An arrhythmia is an abnormal or disturbed heartbeat and can cause patients to feel unsettled. Most patients can find relief with newer medicines that solve their problem by keeping their arrhythmia in check. However, some patients may need a minimally invasive procedure.
Here to speak with us today about what the field of electrophysiology is all about is Dr. Aaron Hesselson. He is an electrophysiologist with UK HealthCare.
Transcription:
Melanie Cole (Host): Electrophysiology is a branch of cardiology that deals with the diagnosis and treatment of heart rhythm disorders. Here to speak with us today about what the field of electrophysiology is really all about is Dr. Aaron Hesselson. He's an electrophysiologist with UK HealthCare. Welcome to the show, Dr. Hesselson. So, what is electrophysiology?
Dr. Aaron Hesselson, MD (Guest): Well, it’s a specialized part of cardiology. You can sort of think of the heart in terms of plumbing and electricity, and the electrical is what an electrophysiology takes care of.
Melanie: So, what kind of training do you have? People hear electrophysiologist. They’re not sure if you're an MD or what kind of doctor that you are. So, what is your training like?
Dr. Hesselson: Well, you can be either an MD or a DO. What you have to have undergone is complete a medical school training and then internal medicine residency. Then, a general cardiology fellowship, and ultimately it allows you to get to be trained in electrophysiology.
Melanie: So, then, what kind of testing – what kinds of thing do you do if you're dealing with cardiological-type disorders? What patients are you seeing, and what kinds of tests can you perform?
Dr. Hesselson: Well, frequently, if we want to put it into very simple terms, we deal with patients who have either a slow heartbeat issue or a fast heartbeat issue. Certainly, on the slow end of issues there are means that we can take care of the patient, such as if they need a pacemaker to keep the heart from getting too slow. On the fast end of the spectrum, there are heart rhythm issues that we perform procedures called ablation through IVs where we actually locate electrically in the heart where abnormal electrical circuits are occurring, and we purposely put a tiny burn in the heart muscle to get rid of those circuits. As well, we treat patients who may have other issues with fast heartbeats that aren’t curable with devices called defibrillators. They are frequently given to people with very weak heart muscle issues, and these devices are there to guard their life.
Melanie: So, electrophysiologists are not just proceduralists, correct, and installers? I mean, you're obviously dealing with ablation and devices, but you're also medical doctors. Do you deal with the patient and some of the maybe comorbidities that they might have that might go along with whatever cardiac disorder they have?
Dr. Hesselson: We do treat some of the comorbidities, but certainly these patients they're not unusual that they have coronary artery disease, high cholesterol, and diabetes. These are things that are more appropriately taken care of by specialists in that regard or even the general cardiologist. As most electrophysiologists having undergone the extra training to do what we do, we most commonly desire to do what we’re good at and leave those other issues to people smarter than us.
Melanie: Hmm. So, what can a patient expect if they’ve been referred to an electrophysiologist? How does it work with meeting with you for the first time, and what can they expect?
Dr. Hesselson: Well, frequently, it’s desired that the electrophysiologist has information about the patient before they're being seen. Most frequently, the patient’s had some interaction with either their general medical doctor or even a general cardiologist for which there is a problem that they sought medical care for. So, that literally lays the ground work for the evaluation. Now, sometimes certainly the patient does show up to the electrophysiologist without much being done. So, in that sense, you're playing detective at that point and figuring out, okay, what kind of tests do I need to do to try and figure the person out? They may have some very vague complaints, such as racing heart or palpitations and frequently one may need to order a monitor to give the patient to walk around and record the heartbeat. It’ll hopefully capturing their symptoms during that point in time.
Melanie: So, what do you see the most of, Dr. Hesselson? Are you seeing atrial fibrillation? What do you see the most?
Dr. Hesselson: I see mostly atrial fibrillation. I believe the Center for Disease Control has literally declared it an epidemic. It’s something that is becoming much more frequent. We found primarily because of the aging of the baby boomer generation. Certainly as electrophysiologists, we have skill sets that are aimed at both medically managing, but it’s really spending a lot of time in procedures trying to get rid of people’s burden of atrial fibrillation because a lot of individuals are very severely affected in terms of their quality of life by that issue.
Melanie: And what are the goals of treatment for A-Fib?
Dr. Hesselson: Well, the goals of treatment are essentially getting rid of the patient’s symptoms. Now, certainly, yes, that could be accomplished with medicines, but a lot of people either a, they're not desirous of taking medicines in the long-term or the medicines themselves aren’t tolerated well. So, that’s when the ablation discussion comes into play.
Melanie: And so, you’re involved in rhythm control and whether the person doesn’t want to be on medication or for some reason cannot be, what is life like for someone with A-Fib after they’ve seen you?
Dr. Hesselson: Well, it can vary. For example, some people we’ve deferred to me who they’ve gone to their general medical doctor for a well visit, and it was incidentally discovered that they're in A-Fib at that point in time. So, for that person who is essentially unaffected by A-Fib which people can be, then there may not be much you need to do for them. Even if the person asymptomatic, A-Fib tends to want to make the heartbeat race. You may have to adjust the medicines to slow things down, but the person with atrial fibrillation also has a risk for stroke. So, they may need to be on specialized medicines called blood thinners.
Melanie: And what's going on in the world of electrophysiology that’s exciting? What are you looking at to do to help people or looking toward this cardiac disorder and this epidemic as you're describing it?
Dr. Hesselson: Well, there are more advanced techniques that can be brought to bear particularly in the ablation world. I amongst others have been involved in utilizing technologies that are trying to get at harder to find sources of atrial fibrillation, and this is the biggest problem that we have right now is what beyond standard ablation of certain structures in the heart does one need to do? Is it required in order to treat all kinds of atrial fibrillation? So, there’s ongoing research in that regard, and there's certainly very heavy industry, private industry support in terms of trying to develop these technologies to allow us to use.
Melanie: So wrap it up for us then, Dr. Hesselson, with your best advice or information, what you like people to know when they say what is that you do for a living?
Dr. Hesselson: [laughs]
Melanie: What do you tell them all the time?
Dr. Hesselson: Well, if they're not too savvy in the medical field, I generally tell them in a nutshell as an electrophysiologist, if the heartbeat’s slow, I can make it faster. If it’s fast, I can make it slower, but certainly, obviously, that drives further conversation to explain what each of those means, but I try to keep it simple.
Melanie: Thank you so much for being with us today. This is UK Health Cast with the University of Kentucky HealthCare. For more information, you can go to ukhealthcare.uky.edu. That's ukhealthcare.uky.edu. I’m Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Electrophysiology is a branch of cardiology that deals with the diagnosis and treatment of heart rhythm disorders. Here to speak with us today about what the field of electrophysiology is really all about is Dr. Aaron Hesselson. He's an electrophysiologist with UK HealthCare. Welcome to the show, Dr. Hesselson. So, what is electrophysiology?
Dr. Aaron Hesselson, MD (Guest): Well, it’s a specialized part of cardiology. You can sort of think of the heart in terms of plumbing and electricity, and the electrical is what an electrophysiology takes care of.
Melanie: So, what kind of training do you have? People hear electrophysiologist. They’re not sure if you're an MD or what kind of doctor that you are. So, what is your training like?
Dr. Hesselson: Well, you can be either an MD or a DO. What you have to have undergone is complete a medical school training and then internal medicine residency. Then, a general cardiology fellowship, and ultimately it allows you to get to be trained in electrophysiology.
Melanie: So, then, what kind of testing – what kinds of thing do you do if you're dealing with cardiological-type disorders? What patients are you seeing, and what kinds of tests can you perform?
Dr. Hesselson: Well, frequently, if we want to put it into very simple terms, we deal with patients who have either a slow heartbeat issue or a fast heartbeat issue. Certainly, on the slow end of issues there are means that we can take care of the patient, such as if they need a pacemaker to keep the heart from getting too slow. On the fast end of the spectrum, there are heart rhythm issues that we perform procedures called ablation through IVs where we actually locate electrically in the heart where abnormal electrical circuits are occurring, and we purposely put a tiny burn in the heart muscle to get rid of those circuits. As well, we treat patients who may have other issues with fast heartbeats that aren’t curable with devices called defibrillators. They are frequently given to people with very weak heart muscle issues, and these devices are there to guard their life.
Melanie: So, electrophysiologists are not just proceduralists, correct, and installers? I mean, you're obviously dealing with ablation and devices, but you're also medical doctors. Do you deal with the patient and some of the maybe comorbidities that they might have that might go along with whatever cardiac disorder they have?
Dr. Hesselson: We do treat some of the comorbidities, but certainly these patients they're not unusual that they have coronary artery disease, high cholesterol, and diabetes. These are things that are more appropriately taken care of by specialists in that regard or even the general cardiologist. As most electrophysiologists having undergone the extra training to do what we do, we most commonly desire to do what we’re good at and leave those other issues to people smarter than us.
Melanie: Hmm. So, what can a patient expect if they’ve been referred to an electrophysiologist? How does it work with meeting with you for the first time, and what can they expect?
Dr. Hesselson: Well, frequently, it’s desired that the electrophysiologist has information about the patient before they're being seen. Most frequently, the patient’s had some interaction with either their general medical doctor or even a general cardiologist for which there is a problem that they sought medical care for. So, that literally lays the ground work for the evaluation. Now, sometimes certainly the patient does show up to the electrophysiologist without much being done. So, in that sense, you're playing detective at that point and figuring out, okay, what kind of tests do I need to do to try and figure the person out? They may have some very vague complaints, such as racing heart or palpitations and frequently one may need to order a monitor to give the patient to walk around and record the heartbeat. It’ll hopefully capturing their symptoms during that point in time.
Melanie: So, what do you see the most of, Dr. Hesselson? Are you seeing atrial fibrillation? What do you see the most?
Dr. Hesselson: I see mostly atrial fibrillation. I believe the Center for Disease Control has literally declared it an epidemic. It’s something that is becoming much more frequent. We found primarily because of the aging of the baby boomer generation. Certainly as electrophysiologists, we have skill sets that are aimed at both medically managing, but it’s really spending a lot of time in procedures trying to get rid of people’s burden of atrial fibrillation because a lot of individuals are very severely affected in terms of their quality of life by that issue.
Melanie: And what are the goals of treatment for A-Fib?
Dr. Hesselson: Well, the goals of treatment are essentially getting rid of the patient’s symptoms. Now, certainly, yes, that could be accomplished with medicines, but a lot of people either a, they're not desirous of taking medicines in the long-term or the medicines themselves aren’t tolerated well. So, that’s when the ablation discussion comes into play.
Melanie: And so, you’re involved in rhythm control and whether the person doesn’t want to be on medication or for some reason cannot be, what is life like for someone with A-Fib after they’ve seen you?
Dr. Hesselson: Well, it can vary. For example, some people we’ve deferred to me who they’ve gone to their general medical doctor for a well visit, and it was incidentally discovered that they're in A-Fib at that point in time. So, for that person who is essentially unaffected by A-Fib which people can be, then there may not be much you need to do for them. Even if the person asymptomatic, A-Fib tends to want to make the heartbeat race. You may have to adjust the medicines to slow things down, but the person with atrial fibrillation also has a risk for stroke. So, they may need to be on specialized medicines called blood thinners.
Melanie: And what's going on in the world of electrophysiology that’s exciting? What are you looking at to do to help people or looking toward this cardiac disorder and this epidemic as you're describing it?
Dr. Hesselson: Well, there are more advanced techniques that can be brought to bear particularly in the ablation world. I amongst others have been involved in utilizing technologies that are trying to get at harder to find sources of atrial fibrillation, and this is the biggest problem that we have right now is what beyond standard ablation of certain structures in the heart does one need to do? Is it required in order to treat all kinds of atrial fibrillation? So, there’s ongoing research in that regard, and there's certainly very heavy industry, private industry support in terms of trying to develop these technologies to allow us to use.
Melanie: So wrap it up for us then, Dr. Hesselson, with your best advice or information, what you like people to know when they say what is that you do for a living?
Dr. Hesselson: [laughs]
Melanie: What do you tell them all the time?
Dr. Hesselson: Well, if they're not too savvy in the medical field, I generally tell them in a nutshell as an electrophysiologist, if the heartbeat’s slow, I can make it faster. If it’s fast, I can make it slower, but certainly, obviously, that drives further conversation to explain what each of those means, but I try to keep it simple.
Melanie: Thank you so much for being with us today. This is UK Health Cast with the University of Kentucky HealthCare. For more information, you can go to ukhealthcare.uky.edu. That's ukhealthcare.uky.edu. I’m Melanie Cole. Thanks so much for listening.
