Cardiac Electrophysiology (also referred to as clinical cardiac electrophysiology, arrhythmia services, or electrophysiology or for short EP), is a branch of the medicine and cardiology that specializes and focuses on the study and treatment of rhythm disorders of the heart. The term “arrhythmia” refers to any change from the normal sequence of electrical impulses that makes the heart beat in normal sequence. The electrical impulses may happen too fast, too slowly, or erratically. When the heart doesn’t beat properly, it can’t pump blood effectively. When the heart doesn’t pump blood effectively, the lungs, brain and all other organs can’t work properly and may shut down or be damaged.

Cardiologists with expertise in this area are usually referred to as electrophysiologists or EPs. Electrophysiologists are trained in diagnosing, treating and managing heart rhythm disorders. They have in-depth knowledge of the mechanisms, function, and performance of the electrical system of the heart. Electrophysiologists work closely with other cardiologists and cardiac surgeons to assist and guide therapy for heart rhythm disturbances (arrhythmias). They are also trained to perform interventional and surgical procedures to treat heart rhythm disorders.

The training required to become a cardiac electrophysiologist is long and requires about 8 years after medical school (in the U.S.). Three years of internal medicine residency, three years of General Cardiology fellowship, and in most instances, two years of clinical cardiac electrophysiology fellowship training. Electrophysiologists perform a number of invasive and noninvasive test to diagnose and treat heart rhythm disorders. An electrophysiology study involves a number of invasive (intracardiac) and non-invasive recording of spontaneous electrical activity, as well as of cardiac responses to programmed electrical stimulation. These studies are performed to assess arrhythmias, elucidate symptoms, evaluate abnormal electrocardiograms, assess risk of developing arrhythmias in the future, and design treatment.

In addition to diagnostic testing of the electrical properties of the heart, electrophysiologists are trained in therapeutic and surgical methods to treat many of the rhythm disturbances of the heart. Therapeutic modalities employed in this field include antiarrhythmic drug therapy and surgical implantation of cardiac monitors, pacemakers and implantable cardioverter-defibrillators, laser procedures to remove pacemaker and defibrillator leads from the heart, catheter ablation procedures directed at areas in the heart causing the heart rhythm disorders. They also deal with stroke prevention strategies in patients with atrial fibrillation including new procedures to occlude the left atrial appendage, the main source of clots in the heart that can cause strokes.