Electrophysiologists are cardiologists who have received additional specialized training in the diagnosis and treatment of heart rhythm disorders.
 
Electrocardiographic Tests
Usually, arrhythmias are diagnosed or identified through the use of electrocardiographic techniques. These techniques, called electrocardiograms (also known as ECG or EKG) are performed by placing small patches, called electrodes, on the body to measure the three major waves of electrical signals. Each wave of electrical signals corresponds to different parts of one’s heartbeat. The first wave is referred to as the P wave, and it shows the activity of the heart’s atria. The second and largest wave is the QRS wave, or the wave that records the electrical activity of the ventricles. Finally, there is the T wave and it allows doctors to see the heart return to its resting state. By examining the size, shape and rate of the waves, doctors are able to see the patterns of a patient’s heartbeat and make conclusions about the heart’s rhythm.

One disadvantage of an ECG is that it is useful only when the arrhythmia occurs during testing, which is quite rare. Therefore, some patients are sent home wearing a device called a Holter monitor that will record their irregular heartbeats. The Holter monitor (ambulatory electrocardiography) allows a physician to observe and evaluate sporadic symptoms or changes related to one’s heart rhythm. The device is worn for a 24-hour period so that the cardiologist can monitor the heart’s rhythm and electrical activity during the patient's daily regimen. Five stickers are placed on the patient’s chest and are connected to the recording device by wires that detects the heart’s electrical pattern. This information is stored in the device, and can later be interpreted by specialists.

For those patients whose arrhythmias happen infrequently, a transtelephonic monitor may be used. These are small recorders that are sent home with an individual for over a month. The patient is instructed to attach the recorder under the arm when symptoms are experienced. The ECG will be recorded and stored in the device, similar to a Holter monitor.

Additional diagnostic techniques for patients with arrhythmias include treadmill testing, a technique which allows doctors to examine irregular heartbeats that may be exercise induced.

Tilt table studies, used for patients who have recurrent fainting spells, often indicate the best treatment method. These studies show the doctor how the heart rate and blood pressure respond to changes in the body’s position.

Diagnosing of tachycardias is slightly different. Some doctors place catheters into the heart to get an intracardiac reading, while others may use electrophysiologic testing. Electrophysiologic testing is able to show where the tachycardia originates with more clarity than any other test. This method involves using local anesthesia and placing electrode catheters in the peripheral veins of the heart using a fluoroscope. These catheters are then placed into the atria and/or ventricles at strategic locations along the conduction system. Here they are able to record the cardiac electrical signals and show the course of each impulse during one heartbeat. In addition to these electrical tests, echocardiograms also are used because their ultrasound recordings offer valuable information about the heart.

Depending on the severity of the arrhythmia, the patient may or may not need treatment. If necessary, the patient may receive implantable devices that control the heart’s rhythm. One such device is a cardioverter defibrillator, which is an implantable electrode patch that provides automatic shock therapy. Implanted pacemakers are similar and send small electrical impulses to the heart muscle in order to maintain a suitable heart rate. A pacemaker defibrillator combines both treatments to restore and maintain a healthy, steady pace in the heart.

Some patients require more invasive treatments such as a radio frequency catheter ablation. This is used if a part of the heart tissue is responsible for the arrhythmia. The treatment uses high frequency radio waves that are inserted into an artery to “zap” the heart tissues and correct the rhythm. GW Hospital utilizes advanced technology, the Ensite 3000, for mapping and treating arrhythmias.