One of my favorite hobbies is playing tennis. During practice, my coach reminds us that we need to focus on our timing, movement and preparation for each stroke. As I thought about that advice, I realized those words summarized the function of the heart. Timing – the electrical system is the spark of life that coordinates the rest of the heart to beat in unison. Movement – the mechanical pump that pumps blood to the rest of the body. Preparation – the blood returns to both the mechanical pump and the coronary vessels before the next beat. Each of these three aspects is vital to the overall performance of the heart, but I would like to focus on the timing or heart rhythm.
For the longest time, people have been interested in the timing of the heart and its relationship with electricity. The ancient Chinese were able to diagnose abnormal heart rhythms dating back to the fifth century B.C by feeling the pulse. More contemporary scholars were captivated by “animal electricity” that is found in nature, such as lightening, lodestone, amber, and the torpedo fish. In 1786, Galvani performed an experiment, where he demonstrated the “twitching of amputated frog legs” with electrical stimulation, which led to the discovery of muscle contraction and the nervous system, i.e., the brain, spinal cord and nerves. In 1913, Einthoven developed a device that captured the electrical patterns of the heart called the electrocardiogram or EKG, which revolutionized our understanding of heart rhythms. Development of diagnostic and therapeutic catheter-based interventions gave rise to the field of cardiac electrophysiology.
The heart, similar to the brain, is a solid conductor that emits an electrical field that can be analyzed as an electrical impulse with varying amplitude and direction. Heart cells or myocytes can be divided into cells that mechanically contract or conduct electrical impulses. These cells, in turn, are made up of ion channels that regulate the movement of ions inside and outside the cell. Abnormal ion channels and myocyte function can lead to cardiac rhythm abnormalities or arrhythmias, which can be generally classified as slow rhythms (i.e., conduction disturbances) or fast rhythms (i.e., tachyarrhythmias). Arrhythmias are managed by a doctor trained in heart rhythms called a cardiac electrophysiologist.
An electrocardiogram or EKG is a non-invasive test performed in the office that provides a 10-second photograph of the electrical patterns of your heart or heart rhythm. For the cardiac electrophysiologist, the EKG provides an initial vital evaluation of your heart rhythm. Other office based non-invasive tests include a holter monitor and an event monitor, which are used to monitor the heart rhythm for 24 hours and up to one month, respectively.
For the select patient who requires further invasive diagnostic and therapeutic heart rhythm management, such as a cardioversion, implantable loop recorder, device therapy (i.e., pacemaker, defibrillator or cardiac resynchronization therapy) and/or an electrophysiology study with catheter ablation, these studies are performed in a hospital-based setting.
At ColumbiaDoctors of the Hudson Valley, we provide a complete electrophysiology service line that includes the aforementioned tests and device clinic and management of heart rhythm disorders, including medications, device therapy, and catheter-based interventions. Our invasive electrophysiology procedures are performed predominantly at the nationally recognized NewYork-Presbyterian Hospital/Columbia University Medical Center.
If you have ever wondered whether your symptoms or family history may be related to a heart rhythm disorder, please come in and talk to us for a complete electrophysiological evaluation.
Joseph M. Lee MD MS FACC RPVI is a board-certified, Level III cardiac electrophysiologist, who specializes in heart rhythm disorders, which includes the management of cardiac arrhythmias and devices. He is also an avid tennis player who plays competitively (NTRP 3) at the USTA National Tennis Center.