Cardiac electrophysiology

Cardiac electrophysiology is a field of cardiology which treats abnormal heart beats (as known as heart rhythm disease or arrhythmias).


Normally, the heart beats at a steady rhythm to supply blood to the lungs and the rest of the body. The beat begins with an electrical impulse in the upper part of the heart (right atrium) and travels down a group of specialized fibers to the lower chambers of the heart (ventricles). This is known as the electrical conduction system of the heart.
An arrhythmia is a condition in which heartbeats may be irregular, too slow (bradycardia), too fast (tachycardia) or too early (premature). Arrhythmias can be caused by problems with the heart’s electrical conduction system; structural problems in the heart or blood vessels caused by birth defects, heart disease or certain specific conditions. Left untreated, heart rhythm disorders can cause a wide range of problems from dizziness and fatigue to stroke and even sudden death.

What are the most common symptoms of heart rhythm disease?
An arrhythmia may be present all of the time or it may come and go. Some people do not experience any symptom while others notice symptoms only when they are more active.
Common symptoms that may occur when an arrhythmia is present include: Dizziness, fainting, confusion, shortness of breath, fatigue, disturbed sleep, chest tightness, fast or slow heartbeats, skip or irregular beats and stroke  

What kind of arrhythmias can be diagnosed and treated?
• Atrial fibrillation is a fast and irregular heart rhythm which arises in the upper chambers of the heart.
• Atrial flutter is an arrhythmia that circulates very rapidly in the upper chambers of the heart in an organized pattern.
• Supraventricular tachycardia is a sudden, very fast heartbeat from the upper chambers of the heart
• Heart block is a condition characterized by an abnormally slow heartbeats (bradycardia). It occurs when some or all of the electrical impulses from the upper chambers of the heart are not properly transmitted to the lower chambers of the heart
• Ventricular tachycardia is a dangerous type of rhythm disease which arises from lower chambers of the heart.  
• Sudden cardiac death is an unexpected and sudden death, caused by a loss of cardiac function.
• Long QT syndrome is a heart rhythm disorder that can cause fast and dangerous arrhythmias.
• Brugada’s syndrome a genetic disorder disease that increases risk of abnormal heart rhythm.
• Wolff-Parkinson-White (WPW) syndrome is a condition in which an extra electrical pathway causes sudden fast heartbeat.
Other arrhythmias can be caused by pregnancy, drugs interactions, or metabolic problems.

How is an arrhythmia diagnosed?

At first, a thorough medical history and physical examination are conducted. Then, several tests can be helpful and include:
• Blood tests. They are done to check the level of certain electrolytes, enzymes, hormones and other chemicals in your blood.
• LogRythmia. This application for smartphone (android and IOS, free of charges) helps to track symptoms related to an arrhythmia. Download from: App Store or Google Play.
• Electrocardiogram (ECG or EKG). This is a recording of the electrical activity of your heart.
• Echocardiogram. This a study uses ultrasound waves to assess the function and the structure of your heart.
• Stress testing. This test measures the heart's ability to respond to physical stress
• Holter monitor. This is a device that records usually your heart beats for 24 to 48 hours.
• Event recorder. This is a device that records any abnormal cardiac rhythms. Typically, this is worn for 7 days consecutively.  
• Implantable loop recorder. This is a small device inserted in the chest under the skin. It records your heartbeat all the time and has a battery life of about 3 years.
• Smartwatch with EKG feature. The watch can usually record the electrical activity of your heart during 30 seconds.
• Electrophysiology study. This is an invasive test in which a catheter is inserted into a large vein in your groin and then placed into your heart. It allows to diagnose electrical conduction failure of your heart.

How is a cardiac arrhythmia treated?

Several treatments and procedures are performed and include:
• Medical treatment. Different cardiac drugs can help control abnormal heart rhythm. In specific condition, oral anticoagulation (blood thinner) may be required to prevent from a stroke.
• Lifestyle changes. Weight loss and regular physical activity can help to better control some heart rhythm problems.    
• Cardioversion or defibrillation.
This is a procedure to restore a normal heart rhythm with a shock of electricity. This is usually done under general anaesthesia.
• Catheter ablation. In this procedure, several catheters are inserted into a blood vessel of your groin and then placed into the heart. The catheter will destroy specific parts of the heart which cause the rhythm disease.
• Pacemaker. This is a small device that sends out electrical signals to help the heart to maintain at a normal rate. It can be placed under the skin of your chest or directly into your heart.
• Implantable cardioverter defibrillator (ICD). This is a small device that can reset the heart rhythm when dangerous arrhythmias occur. It is usually put under the skin of the chest.
Biventricular pacemaker. This is a small device that is put under the skin of the chest. It helps the lower chambers of the heartbeat at the same time. This is known as cardiac resynchronization therapy.


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