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Prakash Chandran: When it comes to heart health, electrophysiology is something we've probably heard of but don't know much about. Luckily, we're joined by an expert and his name is Dr. Cary Rose. He's an electrophysiologist at San Juan Regional Medical Center.

This is Celebrate Health, the podcast from San Juan Regional Medical Center. I'm your host, Prakash Chandran. So Dr. Rose, thank you so much for joining us today. I truly appreciate your time. Let's get started with the basics. What exactly is electrophysiology?

Dr. Cary Rose: Well, electrophysiology is a really, really long word that basically means electrician. Cardiologists are defined pretty much by two different subspecialties. They're the plumbers, they're really cool guys that put all those stents in that you hear about. And then, they're the nerds like me and we're the electricians. We're also the cardiac surgeons. We put in pacemakers, defibrillators, everyone's heard of those. We also do very serious arrhythmia ablations. We fix those palpitations that everybody seems to have. So an electrophysiologist is somebody who studies the electrical surface of the heart, and we perform all those procedures inside the heart.

Prakash Chandran: Okay. And I as a layperson need a little bit more information. So when you say like the electrical parts of the heart, you know, as far as I understand, the heart just pumps blood in and out. I didn't even realize electricity was a part of any of this. So can you broadly talk about how the electrical system works in the heart?

Dr. Cary Rose: Absolutely. It's very fascinating. The heart is actually two things. It's a pump and it's an electrical organ, believe it or not. Just like the human body has a nervous system, which is electrical, the heart pumps blood only because it's being told to pump by its own electrical system. The electrical system runs through the entire heart. It's what gives you your heartbeat from when you were in your mother's womb to when you were born, to when you live, and then ultimately until you die. And so, it is the electrical part of the heart that keeps your heart pumping regularly. We get called when there are irregularities of the electrical system, whether that's a fast heartbeat or a slow heartbeat, or no heartbeat at all, and so we're the ones that come in to fix that.

Prakash Chandran: I see. So, I know recently you hear about kind of the Apple Watch measuring atrial fibrillation and things of that nature. Is that an electrical irregularity?

Dr. Cary Rose: That is correct. The Apple Watch, it's actually an interesting tool. A lot of people wear it. While it's not a diagnostic tool yet, we do respect it and in terms of it brings a lot of patients to us because they're told that they have an irregularity in their heartbeat. It leads us to asking them the right questions and performing some noninvasive tests to confirm the findings of the watch. Cardiac palpitations and arrhythmias are extremely common, especially unfortunately recently with COVID. Just the presence of COVID now has just increased the incidence of arrhythmias, they say up to 50% to 75%. Even in people who've never had arrhythmias before are now experiencing them post-COVID.

Prakash Chandran: I see. So, one of the things you mentioned up at the top was you consider yourself like an electrician. In contrast to the plumbers that put in the stents, at what point does an electrophysiologist like yourself get involved? And how do you work with the plumbers?

Dr. Cary Rose: Well, actually, we work hand in hand. Again, the plumbers are the ones you call when somebody who's having a heart attack. These are the people that get involved right away, and they go in and put stents in your heart or do what's necessary in those acute situations. In our particular situation, our situation is not as emergent as them, although we do have electrical emergencies when people come in with low or no heartbeats and we put in an emergency pacemaker and save their life. We work with the plumbers. And once they are done with their part, then we come in and we fix the rest.

Often when people have heart attacks, that creates more arrhythmia of the heart, in the lower part of the heart called the ventricle. We also deal with arrhythmias in the top of the heart called the atria. And one of the most common arrhythmias that you hear about, everyone has heard about, is AFib or atrial fibrillation, which is just incredible. Everyone knows that there's been about a million Americans plus or minus infected with COVID, but there is estimated 15 to 18 million Americans that have atrial fibrillation at some time in their life, so that gives you an idea of how often people have it.

Prakash Chandran: Yeah, that is incredible. I didn't realize the number was that high. So, you know, this actually sounds like a very complex field. How much extra training did you need or did you receive to go into this field?

Dr. Cary Rose: I don't know about extra training because I did stay at a Holiday Inn last night, so I feel smarter. But interesting the training to become a cardiac EP or an interventional cardiologist, it is a lot of years. We go to college, medical school, internship, residency, and then we do a series of fellowships in specialized in cardiology and then further specialize into what we do.

I don't know if you'd say it's that long. I mean 120, 130 years or so, it feels like that. But it's worthwhile because we get to work with top names in our field. We get to work with experts and then in a sort of apprentice-type relationship. And then, we sort of take the reins and we become the teachers ourselves. And I really enjoy teaching as well. I'm an assistant professor of medicine and I always enjoy having residents and medical students working, because it really opens their eyes as to what we can do and how we can help people.

Prakash Chandran: Now, I want to talk about the conditions that you treat. And I know you mentioned it in the top of the episode. You mentioned AFib and a couple other things, but can you specifically talk about the most common things that you see?

Dr. Cary Rose: Absolutely. AFib has certainly now become the most common thing we see. We see it now. It's happening in younger and younger people. We see it happening in women as well as men. And we've now determined that atrial fibrillation is caused by a variety of things. For example, many people have sleep apnea. A lot of people wear CPAP masks and sleep apnea in younger people is one of the most common causes of AFib. Also, I hate to say this, but people out there becoming weekend warriors, the consumption of a lot of alcohol at once could easily throw a normal healthy heart into atrial fibrillation. It tends to resolve on its own. But when that happens, obviously, we have to counsel people to not do that. Atrial fibrillation is a type of an arrhythmia that can lead to more serious problems, such as heart failure and stroke, those are the two most common. And so, it's our job to fix the AFib before it gets to that point, and that's something that we do.

In addition, there are a lot of other arrhythmias that people get. And the most common symptom that people have is palpitations. They feel their heart beating fast in their chest. They wake up at night and they feel their heart beating fast. And again, these are all classified under something called tachyarrhythmia or fast heartbeat. There are also an equal number of slow heart rhythms, and so those are the things that we treat as well with devices such as pacemakers or defibrillators. So we treat the whole gamut, fast heartbeats and slow heartbeats.

Prakash Chandran: Now, I have a question because I kind of had something similar to this. Like, I think the fast heartbeat that just came about out of nothing. And when I went in, they put me on a treadmill to try to, I think, emulate, I guess, really putting my body under exertion. But at the time when I experienced it, I was playing pickup basketball and I'm not going to get that same workout on a treadmill. So how do you think about diagnosing something like that when it's like a one time thing and not a consistent arrhythmia? And how do you then go about fixing it?

Dr. Cary Rose: Well, you bring up a very good point. One of the most important things that I do with my patients is I try to listen. I listen as to what causes their symptoms. What are they doing? Are they lying down at night asleep? Are they doing normal activities, brushing their teeth? Are they playing basketball? Are they running? These types of things, because each one of these things gives you a clue as to what's going on.

There are a lot of people that have fast heartbeats. It's not an arrhythmia, but their heart tends to speed up a little bit too quickly. There are other people who they didn't even realize they have, you know, the propensity to develop a heart rhythm. And as you get older, that propensity becomes an arrhythmia.

One of the most common arrhythmias that we see is something called SVT. It's very common in women. But it's interesting that it appears at about age 15 to 25 and then it goes away and comes back again about 30 years later if you don't treat it. So it depends on what you're doing, it depends on how often it happens, and it also depends on what are your symptoms. Symptoms can go from being absolutely asymptomatic to feeling just a little bit of palpitations in your chest, progressing to shortness of breath. And in very, very serious cases, you passed out, something we call syncope, that's the most dangerous form of this type of an arrhythmia.

So when I have a patient in my office, I listen to them and then what we do is indeed we will put them often on a monitor, like a Holter monitor or a longer term monitor, and we ask them to exercise. We ask them to do all their normal stuff. We want to see if they can bring out the arrhythmia. And then, we can look at it on the monitor to see what it is they have. And then, we go from there. We basically progress from a noninvasive way to an invasive way. Finally, if we determine the patient's having arrhythmias and they obviously want to fix it, the only true way to fix it is a procedure that we do called an ablation.

Ablation is where we take a couple of wires, they go up into the heart. And we basically zap the small areas that cause the arrhythmia. And in a perfect world, it doesn't ever happen again. Obviously, that doesn't always happen. But we do a pretty good job at taking care of most or all of these arrhythmias.

Prakash Chandran: Yeah. Thanks for that detailed explanation. So I guess this kind of leads to the question around how does one know that they actually need an electrophysiologist?

Dr. Cary Rose: Well, everyone needs an electrophysiologist, you know? It's interesting, the problem with arrhythmias and problems with the heart tend to pile up the older you get. I always tell people in my office, for example, there's few things in this world as strong as a young woman's heart. And let me also say this as an aside, I'm a very big believer in the Red Dress for women. I treat a lot of women in the cardiology field because women's symptoms are very different than men's, which is a very important thing to bring up. Women don't experience the same thing as men.

So basically, how do you know when you need an electrophysiologist? Well, interestingly enough, education. Telling people don't ignore your symptoms. Don't ignore those palpitations. Don't ignore that shortness of breath when you're out there doing chores and you say, "Gosh, I feel really short of breath," and "Oh, well, I'm just getting older," but that's not true. When you feel these symptoms, go to your primary doctor, explain your symptoms. And many primary doctors today are very, very good and they refer the patients to us right away. It's always better to see a cardiologist sooner rather than later because you want to minimize the heart damage.

Prakash Chandran: Yeah. And I would also just add onto that, that sometimes the primary care physician may not think that you have something worth escalating to a cardiologist or an electrophysiologist, but if you have experienced those symptoms a number of different times, no one knows your body like yourself. So you can actually ask your primary care physician, "Hey, look, this is something that I'd like to actually get seen by an electrophysiologist." Isn't that the case? Like you should be an advocate for your own health, right?

Dr. Cary Rose: That is correct. And let me just say that that's why I think that education is very important. People have heard me say this, if I don't learn something new every day, it's a wasted day in my life. And I learn a lot from my patients. I learn a lot from people that I work with.

As far as symptoms go, most primary care doctors nowadays are getting very good at referring people to, for example, cardiology. However, a patient can refer themselves. In many cases, a patient does not even need a referral anymore. You can actually get an appointment with a primary cardiologist, for example. And remember, I'm an electrophysiologist, but I'm also a cardiologist. In other words, under the skin, we're all cardiologists, but we then subspecialize in what we do. What I always tell people simply is to be an advocate for yourself or a member of your family. If you know a member of your family who's not feeling well and they haven't seen somebody, you can advocate for them as well.

And many times the people come in and I reassure them, "Oh, everything is fine. There's nothing to worry about," and that really makes them feel better to know they saw a cardiologist and that the tests are good. So it's very reassuring. I'd rather reassure a patient and tell them everything is fine, than not have them come in and have something very serious going on.

Prakash Chandran: Yeah, I couldn't agree more. So just before we close here today, Dr. Rose, is there anything else that you'd like to share with our audience?

Dr. Cary Rose: I would say that cardiology, electrophysiology, it's a very exciting field. What we can do now, we almost couldn't do 10 years ago with a series of ablations, the new devices that we use. All I would say, is not everyone needs all that, but don't ignore your symptoms or a partner's symptoms or a family member's symptoms. Get yourself checked out. It's easy. It's painless. And find a doctor you trust and you like, and we're here for you. I love the field of cardiology. I love what I do. I feel very blessed to do what I do for a living. And I'll hope to do it for many more years. And my greatest joy is helping people. So, I hope to go on continue doing it.

Prakash Chandran: Well, Dr. Rose, thank you so much for that and thank you so much for your time today. I truly appreciate it.

Dr. Cary Rose: Oh, thank you for having me. It's been my privilege.

Prakash Chandran: That was Dr. Cary Rose, an electrophysiologist at San Juan Regional Medical Center. Thank you all for listening to Celebrate Health, the podcast from San Juan Regional Medical Center. For more information, you can visit sanjuanregional.com. I'm your host, Prakash Chandran. Thanks again for listening, and we'll talk again soon.