Cardiovascular Center: Electrophysiology Program

Image: UF Health Jacksonville Electrophysiology Program

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Electrophysiology studies are tests that record and monitor the electrical activity of your heart. This type of testing can determine what causes abnormal electrical activity in the heart, as well as help your doctor determine which treatment or medication may be most effective.

The Cardiac Electrophysiology Program at UF Health Jacksonville is led by University of Florida cardiologists, as well as a team of skilled nurses trained and specialized in diagnostics, treatment and continuing care of patients with cardiac electrical problems.

Who May Need Testing

There are a variety of situations in which a cardiologist may order an electrophysiology test or other heart monitoring studies. Diagnostic tests evaluate dizziness, palpitations, loss of consciousness resulting from insufficient blood flow to the brain, slow heart rate, fast heart rate, abnormal or irregular heart rhythm, atrial fibrillation and heart failure treatment.

Your doctor may order tests for a number of reasons, including:

Suspicion that you may have a condition that is affecting the electrical activity of your heart and causing an irregular heartbeat.
Testing prior to receiving an implantable cardioverter/defibrillator, so your cardiologist knows which type of device is best suited for your condition.
To better understand how effective your current medications are for an arrhythmia (irregular heart beat).

Video: Symptoms of Arrythmia

Upon completion of diagnostic evaluation, our specialists may perform the necessary intervention at the same time.

Evaluation and Diagnosis

Diagnostic procedures may include:

Electrophysiology Study
An electrophysiology study is a test of the electrical conduction system of your heart. The study is done by threading catheters into a vein where the leg connects to the abdomen to measure the electrical signals generated by your heart.
Holter Monitoring
Holter monitoring continuously records a patient’s heart rhythm, usually for 24 hours, during typical daily activities. It is especially useful in diagnosing abnormal heart arrhythmia. Small conducting patches called electrodes are placed on your chest and attached to a small digital recording monitor that you can carry in a pocket or in a small pouch worn around your neck.
Event Monitoring
Like holter monitoring, cardiac event monitoring is used to diagnose symptoms that are infrequent or sporadic; however, the monitor is worn for a longer period of time — about 30 days — to monitor heart rhythm and to record symptoms.
Tilt Table Study
The tilt table test is used to determine the cause of your fainting spells. During a tilt table study, you’ll be connected to an EKG, an oxygen monitor and a blood pressure monitor and then strapped to a bed that’s tilted in different directions. Your blood pressure and pulse are measured and symptoms are recorded while you are in various positions. The test is designed to cause a fainting spell in a controlled environment and shows how your heart rate and blood respond to changing positions.
Loop Recorder Implantation
An insertable loop recorder is used to determine the cause of fainting or near-fainting spells. The recorder is a small device put inside the body to record heart rhythm during fainting or near-fainting episodes. It is activated by a handheld device used during or after an event to store the event into the recorder’s memory. The device is removed after one or more episodes have been stored into memory.

Preparing for an Electrophysiology Study

If you are a candidate for an electrophysiology study, you will come to the hospital to undergo the test. Here’s how you’ll prepare:

You may need to stop or alter your medication schedule for a few days prior to the test. Your doctor will speak with you about this.
You shouldn’t eat or drink anything after midnight on the night before your study. If you’ll be taking medication that morning, take it with only a tiny sip of water.
You should wear comfortable clothes and leave all jewelry and valuables at home.
Since this is typically an outpatient procedure, you should bring a trusted adult with you, such as a spouse, sibling or adult child, to drive you home afterwards.

What to Expect During Electrophysiology Testing

This test takes two to four hours from start to finish. Your nurse will begin by inserting an intravenous (IV) line into a vein in your arm or hand so your doctor can administer drugs and fluids during the test. You may be given some medication to help you relax, but you will probably not be under full anesthesia. After being cleaned and shaved, your doctor will numb your groin area.

The doctor will then insert several thin, flexible tubes — called catheters — into the groin, through the veins and into your heart, using a tiny camera for guidance. Once in position, the catheters will be able to capture and record the electrical activity of your heart.

During the test, your doctor will send electrical impulses to your heart through the catheters to evaluate how your heart responds. Once the study is complete, your doctor will remove the catheters out through your veins and the incision in your groin. Pressure will be applied to the incision, and you will be on bed rest for an hour or two before being released from the hospital. Your doctor will follow up with you on the results of the test.

Treatment Options

Once your heart condition has been diagnosed, our specialists design a personalized treatment plan, which may include medication, interventional procedures or surgical procedures. Often, an interventional procedure is performed at time of an electrophysiology study.

Advanced treatments options provided include:

Automatic Implantable Cardio-Defibrillator Insertion
The automatic implantable cardio-defibrillator (AICD) is a small, lightweight electronic device that is placed inside the body, constantly monitoring heart rhythm. If it detects a fast, abnormal rhythm, it delivers energy to the heart muscle. While the device is not a cure for a heart rhythm problem, it can save a life by quickly bringing a dangerously fast heart rhythm under control.
Cardioversion
Cardioversion switches one cardiac rhythm or electrical pattern to another, almost always from an abnormal to a normal one. This conversion can be accomplished by using medications or by electrical cardioversion using a defibrillator, which delivers a low-energy shock at the same time as the heartbeat, to restore a normal heart rhythm.
Laser Lead Extraction
Laser lead extraction is a method of removing worn or infected pacemaker and defibrillator wires from patients’ hearts before implanting new ones. The lead, which passes through a major vein in the heart and attaches to the pacemaker or defibrillator, grows into the wall of the vein over time and becomes difficult to remove. Laser lead extraction involves sliding a sheath over the lead containing a laser light that removes the fibrous growth that holds the lead to the wall of the vein. The laser has very low tissue penetration, so it effectively detaches the fibrous tissue directly around the lead, sparing injury to the surrounding vein. Once the lead is no longer attached to the vein wall, it may be pulled out with less risk of damage to the vein.
Maze Procedure for Atrial Fibrillation
The maze procedure is offered for patients suffering from atrial fibrillation, a serious abnormality of the normal heart rhythm that affects a large population of patients. Usually, a cardiothoracic surgeon will perform a modified maze procedure in which radio frequency applicators are used to eliminate the abnormal heart rhythm. While most maze procedures are performed in conjunction with heart valve surgery, it is also possible to treat atrial fibrillation in patients having no heart valve disease.
Permanent Pacemaker Insertion
A permanent pacemaker is used to correct disturbances to the normal rhythm of your heart by analyzing the function of the heart’s own electrical system and, when necessary, sending tiny, precisely timed electrical signals to the heart to correct certain abnormalities in the heart’s electrical system.
Radio Frequency Ablation
Radio frequency ablation is a nonsurgical treatment for people with an abnormal heart rhythm, or arrhythmia, in which a long, flexible wire is passed into the heart to eliminate the precise area of the heart causing the arrhythmia. Radio frequency ablation scars or destroys heart tissue, which triggers abnormal rhythms, bringing the heart back to normal rhythm.
Resynchronization Therapy through Biventricular Pacemaker Insertion
A biventricular pacemaker is an artificial pacemaker or implantable cardio-defibrillator designed to treat congestive heart failure. In many heart failure patients, the walls of the left ventricle — the heart’s main pumping chamber — are no longer synchronized, or pumping together as they normally would. A biventricular pacemaker is designed to resynchronize the pumping action of the left ventricle.

Why Choose UF Health for Electrophysiology

Our doctors are the region’s leaders in providing the most complete evaluation of patients’ hearts’ electrical needs and matching that with the most technologically advanced care of pacemakers, defibrillation therapy or ablation therapy. Our specialists are professors and researchers in one of the nation’s largest cardiothoracic training programs — the University of Florida College of Medicine – Jacksonville — and are able to offer more treatment options than other facilities, which in many cases means better outcomes for cardiovascular patients. We offer a comprehensive atrial fibrillation center where the electrophysiologist and cardiothoracic surgeon use innovative technology to improve the quality of life for our patients.

Jacksonville Electrophysiology & Arrhythmia Specialists

2791 John N. Catanzaro, M.D., M.B.A., FACC, FESC, FHRS

Associate Professor
Associate Medical Director, Electrophysiology Program; Program Director, Clinical Cardiac Electrophysiology Fellowship
Specializes in Cardiovascular Disease; Clinical Cardiac Electrophysiology
3863 Stephen G. Keim, M.D.

Assistant Professor
Medical Director, Electrophysiology
Specializes in Clinical Cardiac Electrophysiology
3874 Prakash Goutham B. Suryanarayana, M.B.B.S. (M.D.)

Assistant Professor
Associate Program Director, Electrophysiology Fellowship
Specializes in Clinical Cardiac Electrophysiology