Suddenly the power cells of your heart might beat more slowly, and you feel dizzy, lightheaded or even pass out. Or these cells rev up your heart rate, and your heart feels as though it’s going to burst out of your chest. Or—without any imminent warning, there’s sudden cardiac death.
“As cardiac electrophysiologists, it’s our job to identify the rhythm problems, identify the mechanisms leading to these abnormal heart rhythms, then treat them either by medication or certain procedures that we do,” said Hreibe.
When You Might Want to See an Electrophysiologist
Most of the time, you’ll know that something is going on with your heart—whether you’re regularly dizzy or short of breath, feel like your heart is beating too fast, or you have a past history of heart attack or have had stents put in.
Younger people tend to have a lower risk—about 1 in 400, for example, are at risk for supraventricular tachycardia, also known as a faster than normal heart rate. But 1 in 65 of people older than 65 will have atrial fibrillation—an irregular, often rapid heart rate—and not even know it.
“It’s a very broad spectrum, and it’s very hard to say what percentage of the population has an electrical problem with their heart,” said Hreibe. “But it’s important to note that we are not talking about rhythm problems or sudden cardiac death related to a genetic condition or congenital abnormality.”
These tragic stories of young, otherwise healthy people who die from sudden cardiac arrest are very hard to identify unless there is another problem and a doctor happens to find the genetic abnormality.
Heart rhythm problems not related to genetics are—just like most things—caused by our lifestyles: “It’s the usual stuff,” said Hreibe, “not eating a healthy diet, not exercising, smoking and not controlling diabetes and blood pressure.”
If you feel like something’s going on with your heart rhythms, it’s important to get checked out because any problem with your heart is potentially life-threatening. “We tell referring physicians: Even if you think nothing’s going on, if you’re not sure, send us the patient,” said Hreibe. “If everything is fine, that’s great. But anything is wrong, it’s better treated earlier rather than later.”
Choosing an accredited electrophysiology lab is also key. For example, Augusta University Health’s EP lab is the first American College of Cardiology accredited EP lab in the state of Georgia. It’s also only the sixth program in the U.S. to earn this voluntary designation, meeting a high standard of care and continuous education and training. “Our surveyor specifically noted the engagement, collegiality, and hard work of the EP lab staff, but most importantly the incredible care they give to patients throughout the CSRA every day,” said Dr. Pascha Schafer, medical director of the cardiac care unit at AU Health.
Getting Back in Rhythm
If you have a slow heart rate:
A cardiac electrophysiologist can insert a pacemaker. Nowadays, these are considered small procedures and take only about 45 minutes.
If you have a fast heart rate:
Whether the problem is within the top or bottom chambers of your heart, your treatment could be medication, or it could be ablation. During cardiac ablation, you’ll go under anesthesia, while a cardiac electrophysiologist inserts a long, flexible tube called a catheter into a vein in your groin. He or she then threads the catheter to your heart. The catheter carries an electrode, which uses energy to scar or destroy the tissue that’s causing your electrical problem.
If you’re at risk for sudden cardiac death:
Your cardiac electrophysiologist will likely recommend an implantable cardioverter defibrillator. This device acts both like a pacemaker, using electrical pulses to help control your heart’s rhythms. But, if it senses dangerous rhythms, it delivers a shock to help correct the life-threatening rhythm.
“I’ve had patients walk into clinic, and their first statement is, ‘I’m feeling fine; I don’t know why they sent me here,’” said Hreibe. “As you start talking to them, you realize they’re not fine; they just started avoiding everything that makes them feel bad. You ask, ‘What do you do all day?’ and they say, ‘I sit down, and I watch TV.’ ‘Do you clean house?’ ‘No, I can’t do that; I get short of breath if I do that.’
That’s when patients should ask themselves, “Is this the way I want to live? Is this the quality of life I’m OK with for the next 30 years?”
Whether or not patients answer no to that question, the point is to get the information and make an informed decision, said Hreibe.
“The majority of the cases we do are considered low risk,” he said. “More than 80% of patients don’t even spend the night in the hospital, but go home the same day. If there’s a chance to feel better and you want to feel better, seek care.”