Electrophysiology (EP)

Electrophysiology (EP) is a specialty that focuses on diagnosing and treating problems related to your heart’s electrical signals, which cause your heart to beat.

What Do Electrophysiologists Do?

At UNC Medical Center, you’ll benefit from the expertise of an electrophysiologist—a physician with advanced training in heart rhythms—who’ll work closely with a multidisciplinary group of cardiac specialists. Your electrophysiologist can:

  • Evaluate symptoms like dizziness, fainting and weakness
  • Determine the cause and location of an arrhythmia
  • Assess the need for a pacemaker, implantable cardioverter defibrillator (ICD) or other implantable device
  • Check to see if a medication is working correctly
  • Treat a heart rhythm problem with medications, a minimally invasive procedure, or implantation of a pacemaker or defibrillator in your chest

Diagnosing Arrhythmia

In addition to other diagnostic procedures, your physician will perform electrophysiology studies (EPS), a specialized form of cardiac catheterization that checks for abnormal heartbeats. During EPS your doctor will send electrical signals to your heart and record its electrical activity. You may feel your heart beat stronger or faster as it receives the signals.

You’ll be awake for the procedure. A local anesthetic will numb the area where the doctor inserts the catheter (usually the groin, arm or neck), and you’ll be given medicine to help you relax, so you won’t feel any pain.

The tests typically last one to four hours, but the procedure could take longer if treatments are also performed during this time. Afterward, you’ll rest in a recovery room for one to three hours before returning home. Read more.

Types of Arrhythmia

If you’re diagnosed with arrhythmia, your doctor will explain which condition affects you. The four main types of arrhythmia are:

  • Premature (extra) beats – Too-early heartbeats that disrupt your heart’s rhythm; may occur in the upper chambers (premature atrial contractions, or PACs) or the lower chambers (premature ventricular contractions, or PVCs) and usually need no treatment
  • Supraventricular arrhythmias – Fast heart rates, or tachycardias, that start in your heart’s upper chambers (atria) or atrioventricular (AV) node; includes atrial fibrillation (AF or a-fib), atrial flutter, paroxysmal supraventricular tachycardia (PSVT), and Wolff-Parkinson-White (WPW) syndrome
  • Ventricular arrhythmias – Arrhythmias that start in the heart’s lower chambers (ventricles); includes ventricular tachycardia and ventricular fibrillation (VF or v-fib)
  • Bradyarrhythmias – A heart rate that’s slower than normal, resulting in not enough blood flow to the brain.

Treating Atrial Fibrillation & Other Arrhythmias

If you have a problem with your heartbeat, it may be treated with medications, a minimally invasive procedure, or implantation of a pacemaker or defibrillator in your chest. Your team will work with you to design the best treatment program for your specific condition. Procedures we offer include:

Catheter Ablation

During this procedure, doctors will use catheters to send radio waves to the heart in order to eliminate small areas of tissue around the spot where your abnormal heartbeats begin. This stops the abnormal signals from travelling to the rest of the heart and restores a normal heart rate and rhythm.

The procedure usually lasts three to six hours. Afterward, you’ll spend several hours recovering in the hospital. You may need to stay in the hospital overnight or longer, depending on your condition. Read more.

Hybrid Catheter & Surgical Ablation (HyCASA)

If you have chronic or difficult-to-treat atrial fibrillation (AF), you may benefit from an innovative treatment that integrates a catheter and a surgical approach. During HyCASA, your cardiac surgeon and electrophysiologist (heart rhythm specialist) will work side-by-side to identify the source of your AF and create a pattern of scar tissue on the heart to treat these problems.

The procedure is performed through several small incisions and punctures. There are no large chest incisions, and your breastbone is left intact.

After your hybrid ablation, you’ll probably stay one to two nights in the hospital. Read more.

Lariat® Procedure for A-Fib

If you have atrial fibrillation and are unable to take blood thinning medications, a Lariat® procedure can successfully reduce your risk of stroke. During this procedure, doctors guide a catheter carrying the Lariat tool to your heart. Then they “lasso” and tie off an appendage where blood can accumulate and clot. This blocks stroke-causing blood clots from reaching the brain.

UNC Medical Center is the only hospital in North Carolina to offer this innovative procedure.

Implantable Devices

Implantable devices provide electrical stimulation to particular areas of your heart to help maintain normal heart rate or rhythm. Your device will be placed just under the skin in your upper left chest and attached to small wires (leads) that carry a current back to the heart.

At UNC Medical Center, you’ll benefit from a team of electrophysiologists, nurses and technicians with extensive experience implanting and supporting:

  • Pacemakers – Help maintain the heart rate when it’s too slow by delivering small electrical impulses to the heart; single-chamber pacemakers connect to one chamber of the right side of the heart, while dual-chamber pacemakers connect both the upper and lower right chambers
  • Bi-ventricular pacemakers – Can maintain heart rate using synchronized pacing, or cardiac resynchronization therapy (CRT), because they connect to both the right and left ventricles; used to treat advanced heart failure
  • Implantable cardioverter defibrillators (ICD) – Monitor and pace the heart; deliver energy to the heart to restore a normal rhythm when they detect a dangerous rhythm; available in single-chamber, dual-chamber and bi-ventricular models.
Pacemaker and ICD implantation is usually a minor surgery performed under a local anesthetic. You’ll be admitted to the hospital overnight after your pacemaker or defibrillator is implanted.

Lead Extraction Surgery

UNC Medical Center is one of only a few hospitals to offer lead extraction surgery. A lead is a wire that delivers energy from a pacemaker or implantable cardioverter defibrillator (ICD) to your heart. You may need a lead extraction if:

  • Damage occurs inside or outside of the lead
  • Infection exists at the site of the lead or the device
  • Scar tissue blocks the tip of the lead, causing it to need more energy to function than your pacemaker or ICD can deliver
  • Additional leads are needed but space is limited
  • The lead fails or the manufacturer issues a recall

Leads may be extracted through an incision in your chest or through a small puncture in your groin. New leads may be implanted during this procedure or at a later date, depending on the reason for the procedure.

Contact Us

Call the Heart & Vascular Center referral line at 866-862-4327 to find specialists, make an appointment or learn more about preventing heart disease.

Open Access is a new physician referral service, created by the UNC Center for Heart & Vascular Care, which coordinates all admissions and transfers through a single phone call and guarantees immediate acceptance for patients. Please contact us to learn more or call 866-862-4327.

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