the appropriate medication to manage the arrhythmias.
The evolution of arrhythmia treatment
The introduction of catheter ablation in the 80s was a milestone in electrophysiology. Initially, we used direct current ablation, taking energy from a bedside defibrillator to shock someone’s heart back to normal rhythm. This was like setting off an explosion inside the heart and it was difficult to control the scope of injury to the heart that would occur as a result of the treatment.
The field rapidly developed with the emergence of radiofrequency ablation which used different electrical currents to create a laser-like beam of energy that gave us more control, enabling us to spot weld the malfunctioning electrical pathway in the heart. This was the most dramatic advance in electrophysiology I’ve seen in my career.
After attending a meeting in Boston, in the 80s, I was able to acquire a radiofrequency ablation machine for Baylor University Medical Center in Dallas and we started using it to treat a variety of arrhythmias. With catheter ablation, we were able to eliminate open heart surgery by performing a 4-5 hour minimally invasive procedure in the catheterization lab where we spot welded the short-circuiting pathway, allowing the patient to leave the hospital the next morning, cured.
To have gone from open heart surgery that involved a multi-day hospital stay to what has evolved today into an outpatient procedure that takes just 2-3 hours is absolutely incredible.
The second equally significant advance in EP was the development of the automatic implantable defibrillator (AID). I saw the technology at a national meeting and got on the list to participate in clinical trials. I was honored to be the lead investigator of the USDA pivotal trial in the mid-80s that proved the efficacy of the technology that has revolutionized how we save the lives of people with different disease processes. Initially, we implanted the defibrillator using open heart surgery. Today, much like a pacemaker, we implant the AID under the shoulder in an outpatient procedure.
The future for EP at Baylor Scott & White Health is to remain the leader in the expanding intersection of research and clinical application. One of our responsibilities to our patients is to help perfect the tools, products, techniques and technologies that help solve their needs and save their lives. I’m excited to see where our focus on innovation takes us in the world of electrophysiology.