Cardiac electrophysiology is a branch of

cardiology Cardiology () is the study of the heart. 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 di ...

and

basic science Basic research, also called pure research, fundamental research, basic science, or pure science, is a type of scientific research with the aim of improving scientific theories for better understanding and prediction of natural or other phenomen ...

focusing on the electrical activities of the

heart The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...

. 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. However, cardiac electrophysiology also encompasses

basic research Basic research, also called pure research, fundamental research, basic science, or pure science, is a type of scientific research with the aim of improving scientific theories for better understanding and prediction of natural or other phenome ...

and

translational research Translational research (also called translation research, translational science, or, when the context is clear, simply translation) is research aimed at translating (converting) results in basic research into results that directly benefit humans ...

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, are irregularities in the heartbeat, including when it is too fast or too slow. Essentially, this is anything but normal sinus rhythm. A resting heart rate that is too fast – above 100 beats ...

, elucidate symptoms, evaluate abnormal

electrocardiograms Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity through repeated cardiac cycles. It is an electrogram of the heart which is a graph of voltage versus time of ...

, 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, sensory nerves or a dysfunctional tissue is ablated using the heat generated from medium fre ...

, 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, implantable cardioverter-defibrillators 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 A fellow is a title and form of address for distinguished, learned, or skilled individuals in academia, medicine, research, and industry. The exact meaning of the term differs in each field. In learned or professional societies, the term refers ...

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 ...

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 ee the Electron#Etymology, etymology of "electron" ; and ) is the branch of physiology that studies the electrical properties of biological cell (biology), cells and tissues. It involves measurements of voltage change ...

, which in turn is a sub-area of

physiology Physiology (; ) is the science, scientific study of function (biology), functions and mechanism (biology), mechanisms in a life, living system. As a branches of science, subdiscipline of biology, physiology focuses on how organisms, organ syst ...

. This specialization usually requires education at the doctoral (PhD, DSc, or MD/DO) level to become a principal investigator 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 Cell isolation, isolated living cells, tissue sections, or patches of cell membrane. The technique is especially useful in the st ...

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 A university () is an institution of tertiary education and research which awards academic degrees in several academic disciplines. ''University'' is derived from the Latin phrase , which roughly means "community of teachers and scholars". Uni ...

in the

Netherlands , Terminology of the Low Countries, informally Holland, is a country in Northwestern Europe, with Caribbean Netherlands, overseas territories in the Caribbean. It is the largest of the four constituent countries of the Kingdom of the Nether ...

and attending cardiologist at the Academic Hospital in

Maastricht Maastricht ( , , ; ; ; ) is a city and a Municipalities of the Netherlands, municipality in the southeastern Netherlands. It is the capital city, capital and largest city of the province of Limburg (Netherlands), Limburg. Maastricht is loca ...

. 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 university, private, Ivy League research university located in Philadelphia. Founded in 1765, the Perelman School of M ...

Philadelphia, Pennsylvania Philadelphia ( ), colloquially referred to as Philly, is the List of municipalities in Pennsylvania, most populous city in the U.S. state of Pennsylvania and the List of United States cities by population, sixth-most populous city in the Unit ...

, professor of medicine at

Harvard Medical School Harvard Medical School (HMS) is the medical school of Harvard University and is located in the Longwood Medical and Academic Area, Longwood Medical Area in Boston, Massachusetts. Founded in 1782, HMS is the third oldest medical school in the Un ...

, 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 and one of the founding members of Beth Israel Lahey Health. It was formed out of the 1996 merger of Beth Israel Hospital (f ...

Boston, Massachusetts Boston is the capital and most populous city in the Commonwealth (U.S. state), Commonwealth of Massachusetts in the United States. The city serves as the cultural and Financial centre, financial center of New England, a region of the Northeas ...

. 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 The European Society of Cardiology (ESC) is an independent Nonprofit organisation, non-profit, non-governmental professional association that works to advance the prevention, diagnosis and management of diseases of the heart and blood vessels, a ...

, 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

Electroanatomic mapping uses electric and magnetic fields to create three dimensional models of heart structures using specialized catheters.

Notable cardiac electrophysiologists

*Kenneth Ellenbogen, American *Richard N. Fogoros, American * Michel Haïssaguerre (born 1955), French *

Mark Josephson Mark E. Josephson (1943-2017) was an American cardiologist and writer, who was in the 1970s one of the American pioneers of the medical cardiology subspecialty of cardiac electrophysiology. His book titled ''Clinical Cardiac Electrophysiology: T ...

(1943–2017), American * George Klein, Canadian * Bruce Lerman, American * John Alexander MacWilliam (1857–1937), British/Scottish * Michel Mirowski (1924–1990), Polish-Israeli-American *Eric Prystowsky, American * Amiran Revishvili (born 1956), Russian * Hein Wellens (1935–2020), Dutch

References

{{DEFAULTSORT:Cardiac Electrophysiology