Heart rhythm is one of the crucial parts of cardiac science. Unfortunately, this is often overlooked and ignored in the community as a considerable health issue. Electrophysiologists are cardiologists who are specially trained in the electrical disorders of the heart. Their expertise allows them to accurately diagnose and treat complex heart rhythm disorders.

In India, there are around 250 electrophysiologists who are members of the Indian Heart Rhythm Society (IHRS) forum. Around forty percent of cardiac patients in India, suffering from cardiac problems, show signs of heart rhythm disorders while ninety percent of cardiac arrests are caused by arrhythmia or irregular heart rhythm. Despite these alarming data, a lot of patients remain undiagnosed. As we celebrate World Heart Rhythm Week, it is important to understand the role of an electrophysiologist in managing one’s heart health.

One of the most common phenomena we have seen is that people going for a pacemaker due to abnormal heart rhythm are often identified on ECG. Herein, consulting an electrophysiologist becomes a crucial step in the process, because the finding of ECG or Holter monitor merely may not suffice the rationale of pacemaker implantation.

An electrophysiologist conducts a thorough evaluation that includes a detailed review of the patient’s medical history, analysis of symptoms, and a variety of non-invasive tests. They assess the patient’s previous heart conditions, surgeries, and current medications, and correlate symptoms such as palpitations, dizziness, or fainting with potential electrical issues in the heart. They use advanced tests like electrophysiological studies (EPS) to determine the exact nature of the heart rhythm issue, ensuring that the treatment plan is based on accurate and detailed information. They tailor the treatment to the patient’s specific needs by recommending the most suitable type of therapy such as medicines or Radiofrequency Ablation (RFA) or pacemaker and optimal placement. This personalized approach enhances the effectiveness of therapy.

Electrophysiologists implant pacemakers or other high-end Implantable electronic device therapy like Automated Implantable Defibrillator (AICD) in addition to its comprehensive follow-up and monitoring. This holistic approach involves adjusting medications that manage arrhythmias or other heart conditions and advising on diet, exercise, and lifestyle factors that influence heart health and the pacemaker’s effectiveness. Additionally, they work with other medical specialists to ensure that device therapy integrates seamlessly with any other required surgical or medical interventions.

It is observed that sometimes patients experience issues such as receiving electric shocks from the device or facing other complications. An electrophysiologist helps the patient determine which pacemaker is most effective. In some cases, whether patients may need a pacemaker at all or not.

An electrophysiologist also provides a detailed risk assessment and management plan for the pacemaker. They evaluate the risks associated with pacemaker implantation, such as infection, lead displacement, or device malfunction, and recommend preoperative preparations to manage other medical conditions to minimize complications. Postoperative care is also planned, including detailed follow-up to monitor the device function and adjust settings as needed, ensuring long-term success and patient safety.

Electrophysiologists provide ongoing care and follow-ups to ensure the device functions correctly and to make necessary adjustments over time. Consulting an electrophysiologist ensures a thorough understanding of the heart’s electrical system and the patient’s specific medical needs, leading to better outcomes, optimized treatment, and ongoing care tailored to the individual patient.

About the author- Dr. Rakesh Sarkar, Senior Consultant, Department of Cardiology & Electrophysiology, BM Birla Heart Hospital