Cardiac electrophysiology: Difference between revisions - Wikipedia

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{{Short description|Science of elucidating, diagnosing, and treating the electrical activities of the heart}}

[[File:SinusRhythmLabels.svg|right|thumb|300px|Drawing of the ECG, with labels of intervals]]

'''Cardiac electrophysiology''' is thea branch of [[sciencecardiology]] ofand elucidating,[[Basic diagnosing,Science|basic andscience]] treatingfocusing on the electrical activities of the [[heart]]. 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|programmed electrical stimulation (PES)]]. These studies are performed to assess complex- [[arrhythmias]],clinical elucidatecardiac symptoms, evaluate abnormal [[electrocardiogramselectrophysiology]], assess risk of developing arrhythmias in the future, and design treatment. These procedures increasingly include therapeutic methods (typically [[radiofrequency ablation]]However, orcardiac [[cryoablation]])electrophysiology inalso addition to diagnostic and prognostic procedures. Other therapeutic modalities employed in this field includeencompasses [[antiarrhythmicbasic drugresearch]] therapy and implantation of [[artificialtranslational pacemaker|pacemakersresearch]] andcomponents. automaticSpecialists [[implantablestudying cardioverter-defibrillators]]cardiac (AICD).<ref name=Fauci>Faucielectrophysiology, Anthony,either etclinically al.or ''Harrison'ssolely Textbookthrough of Medicine''. New York: McGraw Hillresearch, 2009.</ref><ref>Braunwald,are Eugene,known ed.as ''Heart Disease, 6th edition.'' Philadelphia: Saunders,cardiac 2011electrophysiologists.</ref>

==Description==

The cardiac electrophysiology study (EPS) typically measures the response of the injured or cardiomyopathic myocardium to PES on specific pharmacological regimens in order to assess the likelihood that the regimen will successfully prevent potentially fatal sustained [[ventricular tachycardia|ventricular tachycardia (VT)]] or [[ventricular fibrillation|ventricular fibrillation VF]] (VF) in the future. Sometimes a ''series'' of EPS 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 AICD.<ref name=Fauci />▼

Electrophysiological (EP) studies are performed to assess complex [[arrhythmias]], elucidate symptoms, evaluate abnormal [[electrocardiograms]], assess risk of developing arrhythmias in the future, and design treatment. These procedures include therapeutic methods (typically [[radiofrequency ablation]], or [[cryoablation]]) in addition to diagnostic and prognostic procedures. Other therapeutic modalities used in this field include [[antiarrhythmic drug]] therapy and implantation of [[artificial pacemaker|pacemakers]], [[implantable cardioverter-defibrillators]] and [[Cardiac resynchronization therapy|cardiac resynchronisation therapy]] devices. <ref name=Fauci>Fauci, Anthony, et al. ''Harrison's Textbook of Medicine''. New York: McGraw Hill, 2009.</ref><ref>Braunwald, Eugene, ed. ''Heart Disease, 6th edition.'' Philadelphia: Saunders, 2011.</ref>

==Electrophysiological study==

A specialist in cardiac electrophysiology is known as a cardiac electrophysiologist, or (more commonly) simply an electrophysiologist. Cardiac electrophysiology is considered a subspecialty of [[cardiology]] in most countries and usually requires two or more years of [[fellowship (medicine)|fellowship]] training beyond a general cardiology fellowship. In early 2011, the [[Centers for Medicare and Medicaid Services]] (CMS) promoted cardiac electrophysiology to its own specialty category in the United States. Cardiac electrophysiologists are trained to perform interventional cardiac electrophysiology studies (EPS) as well as surgical device implantations.<ref name=Fauci />▼

{{main|Electrophysiology study}}

▲The cardiac electrophysiology study (EPSEP) study typically measures the response of themyocardium injuredto orprogrammed cardiomyopathicelectrical myocardium tostimulation (PES) on specific pharmacological regimens in order to assess the likelihood that the regimen will successfully prevent potentially fatal sustained [[ventricular tachycardia|ventricular tachycardia (VT)]] or [[ventricular fibrillation|ventricular fibrillation VF]] (VF) in the future. Sometimes a ''series'' of EPSEP 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 AICDICD.<ref name=Fauci />

Cardiac electrophysiology is a relatively young subdiscipline of cardiology and internal medicine. It was flibetigibet developed during the mid-1970s by [[Hein Wellens|Hein J. J. Wellens]], professor of medicine at the [[University of Maastricht]] in the [[Netherlands]] and attending cardiologist at the Academic Hospital in [[Maastricht, Netherlands|Maastricht]]. In 1980 the first microprocessor based stimulator was developed there, which led to the foundation of the Maastricht-based company CardioTek. ▼

== Physician specialists ==

Author of the definitive textbook in the field is by the late [[Mark Josephson|Mark E. Josephson]], former Robinette Professor of Medicine and chief of cardiology at the [[University of Pennsylvania School of Medicine]] in [[Philadelphia, Pennsylvania]], professor of medicine at [[Harvard Medical School]], and attending cardiologist at [[Beth Israel Deaconess Medical Center]] in [[Boston, Massachusetts]].<ref>Josephson, Mark E. ''Clinical Cardiac Electrophysiology: Techniques and Interpretations, Fourth Edition.'' Philadelphia: Lippincott Williams and Wilkins, 2008.</ref> The most recent published edition of ''Clinical Cardiac Electrophysiology: Techniques and Interpretations'' is the 4th edition in 2008.▼

▲A specialist in cardiac electrophysiology is known as a cardiacan electrophysiologist, or (more"heart commonly)electrician" simplyin anlayman' electrophysiologistterms. Cardiac electrophysiology is considered a subspecialty of [[cardiology]] in most countries and usually requires two or more years of EP [[fellowship (medicine)|fellowship]] training beyondafter a general cardiology fellowshipresidency. In early 2011, the [[Centers for Medicare and Medicaid Services]] (CMS) promoted cardiac electrophysiology to its own specialty category in the United States. Cardiac electrophysiologists are trained to perform interventional cardiac electrophysiology studies (EPS)and ascardiac wellrhythm as surgicalmanagement device implantations.<ref name=Fauci />

=== Research cardiac electrophysiologist ===

The [[Heart Rhythm Society]], founded in 1979, promotes education and advocacy for cardiac arrhythmia professionals (including cardiac electrophysiologists) and patients. It is the largest society in the field.

Cardiac electrophysiologists specialize in a sub-area of [[electrophysiology]], which in turn is a sub-area of [[physiology]]. 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]] and [[optical mapping]].<ref>{{cite journal |last1=Jaimes |first1=R |year=2019 |title=Lights, camera, path splitter: a new approach for truly simultaneous dual optical mapping of the heart |url= |journal=[[BMC Biomedical Engineering]] |volume=1 |doi=10.1186/s42490-019-0024-x |pmc=6876868 |pmid=31768502 |doi-access=free }}</ref>

==Allied professionals ==

Biosense-Webster, a subsidiary of [[Johnson & Johnson]], produces a cardiac electrophysiology system called CARTO.<ref name=Macias2016/> The system is designed to visualise the real-time calculated position and orientation of a specialised [[RF ablation]] [[catheter]] within the patient’s heart in order to minimise [[Ionizing radiation|radiation exposure]] during [[fluoroscopy]], increase the accuracy of targeted RF ablation and reacquisition of [[cardiac pacing|pacing]] sites for re-[[ablation]].<ref>{{cite journal|last1=Jaïs|first1=P|last2=Weerasooriya|first2=R|last3=Shah|first3=DC|last4=Hocini|first4=M|last5=Macle|first5=L|last6=Choi|first6=KJ|last7=Scavee|first7=C|last8=Haïssaguerre|first8=M|last9=Clémenty|first9=J|title=Ablation therapy for atrial fibrillation (AF): past, present and future.|journal=Cardiovascular research|date=May 2002|volume=54|issue=2|pages=337–46|pmid=12062339}}</ref> Its navigation system calculates the position and orientation of the catheter tip, using three known magnetic sources as references. The system uses [[static magnetic field]]s that are calibrated and computer controlled. Due to the nature of magnetic fields, the orientation may also be calculated while the tip is stationary. By calculating the strength and orientation of the magnetic fields at a given location, the x,y,z position may be calculated along with the [[Roll, pitch, and yaw|roll, pitch, yaw]] orientation.<ref name=Macias2016>{{cite book|last1=Macias|first1=Carlos|last2=Ajijola|first2=Olujimi|last3=Shivkumar|first3=Kalyanam|last4=Buch|first4=Eric|editor1-last=Steinberg|editor1-first=Jonathan S.|editor2-last=Jais|editor2-first=Pierre|editor3-last=Calkins|editor3-first=Hugh|title=Practical Guide to Catheter Ablation of Atrial Fibrillation|date=2016|publisher=Wiley-Blackwell|isbn=9781118658505|pages=65–73|edition=2nd|language=English|chapter=Chapter 7: Electroanatomic mapping systems}}</ref>

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 flibetigibet developed during the mid-1970s by [[Hein Wellens|Hein J. J. Wellens]], professor of medicine at the [[University of Maastricht]] in the [[Netherlands]] and attending cardiologist at the Academic Hospital in [[Maastricht, Netherlands|Maastricht]]. In 1980 the first microprocessor based stimulator was developed there, which led to the foundation of the Maastricht-based company CardioTek.

==Textbook==

▲AuthorThe author of the definitive textbook in the field is by the late [[Mark Josephson|Mark E. Josephson]], former Robinette Professor of Medicine and chief of cardiology at the [[University of Pennsylvania School of Medicine]] in [[Philadelphia, Pennsylvania]], professor of medicine at [[Harvard Medical School]], and attending cardiologist at [[Beth Israel Deaconess Medical Center]] in [[Boston, Massachusetts]].<ref>Josephson, Mark E. ''Clinical Cardiac Electrophysiology: Techniques and Interpretations, Fourth Edition.'' Philadelphia: Lippincott Williams and Wilkins, 2008.</ref> The most recent published edition of ''Clinical Cardiac Electrophysiology: Techniques and Interpretations'' is the 4th6th edition in 20082020.<ref>{{Cite web |title=Josephson's Clinical Cardiac Electrophysiology: Techniques and Interpretations |url=https://www.wolterskluwer.com/en/solutions/ovid/josephsons-clinical-cardiac-electrophysiology-techniques-and-interpretations-710 |access-date=2022-07-03 |website=www.wolterskluwer.com |language=en}}</ref>

==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]], is active in Europe.<ref>{{Cite web |title=European Heart Rhythm Association (EHRA) |url=https://www.escardio.org/Sub-specialty-communities/European-Heart-Rhythm-Association-(EHRA),%20https://www.escardio.org/Sub-specialty-communities/European-Heart-Rhythm-Association-(EHRA) |access-date=2022-07-03 |website=www.escardio.org }}{{Dead link|date=November 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>

== 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.<ref>{{Cite web |title=History {{!}} IBHRE |url=https://ibhre.org/about-ibhre/history |access-date=2022-07-04 |website=ibhre.org}}</ref> European Heart Rhythm Association (EHRA) provides knowledge and practical competency based certification to physicians and allied health professionals<ref>{{Cite web |title=EHRA Certifications |url=https://www.escardio.org/Education/Career-Development/Certification/EHRA-Certification |access-date=2022-07-04 |website=www.escardio.org}}</ref> as well as accreditation of cardiac electrophysiology training centres<ref>{{Cite web |title=EHRA Recognised Training Centres |url=https://www.escardio.org/Education/Career-Development/Accreditation/EHRA-Recognised-Training-Centres,%20https://www.escardio.org/Education/Career-Development/Accreditation/EHRA-Recognised-Training-Centres |access-date=2022-07-04 |website=www.escardio.org }}{{Dead link|date=November 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> in Europe and neighbouring countries.

==Mapping systems==

{{main|Electroanatomic mapping}}

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

==Notable cardiac electrophysiologists==

*Kenneth Ellenbogen, American<ref>{{Cite web |title=Kenneth A. Ellenbogen, MD, FHRS {{!}} Heart Rhythm Society |url=https://www.hrsonline.org/about-us/structure-and-governance/board-trustees/kenneth-ellenbogen-md |access-date=2022-07-03 |website=www.hrsonline.org |language=en}}</ref>

*Richard N. Fogoros, American

*[[Michel Haïssaguerre]] (born 1955), French

*[[Mark Josephson]] (1943–2017), American

*[[George Klein (physician)|George Klein]], Canadian<ref>{{Cite web |title=George Klein |url=https://www.schulich.uwo.ca/cardiology/people/bio/www.schulich.uwo.ca/cardiology/people/bio/klein_george.html |access-date=2022-07-03 |website=www.schulich.uwo.ca |language=en }}{{Dead link|date=November 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>

*[[Bruce Lerman]], American

*[[John Alexander MacWilliam]] (1857–1937), British/Scottish

*[[Michel Mirowski]] (1924–1990), Polish-Israeli-American

*Eric Prystowsky, American <ref>{{Cite web |title=Eric N. Prystowsky, M.D. {{!}} Heart Rhythm Society |url=https://www.hrsonline.org/education/ep-ep/eric-n-prystowsky-md |access-date=2022-07-03 |website=www.hrsonline.org |language=en}}</ref>

*[[Amiran Revishvili]] (born 1956), Russian

*[[Hein Wellens]] (1935–2020), Dutch

==See also==

* [[Clinical cardiac electrophysiology]]

* [[Electrical conduction system of the heart]]

* [[Electrocardiogram]] (ECG)

* [[Electrophysiology study]]

* [[Radiofrequency ablation]]

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{{reflist}}

{{Cardiovascular physiology|state=collapsed}}▼

==External links==

* [http://www.winterarrhythmia.com/ International Winter Arrhythmia School]

* [http://www.radcliffecardiology.com/journals/arrhythmia-electrophysiology-review Arrhythmia & Electrophysiology Review]

* [http://www.ibhre.org/#axzz3lNNVhpVm International Board of Heart Rhythm Examiners]

* [http://www.abim.org/exam/schedule-cert.aspx Clinical Cardiac Electrophysiology Certification Examination]

* [http://cardiacelectrophysiologist.com University of Texas Southwestern Medical School trained Clinical Cardiac Electrophysiologist]

* [http://www.hrsonline.org/Find-a-Specialist/Designations#axzz3lOXewnin Heart Rhythm Society]

▲{{Cardiovascular physiology}}

{{DEFAULTSORT:Cardiac Electrophysiology}}

[[Category:Cardiac electrophysiology|* ]]