Your heart generally has a predictable, steady rhythm. But sometimes the rhythm can become irregular, a condition called an arrhythmia. Your heart might go too fast or too slow. You could feel like your heart is skipping a beat or adding extra beats. When that happens, your doctor may refer you to a specialist called a cardiac electrophysiologist.
A cardiac electrophysiologist is a specialist who understands heart rhythms and can diagnose and treat any heart rhythm problems.
What Does a Cardiac Electrophysiologist Do?
A cardiac electrophysiologist uses testing to examine how your heart beats and what is causing any issues with its rhythm. Once your medical team knows the cause of your arrhythmia, your doctors can make a diagnosis and start a treatment plan for you.
Education and Training
A cardiac electrophysiologist is a cardiologist who has 2 years of extra training to learn about heart rhythms and how to diagnose problems with them. Training to become certified as a cardiac electrophysiologist involves:
- A 4-year medical school program
- A 3-year residency in internal medicine
- Board certification in internal medicine by the American Board of Internal Medicine
- A 3-year training program to specialize in cardiology, followed by board certification from the American Board of Internal Medicine in cardiovascular disease
- Another 2 years of training for certification in clinical cardiac electrophysiology from the American Board of Internal Medicine
Reasons to See a Cardiac Electrophysiologist
Your primary care doctor may refer you to a cardiac electrophysiologist if you have noticed irregular heartbeats, such as a fluttering sensation, a racing heart, or feel like your heart skipping a beat.
Less obvious symptoms can include fatigue, dizziness, fainting, or unexplained sweating. Even if you don't feel a difference in your heartbeat, your doctor might notice an irregularity during a routine exam and refer you on for more testing.
There are several types of heart arrhythmia that a cardiac electrophysiologist can diagnose and treat. Some of the common types include:
- Atrial fibrillation. A fast rhythm in the upper chambers of the heart
- Bradycardia. A slow heartbeat
- Tachycardia. A fast heartbeat
- Ventricular tachycardia. A fast rhythm in the lower chamber of the heart
- Supraventricular tachycardia. A very fast heartbeat in the top chambers of the heart
- Long QT syndrome. A condition that can cause sudden arrhythmias
- Other arrhythmias. Heartbeat changes due to pregnancy, medication interactions, or other reasons
What to Expect at the Cardiac Electrophysiologist
The first thing a cardiac electrophysiologist will do is specialized testing. Some tests are as simple as blood work, but you will probably need additional testing to look at your heartbeat pattern. Common tests include:
- Electrocardiogram. Also known as an EKG, the test uses electrodes on your chest to record your heartbeat.
- Echocardiogram. This is like a sonogram for your heart, so the doctor can watch it beating.
- Treadmill test. This allows doctors to monitor how your heart performs during exercise.
- Tilt-table test. This is to see how your heart responds to sudden changes of position.
- Portable heart monitor. This lets your doctor see how your heart beats as you go about your daily life. It’s useful if you have intermittent arrhythmia that doesn’t happen in the doctor’s office.
- Electrophysiology study. In this test, the doctor inserts a catheter into a blood vessel to track your heart’s electrical activity. It is a more invasive procedure and might require special preparation. Speak with your doctor about what to expect before, during, and after this kind of test.
Depending on your diagnosis, you may have to take medications to control your heart rate. In some cases, you might need a procedure called an ablation, which uses radiofrequency energy to burn away a small amount of heart tissue and stabilize the rhythm. In other cases, you may require a pacemaker or implantable cardiac defibrillator.
You should discuss your treatment options with your doctor.