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What is cardiac electrophysiology?

Most simply, cardiac electrophysiology is the field of medicine concerned with the study and treatment of the heart’s intrinsic electrical activity. Electrical activity - the movement of charged particles down gradients and across barriers - forms the basis of many living processes including nerve function, contraction and relaxation of muscles, peristalsis of the gut, and movement and coordination of the heart. Each heart beat is the product of a highly choreographed sequence of electrical events that allows a heartbeat to (nearly) always start in the same place and spread in the same way through the heart, up to 100,000 times a day in a healthy human. The route of spread of the heartbeat is important, because as the beat spreads, so the heart twitches into life - moves - to propel blood forward through the body via arteries and veins. If the heart’s electrical activity is not properly coordinated, then the mechanical function of the heart - the pumping action - will be compromised. W
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What is atrial flutter?

The terms “atrial fibrillation” and “atrial flutter” are often used almost interchangeably, and even within the medical profession there is some haziness about where one problem stops and the other starts. The difference between these two diagnoses is important, however, because symptoms, prognosis and treatment options differ considerably between these two distinct rhythm problems. A lot of the misunderstanding in this area arises because the term “flutter” tends to be used rather imprecisely by both patients and doctors. I meet quite a lot of patients, for example, who describe the feeling they get in their chest as a “flutter”. There is of course nothing wrong with using this word! If you feel you have a “flutter in your chest” then no-one - least of all me - is in a position to tell you that you are wrong. Where things become confusing is when your doctor then uses your terminology about the symptom you feel to describe the mechanism of the arrhythmia (the so-called “pathophysiolog
Location: Ashford, UK
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How is cardiac arrhythmia treated?

This is a difficult question to answer with any precision, because “arrhythmia” is not a precise diagnosis. Rather, the word is a collective term for a family of related conditions that alter the normal pattern of electrical activation of the heart during a heartbeat. Arrhythmias tend to cause disruption of the heart’s usual pattern of beating, either making it too fast (the tachycardias) or too slow (the bradycardias). Just to mix things up a little more, all patients respond slightly differently to arrhythmias, so that a condition that causes an extremely fast beat (tachycardia) for one individual may lead to a normal or even a slow heartbeat in another individual. The underlying mechanism of rhythm disturbance could be exactly the same but the treatment required could be opposite, with the tachycardic patient requiring drugs to slow their heart, while the bradycardic patient might need a pacemaker to speed their heart up. Some arrhythmias are serious - life threatening even. Others
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Can Apple Watch help manage my heart rhythm?

Apple Watch series 4 and above includes an app that allows you to make a 30 second recording of your heartbeat’s electrical activity (also called an “electrocardiogram” or “ECG”). The app itself is called “ECG” and can link to the “Health” app on a paired iPhone. You can then use the iPhone display to review the data you have captured, and even use email to send the recording to someone else, for example your electrophysiologist. There is also a built-in algorithm within the app that Apple say can identify the most common heart rhythm abnormality - atrial fibrillation - automatically. Lots of my patients have an iPhone and an Apple Watch, and I am often asked whether we can use the data from their Apple Watch to diagnose or manage their heart rhythm problems. First off,  we should be clear that we are not talking about heart rate data. Separate from the ECG app, Apple Watch can continuously measure your heart rate and feed this into the Health app on your iPhone to give a continuous gr
Location: Ashford, UK
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Does coffee cause arrhythmia?

Many patients ask me whether coffee and other caffeine sources are beneficial or harmful to the health of their heart and circulation. Typically, these questions focus on whether caffeine causes irregular heart rhythms such as atrial fibrillation and ventricular ectopic beats. A typical patient raising such a question might have come to see me to find out what is causing their feeling of palpitations; perhaps we’ve done some tests and identified short periods of disturbed heart rhythm that explains their symptoms. The next question is inevitably, “What can I do to reduce the problem?” and sooner or later we will get onto discussing the question of caffeine and whether they should cut down or avoid it all together. This is a nuanced area of medicine and one where the “evidence” (i.e. the results of scientific studies) do not necessarily fit with patients’ lived experience. Both the individual and the scientific perspectives on the issue are valid, and both deserve some sort of explanati
Location: Canterbury, UK
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