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Electrophysiology

As a descriptive word, Electrophysiology sounds over-complicated. When introducing myself to patients, I almost always refer to myself as a heart-rhythm specialist. Other doctors call us “EPs.”

EP–a much easier name–is a branch of cardiology that deals with the diagnosis and treatment of heart rhythm disorders. We do an extra year (or two) of training after the standard cardiology fellowship.

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EP doctors do three things:

  • Ablate (We burn).
  • Implant and manage cardiac devices (We install).
  • Take care of patients (We doctor).
  • Burning:

Catheter ablation is a heart-cath-like procedure in which a small catheter is placed inside the heart (via a leg vein). The catheter has a 4-8 mm metal tip through which radio-frequency energy is skillfully delivered to selected parts of the heart. (The area to ablate is selected primarily by two simple strategies: vector analysis of the how the arrhythmia activates the heart (ie…north-south, east-west) and secondly, by moving the ablation catheter in a “warmer-colder” trial-and-error manner.) The 4-8 mm ablation lesions can eliminate rogue cells that have electrically run amok, or in the case of AF, isolate entire areas of the heart into quadrants. Catheter ablation is the only cardiac procedure that can be correctly called curative. (No, stents do not cure atherosclerosis.) I learned ablation in the mid-1990s but did not start using it for atrial fibrillation until 2004. Over the past few years, AF-ablation has emerged as electrophysiology’s most exciting therapy, and it is a focus of my practice. Here is a link to my atrial fibrillation page.