Cardiac Electrophysiology

The electrical system of the heart governs your heartbeat and rhythm. Disorders of this system — known as arrhythmias — can impair the heart’s ability to pump effectively and may lead to serious complications. Cardiac electrophysiology offers advanced diagnostic and therapeutic approaches to identify, localise and treat electrical conduction abnormalities of the heart.

Cardiac electrophysiology refers to the study and treatment of the heart’s electrical activity. At our hospital, we use high-precision catheter-based techniques, specialised mapping systems and device therapy to restore normal rhythm, reduce symptoms, improve quality of life and lower risk from arrhythmias.

Cardiac electrophysiology is a specialized field of cardiology that focuses on diagnosing and treating heart rhythm disorders (arrhythmias) by studying the heart’s electrical system. Through advanced techniques such as electrophysiology (EP) studies, physicians can identify the source of abnormal rhythms and offer targeted treatments including catheter ablation, medication optimization, or device implantation. Cardiac device therapy plays a vital role in managing rhythm disturbances and heart failure, using permanent pacemakers to correct slow heartbeats, implantable cardioverter defibrillators (ICDs) to prevent sudden cardiac death, and cardiac resynchronization therapy (CRT) devices to improve heart function in select patients. Together, these approaches enable patients to live longer, healthier, and more active lives with significantly reduced risks from dangerous arrhythmias.

Your heart beats because of electrical signals that tell it when to contract and relax. If these signals are too fast, too slow, or irregular, it can lead to heart rhythm problems, called arrhythmias.

Arrhythmias are problems with the speed or pattern of your heartbeat. Examples include:

• Atrial fibrillation (AFib): fast, irregular heartbeat
• Bradycardia: slow heartbeat
• Tachycardia: very fast heartbeat
• Heart block: delayed or blocked electrical signals

Based on the findings, doctors can:

• Ablate (damage) small areas causing the abnormal rhythm
• Implant a pacemaker to fix slow heartbeats
• Implant a defibrillator (ICD) to stop dangerous fast rhythms
• Adjust or start medications to control rhythm 

Cardiac device therapy involves the use of small electronic devices implanted in the body to help manage heart rhythm problems. These devices help the heart beat at the right pace and can even prevent life-threatening events.

Cardiac electrophysiology evaluation or treatment is recommended in patients with:

• Palpitations, fainting (syncope), dizziness or fluttering of the heart.

• Documented arrhythmias (e.g., atrial fibrillation, supraventricular tachycardia, ventricular tachycardia).

• Persistent abnormal rhythms despite medication or lifestyle management.

• Bradycardia (very slow heart rate) requiring device therapy.

• Risk of sudden cardiac arrest or prior cardiac arrest when device therapy may be indicated.

Before the procedure:

• A detailed medical and medication history will be reviewed, including anticoagulant/antiplatelet therapy.

• You may be asked to stop certain blood-thinning medicines or anticoagulants for a short period.

• Fasting for several hours prior to the procedure is usually required.

• You will meet with the electrophysiology team, anaesthesia team (if sedation/general anaesthesia is to be used), and appropriate investigations (blood tests, ECG, echocardiogram) will be performed.

• You will receive pre-procedural instructions such as shaving the groin/neck site, not having heavy meals, and pre-medication if needed.

   

During the procedure:

• You will lie on a table in a catheterisation/electrophysiology lab. Sedation or light anaesthesia may be given to keep you comfortable but usually you remain conscious.

• Local anaesthesia is applied at the vascular access site (groin or neck).

• One or more sheaths (thin tubes) are inserted into the blood-vessel and advanced under imaging (fluoroscopy) to the heart.

• Catheters are placed in designated chambers of the heart to record electrical signals, map conduction pathways, and, if needed, deliver programmed electrical stimulation to induce arrhythmias.

• Using mapping systems, the electrophysiologist identifies the focus or circuit of the arrhythmia.

• If indicated, ablation (radiofrequency energy or cryoenergy) is applied via the catheter tip to eliminate or isolate the abnormal tissue.Focus may also be on trigger zones, substrate modification or pathway interruption.

• If arrhythmia is due to slow conduction or bradycardia, device implantation (pacemaker or ICD) may follow in the same setting or subsequently.

• At completion, the sheaths/catheters are removed, vascular access is closed (manual pressure or closure device) and you are moved to a recovery monitor area.

After the procedure:

• You will be admitted to a monitored ward or ICU (as required) for observation.

• You may be asked to keep the leg (or arm) straight for a few hours if groin access was used, to prevent bleeding/haematoma formation.

• Pain at access site, mild bruising, or groin discomfort may occur.

• The team will monitor your ECG, heart rate, rhythm, vascular site, bleeding signs, and general condition.

• Discussion will be held regarding the findings and next steps (e.g., whether further ablation(s) are required, device implantation, or rhythm-control medications).

• You will be discharged when clinically stable, often within 1–2 days though complex cases may require longer stay.

• You will be given instructions on activity (e.g., avoid heavy lifting, vigorous exercise for a period), medications, follow-up visits and lifestyle advice.

Benefits:

• Accurate diagnosis of arrhythmia mechanisms and localisation of abnormal tissue.

• Potential cure or substantial symptomatic relief from arrhythmias, reducing palpitations, fainting risk, and improving quality of life.

• Reduced reliance on long-term medication (in selected cases).

• Implantation of devices (pacemaker/ICD) may protect against sudden cardiac death or manage bradycardia effectively.

   

Risks:

• Vascular access complications: bleeding, haematoma, pseudoaneurysm at entry site.

• Blood-clot formation at catheter site, leading to embolism (rare).

• Cardiac perforation or tamponade (very rare).

• Injury to heart conduction system requiring permanent pacemaker (rare).

• Infections, contrast-induced renal injury (if contrast used), allergic reactions.

• Radiation exposure (though minimal) and sedation‐related complications.

• Our hospital is equipped with state-of-the-art EP lab with advanced mapping and ablation systems, high-precision imaging and experienced multi-disciplinary teams of electrophysiologists, interventional cardiologists, anaesthetists and cardiac care staff.

• We treat both simple and complex rhythm disorders including atrial fibrillation, ventricular tachycardia, device implantation (pacemakers/ICDs), and provide full post-procedure monitoring and rehabilitation.

• Individualised care: we tailor each plan based on the patient’s heart condition, rhythm type, comorbidities and expected outcome.

• Comprehensive service: from evaluation, diagnosis, procedure, device therapy, to follow-up programs and lifestyle / rehabilitation support.

Cardiac electrophysiology offers a powerful set of tools to diagnose and treat heart rhythm disorders effectively. For patients with symptomatic arrhythmias or at risk of rhythm-related complications, it presents a pathway to improved health, reduced symptom burden and better long-term outcomes. If you experience palpitations, fainting, irregular heartbeat or have been diagnosed with an arrhythmia, speak to our electrophysiology team about your options.