Frequently Asked Questions

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Cardiac Electrophysiology

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FAQs for Primary Care Physicians

What Is a Typical Patient Referral Scenario for EP (from PCP to cardiologist)?

Every patient with Atrial Fibrillation (AFib) should be seen by a cardiologist at a minimum, and some should be directly referred to an electrophysiologist. For example, if a patient has pre-existing heart disease, a referral to a cardiologist is appropriate. If AFib is the patient’s only diagnosis, referral to an electrophysiologist is ideal.

When Patients Are Referred to You With AFib – Have They Already Been Treated With Medications by Their Cardiologist? Are There Medication Side Effects?

Patients referred by a cardiologist typically have been on medications to control their heart rate or heart rhythm. A common medication side effect is fatigue. That’s because the heart rate is not as high as it may have been before, so the patient may feel very tired. Ten years ago, medications were the only available treatment; now we have procedures that offer a long-term solution.

What Tests Are Ordered for AFib Patients?

The bare minimum workup for an AFib patient is: 1) a thyroid function lab test done by the PCP and 2) an echocardiogram to make sure there are no structural causes for AFib.

What Are the Treatment Options and Possible Outcomes?

AFib is associated with a reasonable stroke risk up to 25%, so there is a need to thin the blood to prevent stroke if the patient is older (age 65+). If the patient is relatively young, that’s not an issue. Strategies to control symptoms can be via medications or a catheter procedure. There are two types of medications: one controls the patient’s heart rate and makes it more tolerable; the other is a stronger medication that keeps the patient from going into AFib. Some patients have no success with medication and others just prefer to have the catheter procedure. It depends on the patient, of course, but a frontline ablation is often a preferred approach over medications.

What Is the Typical Rate of Success?

The success rate varies depending on whether the patient had intermittent or continuous AFib. For simple arrhythmias, there is usually no role for medicines; the toxicity of the medication is greater than the risk of the procedure. There is a very low risk of recurrence; it’s a one-and-done procedure with the patient being home the same day. The rate of success is 98-99%.

For AFib ablation or more complex procedures, there is a 75-85% range of long-term success, that is, the patient is free of arrhythmias three months after the procedure without medications and may not need a second procedure for complete success. There is a 1 in 3 chance of needing a second procedure. A second procedure may be needed for long-term success, that is, complete freedom from arrhythmias and medications. The second procedure is usually less involved since the majority of work was done in the first procedure. It typically involves taking care of areas that may not have healed perfectly in the first procedure.

What Follow-Up Care is Required?

After an ablation procedure, all patients need blood thinner medication for about a three-month healing period to prevent any complications. Atrial flutter patients usually need blood thinner medication for just one month and then an EKG after 4-6 weeks.

Why Should I Send My Patients to Swedish for Treatment? What Are the Advantages?

  • High volume - The volume of the center where you have your treatment is critical. Swedish performs a high volume of procedures which translates into better outcomes.
  • Best technology - Electrophysiology is a fast moving field where the technology changes quickly. Swedish has the most advanced EP infrastructure in the region including radiofrequency ablation, cryoablation, and 3-D mapping without using X-rays for catheter manipulation. And, Swedish has the only remote navigation system in the state, which is used in manipulating catheters.

What Is Most Critical for PCPs to Know About Swedish When Referring Their Patients Who Need AFib Treatment?

The most important thing to know is that there is treatment available for all AFib patients. The patient should be seen by a cardiologist (if they have pre-existing heart disease) or an electrophysiologist (if that is their only condition). At the very least, a patient should be screened to rule out more serious conditions that could be triggering AFib such as valvular disease or weakened heart muscles. The goal is to eliminate or control the condition.

What Are Some Common Questions Patients May Have About EP/Afib?

  • What caused my AFib?
  • Will it go away on its own?
  • Does it mean I’m going to have a heart attack?
  • Is it a genetic condition?
  • What are my treatment options?
  • Is there a long-term cure?
  • Do medications work?
  • Are my chances high for having a stroke with AFib?
  • View more common patient questions here.

More Resources: -

Heart Rhythm Society -

American College of Cardiology -