Who is an arrhythmologist and when should you see one?

An arrhythmologist (electrophysiologist) is a cardiologist who has completed additional training in heart rhythm disorders. The ESC guidelines (2024 — atrial fibrillation, 2021 — cardiac pacing, 2022 — ventricular arrhythmias) name catheter ablation, the electrophysiology study (examining the electrical activity of the heart), implantation of a pacemaker or an ICD (implantable cardioverter-defibrillator) and long-term rhythm monitoring among the work an arrhythmologist does. This does not mean every patient needs them: the decision is made by the doctor, with your participation.

According to AFib Matters (ESC/EHRA), the feeling of your heartbeat may come and go; you should see a doctor, especially if dizziness, chest pain or shortness of breath come with it. Fast and exhausting episodes, as well as episodes with shortness of breath, dizziness, fainting or chest pain, need urgent medical attention. According to the 2022 EHRA practical guide, if a watch or another device has shown an unusual rhythm, it must be confirmed with an ECG and assessed by a team that includes an arrhythmologist or a cardiologist. The sources do not give exact thresholds (for example, the number of beats), so the decision is the doctor's.

Gather the following in advance, so the doctor gets a fuller picture of your condition:

• Results of previous ECGs, Holter monitoring and other tests (on paper or as photos).
• A list of all the medicines you take, including over-the-counter ones and supplements.
• A symptom diary: as AFib Matters recommends, how long episodes last, triggers and accompanying symptoms.
• Smart watch or phone recordings with the date and time: according to the EHRA practical guide, the doctor must review them personally.
• Information on whether close relatives have had sudden death or a disease of the heart muscle.
• A list of questions: What rhythm disorder do I have? Which test do I need? What are the options, and what are their benefits and risks? When should I come back? With which symptoms should I call 103?

According to the 2022 ESC guideline on ventricular arrhythmias and sudden cardiac death (ACC summary), in some cases an ECG and echocardiography are recommended for first-degree relatives (parents, brothers, sisters, children). This applies, for example, if the patient was diagnosed before the age of 50, if there are signs of an inherited disease, or if there have been cases of enlarged heart muscle disease (dilated cardiomyopathy) or early, unexpected sudden death in the family. So if your close relatives have had such conditions, tell the doctor and find out at what age they happened. Whether your relatives need to be tested is decided by the doctor.

In general terms: the doctor asks about your symptoms and medical history, examines you and may record an ECG. The order of the appointment differs depending on the doctor and the situation, and the doctor decides which steps are needed. According to AFib Matters, a resting ECG can detect palpitations that are constant, but what matters most is a recording made during symptoms. If symptoms are infrequent, the doctor may suggest longer monitoring: according to BC Guidelines, the type of monitoring is chosen based on how often the symptoms occur.

According to a review of the 2024 ESC/EACTS guideline, the patient and the doctor choose the direction of treatment together, with the help of a multidisciplinary team; education of patients and family members is recommended. The 2021 ESC/EHRA guideline also states that your wishes and preferences are taken into account in the decision about a pacemaker.