Electrophysiology

Clinical cardiac Electrophysiology is a branch of cardiology which deals with problems of the cardiac conduction system and rhythm. It is a new and exciting field which is rapidly evolving to cater for a growing population of patients which suffer from different type of rhythm problems or advanced heart failure. Clinical Cardiac Electrophysiology was introduced at a very basic level during the late nineties in Pakistan and Armed Forces Institute of Cardiology has been at the forefront of electrophysiology right from its introduction in Pakistan. Diagnostic and therapeutic capabilities of Clinical Cardiac Electrophysiology department of AFIC/NIHD range from basic electrophysiological study to complex high density mapping to locate and ablate complex arrhythmias. We are continuously making an endeavor to further enhance our capabilities and introduce the latest trends in electrophysiology. We are committed to provide best cardiac electrophysiology services at most affordable rates in Pakistan.

Electrophysiology department at AFIC/NIHD is well equipped to perform all contemporary cardiac electrophysiological investigations and procedures. We are continuously upgrading our equipment to remain pioneers in introduction of latest diagnostic and therapeutic advances in the field of cardiac electrophysiology.

Investigations:

• Electrocardiography.
  Electrocardiography or ECG is performed to determine the basic resting rhythm of the patient. In some patients Stress ECG is also performed to study the effects of cardiac ischemia on ECG.

• Transthoracic and Transesophageal echocardiography.
  Both modalities of echocardiography are performed to study the cardiac structure, function and identify any blood clots in cardiac chambers

• 24 hour holter monitoring
  This test is often offered to those patients who present with history of palpitations of syncope. During this test ECG electrodes are attached to the patient along with a portable recorder and the patient is advised to report back after 24 hours. Upon return, the data from the recorder is transferred to the computer which then analyses any rhythm problems that might occur during the preceding 24 hours.

• Extended event recorders
  These recorders have the capability to record the ECG over a longer period of time. They are utilized in those patients who have infrequent symptoms of palpitations or heart sinking.

• Head up tilt test
  Head up tilt test is offered to patient who present with history of syncope. The patient is firmly secured on a table which can tilt at different angles. The test if performed to identify vascular causes of syncope.

• Invasive electrophysiological study (EPS)
  EPS is performed when there is definite evidence of arrhythmia and the objective is to identify the culprit area in the heart.

• 3D High density mapping for complex arrhythmias
  3D high density mapping is the latest diagnostic armament in the field of cardiac electrophysiology. It is used to map complex arrhythmias where conventional tools are unable to accurately locate the culprit cardiac region. AFIC/NIHD is the only hospital in Pakistan to use latest mapping hardware including RYTHMIA HDx mapping system along with INTELLAMAP ORION catheters.

Procedures:

• Radiofrequency ablation
  
  • It is an invasive procedure during which specialized catheters are advanced through blood vessels in groin area to the heart. The catheters are then used to ablate the culprit cardiac area responsible for rhythm problem.
  • This procedure is used to treat rhythm disorders like SVT, WPW Syndrome and Ventricular Tachycardias.

• Permanent pacemaker
  Permanent pacemakers are placed in those patients whose intrinsic cardiac electrical system fails to ensure regular and effective heat beats such as patients with complete heart block.

• Implantable cardioverter defibrillator(ICD)
  ICD is a small device like pacemaker which is placed in those patients who are at increased risk of sudden cardiac arrest due to ventricular tachycardia or ventricular fibrillation.

• Cardiac resynchronization therapy (CRT))
  CRT is a new hope for patients with advanced heart failure with ventricular dyssynchrony. This invasive procedure involves pacing of both ventricles which endure efficient ventricular contraction and brings about functional improvement in such patients.

Future Projects:

• Armed Forces Institute of Cardiology has acquired the hardware for Laser Lead Extraction. First Workshop by international experts is planned in Feb,2019 after which AFIC/NIHD will become the only institute in the country to offer this service
• Hardware has been installed and soon trans-septal cryo-ablations for atrial fibrillation will also commence at AFIC/NIHD

There are number of symptoms and conditions with which you should consult a clinical cardiac electrophysiologist such as:

• Palpitations
  Palpitation is a common symptom where a patient can feel either an abnormally rapid or irregular heart rate. The underlying cause could be benign or life threatening. Electrophysiology department will help you identify the rhythm abnormality, explain the prognosis and devise a management strategy in line with your life goals and activity levels

• Syncope
  Syncope or transient loss of conscience can be due to underlying cardiac disorder. Complete evaluation including 24 hour Holter monitoring, Extended event recorders and Head up tilt test will help you identify the cause of syncope. Patient and physician then can discuss appropriate treatment strategy.

• Survivor of cardiac arrest
  Until recently there was no real treatment to prevent future episodes of sudden cardiac arrest among survivors of cardiac arrest. Electrophysiology department at AFIC/NIHD offers wide range of implantable cardioverter defibrillators with can help such patients live a productive happy life.

• Family history of sudden cardiac arrest
  Individuals who have positive family history of sudden cardiac arrest should consult Electrophysiology department for complete assessment of their risk of having sudden cardiac arrest. Patients deemed high risk for sudden cardiac arrest are then advised implantable cardioverter defibrillators.

• Advanced heart failure
  There is very little which medical therapy can offer patients with advanced heart failure but new developments in clinical cardiac electrophysiology have enabled to improve the functional status in patients with advanced heart failure who suffer from ventricular dyssynchrony with the help of Cardiac Resynchronization therapy(CRT). Such patients would be evaluated in detail for their candidacy to benefit from CRT.

Since Clinical cardiac Electrophysiology is a specialized field of cardiology, Electrophysiology consult is offered on referral basis. Keeping in view the growing demand and limited trained workforce it is recommended to secure appointment in advance. Walk in patients can also be accommodated in case of emergency or availability of vacant slots

There are two dedicated OPD days for entitled clientele:

• Monday: (Arrhythmia Clinic) for all new patients and follow up of those who have undergone EPS + RFA (Electrophysiology Study & Radiofrequency Ablation).
• Thursday: (Pacing Clinic) for all new patients and follow up patients who have been Implanted with Devices.

Non Entitled patients are seen after 1500 hrs. except in case of emergency.

For Appointments Contact:051-9271002 Ext. 3591, 3235, 3529

Education:
Electrophysiology department at AFIC/NIHD is committed to promoting specialty education among all tiers of healthcare and allied professionals. Examples of some of the educational activities are as follows:

• ECG Workshop:
  ECG Workshop is organized every year in month of October to November. Eminent electrophysiologist from all over Pakistan and abroad are invited to deliver lectures. The lectures are designed to cater for all tiers of health care professional starting from medical and nursing students to electrophysiology fellows.

• International Electrophysiology conference
  Electrophysiology department of AFIC/NIHD has the honour of organizing an international electrophysiology conference in the month of February every year. Electrophysiologist and allied industry professional from all over the world attend and contribute in this event. This is so far the largest electrophysiology event in Pakistan.

• Electrophysiology Study and mapping workshops
  AFIC/NIHD has the honour of international collaboration with industry leaders in electrophysiology. They are engaged in arranging EPS and advanced mapping workshops to train local professionals in this evolving field.

Fellowships:

• Electrophysiology department at AFIC/NIHD offers two fellowship slots for training in clinical cardiac electrophysiology each year. The fellows are selected in July through a competitive process. Aspiring doctors should have completed FCPS (Cardiology) or equivalent.

Research:

• Research is an integral part of working at AFIC/NIHD. The hospital has a dedicated research department where data from different hospital registries are collected and published in reputed journal in both local and international journals. Electrophysiology department being industry leader in Pakistan is engaged in continuous research to evaluate the efficacy and safety of newer treatments to determine their utility in local population

Pacemakers have been implanted in Pakistan Since 1976. With technological advancements, new high energy devices have been introduced in the treatment of heart rhythm disorders such as implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT). While these devices have enabled cardiac electrophysiologists to treat many rhythm disorders and improve the quality of life of patients with advanced heart failure, the leads associated with them have created some problems when they stay in the body for a long time. Till now there was no hospital in Pakistan with capability of laser lead extraction. Armed forces Institute of Cardiology & National Institute of Heart Diseases has once again taken the lead in introduction of laser lead extraction which will now enable patients to have their leads removed without any major operation. Because of the sophisticated gadgetry involved, the treatment initially is expensive but with the passage of time its cost would come down and we shall be able to help a lot of patients.