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Our hearts are complicated organs that help keep oxygen and nutrient-rich blood running throughout our bodies. Several components of the heart ensure that our circulation remains strong. Like electricity that keeps the lights on in our houses, the electricity in our hearts keeps them pumping rhythmically so enough blood is distributed for our bodies to thrive.

Electrophysiology
When the heart's electricity isn't working properly, cardiac electrophysiologists can help. "We are like electricians of the heart," says D. Michael Farmer, M.D., Cardiac Electrophysiologist at Mount Auburn Hospital, a teaching hospital of Harvard Medical School. "Electrophysiology (EP) is a subspecialty of cardiology that deals with the diagnosis and treatment of a variety of cardiac arrhythmias. Symptoms of cardiac arrhythmias include very slow or fast heart rates; palpitations; or loss of consciousness."

Arrhythmias usually can be treated with medications. In some instances, an EP study and potential ablation procedure may be the best option. The study can provoke arrhythmic events and map electrical circuits on the inside of the heart. This can help diagnose and treat these conditions. This is often an outpatient procedure that allows doctors to access different regions of the heart through catheters that are guided from the femoral vein in the leg to the heart. "The EP procedures are more efficient than ever before," says Dr. Farmer.

The EP study uses advanced mapping systems, which allow doctors to map out the electrical systems of the heart, locate the abnormal electrical impulses, and assess the need for an implantable device or cardiac ablation procedure. If an implantable device or ablation procedure is necessary, it can often be done at the same time as the EP study.

Intervention with implantable devices
"Several different implantable devices can be used to treat cardiac arrhythmias," says Dr. Farmer. "Pacemakers are used to treat slow heart rates. Implantable cardioverter defibrillators (ICDs) can treat patients who are at risk for cardiac arrest."

ICDs are particularly beneficial to stop sudden cardiac death in patients who have experienced a previous heart attack or have congestive heart failure. "Like a small computer monitoring every heart beat, an ICD can detect cardiac arrest and stop it by jolting the heart," says Dr. Farmer.

Advancements in pacemakers and ICDs have led to an innovative treatment called cardiac resynchronization therapy, also called biventricular pacemakers or biventricular ICDs. Cardiac resynchronization therapy is an extension of the ICD technology and helps people with congestive heart failure by coordinating multiple chambers of the heart. "This technology can help alleviate shortness of breath symptoms and improve quality of life," says Dr. Farmer.

Intervention using cardiac ablation
Cardiac ablation is most commonly used for patients who have supraventricular tachycardia, which includes atrial fibrillation. Ablation is also utilized for people with ventricular tachycardia.

"After we delineate the electrical circuits in the heart, we can often disrupt the abnormal circuits with ablation," says Dr. Farmer. "This procedure uses small catheters to disrupt abnormal electrical circuits in the heart." The end of the catheter uses a form of energy, usually heat, to create scars in small areas of abnormal tissue. "Patients lie flat for several hours after the procedure, but are typically back to their daily routine the following day," says Dr. Farmer.

Electrophysiologists at Mount Auburn Hospital take a multidisciplinary approach when treating patients with cardiac arrhythmias. "We always work with the patient's primary cardiologist," says Dr. Farmer. "Since we are dealing with multiple heart concerns, from coronary disease and congestive heart failure to electrical problems of the heart, working as a team helps us ensure comprehensive cardiac care."

For a free Mount Auburn Hospital physician directory, please call us at 617-499-5094.