An electrophysiologist is a cardiologist who has specialized in the study of the electrical impulses which affect cardiac rhythm. To become an electrophysiologist takes many years of study. Patients who will seek the advice of an electrophysiologist include those with cardiac arrhythmias or to determine their risk for cardiac disease or sudden cardiac arrest. The doctor must have a keen interest in the electrical workings of the heart to become an electrophysiologist
The process to become an electrophysiologist is long. The normal four years of medical school must be completed, followed by three years in a resident program. After this, they will specialize in cardiology via a fellowship, which may take two to three years. Only after this can electrophysiology be studied, which can take up to two years. Basically, to become an electrophysiologist may take up to twelve years from beginning to end.
Once the doctor has become an electrophysiologist, they will have patients referred to them, either by general practitioners or cardiologists. They can perform a number of different procedures used to establish the presence and severity of cardiac abnormalities and arrhythmias. These range from simple, non-invasive procedures such as echocardiograms and placement of external cardiac rhythm monitors, to the more invasive procedures which include an electrophysiology study and the placement of pacemakers.
Echocardiograms record the heart's impulses and allow the electrophysiologist to establish what type of arrhythmia, if any, is present. A Holter monitor may be placed on a patient to determine the heart's functioning over a period of time. It records the continuous functioning of the heart over a day or two. Alternatively, an event recorder may be used, which responds only if there is a change in cardiac rhythm, and sends a signal. All of these help to establish the type of arrhythmia and the best treatment thereof.
During an electrophysiology study, which is performed under highly controlled conditions in the electrophysiology lab, the patient is hooked up to an IV line and various monitors and will be given medication to relax them but not put them to sleep. Local analgesic will be injected at a spot in the groin where a tiny incision is made to insert a catheter. This is guided up into the heart. A pacemaker is used to increase the heart rhythm and medications may be given to see their effect. Constant monitoring is done throughout.
Depending on what is seen, a pacemaker may be inserted, medication prescribed or surgery recommended. The procedure may take two to four hours and, in most cases, the patient can go home afterwards. A friend or family member should drive them though, due to the sedative which is given. The job of an electrophysiologist is very specialized and intricate and requires years of study and experience.