The heart is a muscle that pumps blood around the circulation. To initiate the pumping process, the heart has electrical channels that spread the electricity in an organised manner to its cells.  This electrical impulse originates at the sinus node, the heart's natural pacemaker.  Arrhythmia is the disturbance of the electrical activity of the heart. Being a human organ and not a machine, the heart occasionally goes out of rhythm.  This is called an arrhythmia. Arrhythmias can cause symptoms, usually palpitations, that commonly let people visit a Cardiologist or an Electrophysiologist.

Most arrhythmias are benign but can be unpleasant, so we tend to treat them for symptomatic relief. Unfortunately, some rhythm disturbances are potentially dangerous and should be diagnosed early to avoid disastrous consequences.

There are a vast number of arrhythmia substrates, and there is a specific treatment for each and every one of them. The General Cardiologist can manage most of the arrhythmias, but some aspects of the treatment require a specialist opinion by an Electrophysiologist.

Many investigations are available to discover the specific rhythm problem, and the skill is to decide which is the correct one to avoid wasting a patient’s time and unnecessary expenses.  This often depends on the experience of the electrophysiologist.

Diagnosis and Treatment of:

-Atrial Fibrillation (AF)

-Cardiomyopathies

-Congenital Channelopathies

-Palpitation-Arrhythmias

-Sudden Cardiac Death Syndromes

-Supraventricular Tachycardia (SVT)

-Syncope/Faint

-Ventricular Extrasystoles-Ectopic Beats

-Wolff-Parkinson White Syndrome (WPW)

-24-hour Ambulatory Electrocardiogram (Holter) Monitoring

-Pharmacological Infusion Tests

-Pacemakers/Defibrillators- Regular Check-ups

The infusion of some intravenous medication can help identify specific arrhythmia substrates. Other infusion tests can assist in diagnosing inherited, potentially lethal electrical abnormalities. An experienced specialist in cardiac arrhythmias performs these procedures.

Following the implantation of a pacemaker or defibrillator, the device should be checked on at least an annual basis. The check involves testing the parameters of the wires, the battery and the programmed settings and fine-tuning the device function.   No operation is needed for these tests as the pacemaker communicates with the programmer equipment via radio waves.

-Ablation of Atrial FlutterAblation of Atrial Fibrillation (AF)

-Ablation of Supraventricular Tachycardia (SVT)

-Ablation of Ventricular Tachycardia

-Direct Current Cardioversion

-Electrophysiological Study (EP Study)

-Implantation of  Internal Loop Recorder (ILR)

-Implantation of Biventricular Pacemakers

-Implantation of Cardiac Defibrillators

-Implantation of Permanent Pacemakers

-Pacemaker Battery Replacement

An electrophysiological study is an invasive procedure undertaken to determine the cause of abnormal heart rhythms or exclude the presence of an abnormal substrate. A number of catheters are introduced into the heart via small punctures in the veins of the leg, shoulder or neck.   Various measurements are taken of the electrical conducting system of the heart. In most cases, abnormal heart rhythms are initiated by various pacing manoeuvres. After the problem is identified with the electrophysiological study, an ablation procedure can be performed at the same time.  These procedures are done with sedation or a general anaesthetic.

Ablation is the process that modifies small parts of the heart muscle that are responsible for abnormal heart rhythms or palpitations.  This is done by heating the area using a radiofrequency electric current at the end of a catheter placed in contact with the heart muscle.

Once that part of the heart muscle is modified, it no longer conducts electrical impulses, so the palpitations that originate from that area stop. The procedure is performed with heavy sedation and strong pain relief.  Sometimes a general anaesthetic can be used.

The heart has its own natural pacemaker called the sinus node, which produces regular electrical impulses. This keeps the heart beating regularly throughout life.

If the heart rate is too slow, a pacemaker may be needed to speed it up. An artificial pacemaker is a small electronic box about the size of a cigarette lighter which can generate electrical impulses. The pacemaker is connected to pacing wires, which have been placed inside the heart via some veins, usually under the collarbone.

The pacemaker monitors the heart rate continuously, and when it detects that the pulse has slowed down, it generates an electrical signal which travels through the pacing wires to make the heartbeat.

A specialist in cardiac devices and arrhythmias performs the procedure under sterile conditions, using local anaesthetic, pain relief and sedation. The device is placed under the skin leaving a small scar on the left side under the collarbone. The recovery is quick, with most patients being discharged the day following the procedure.

Life-threatening arrhythmias cause sudden cardiac death. Implantable cardiac defibrillators continuously monitor the heart rhythm, automatically function as pacemakers for heart rates that are too slow, and deliver life-saving shocks if a dangerously fast heart rhythm is detected.

The implantation is similar to a pacemaker by gently positioning wires in the heart and connecting them to the defibrillator box below the left collarbone. A specialist in cardiac devices and arrhythmias performs the procedure.

Cardioversion is a brief procedure where an electrical shock is delivered to the heart to convert an abnormal heart rhythm back to a normal rhythm. The procedure resets the heart and is commonly performed to treat atrial fibrillation. This is done under heavy sedation or an anaesthetic.