People of all ages suffer from heart rhythm disorders, or “arrhythmias.” Cardiac electrophysiologists are cardiologists with special expertise in diagnosing, treating and often curing heart rhythm problems. Drs. Ian Santoro and James O’Brien are both board-certified by the American Board of Internal Medicine in the specialty of Cardiac Electrophysiology, and they have helped thousands of people with arrhythmias. “Most people have never heard of cardiac electrophysiologists before they meet us,” says Dr. Santoro. “We are fully trained in general cardiology, but instead of focusing on coronary artery disease and vascular interventions, we have gone on for additional training in cardiac electrophysiology. This additional training enables us to perform special procedures that help people with arrhythmias, such as electrophysiology studies and catheter ablation, tilt-table studies, and pacemaker and defibrillator implantation.”

Cardiac electrophysiologists focus their care specifically on people with heart rhythm and fainting disorders. As Dr. O’Brien explains, electrophysiologists offer more to patients than simple drug treatment: “Many people have rapid heart rates or palpitations that can make them weak, short of breath, or even cause them to faint. In some cases, the rhythm problems can be fatal. One of the first approaches is to give the patient a Holter monitor or event recorder to document the heart rhythm disorder. If the patient doesn’t have palpitations during the recording period — as many don’t — then the cause of the palpitations may go undiscovered. We go one step further and do an electrophysiology or “EP” study. The EP study is an outpatient procedure that involves threading temporary pacing catheters to the heart through a vein in the groin. These catheters enable us to start and stop arrhythmias. Computer analysis allows us to diagnose the mechanism of the person’s palpitations and recommend proper treatment. The whole test takes about one hour, and most people sleep through it. Many of our patients have had palpitations or fainting problems for years, and the EP study is a quick and safe way to make a diagnosis.”

Another test performed in conjunction with EP studies is the tilt-table study, a test designed to provoke fainting in persons with neurocardiogenic or vasovagal syncope. “The tilt-table study induces fainting and provides a diagnosis for many people who repeatedly faint with no obvious cause,” says Dr. O’Brien. “There are very effective medicines for people with recurrent fainting problems, but first the diagnosis must be established.”

Dr. Santoro stressed the tremendous impact of a procedure known as catheter ablation because it cures many rhythm disturbances and removes the need for lifelong drug therapy. “No longer do many patients with arrhythmias need to take drugs — catheter ablation cures them,” explains Dr. Santoro. “Catheter ablation is similar to an EP study except that we apply electrical current with a special catheter to the area inside the heart where the abnormal rhythm starts. We make a small, pea-size lesion there and the arrhythmia is cured. The patient is admitted the morning of the procedure for an overnight hospital stay, and is able to resume normal activities the next day; there are no scars and there are no more drugs. The procedure is safe and tremendously cost-effective for the patient, hospital and insurance companies because the problem is eliminated.”

Dr. O’Brien attended St. Michael’s College and received his medical degree from the Royal College of Surgeons. He completed his medical residency as Chief Medical Resident at St. Vincent’s Hospital and Medical Center in Manhattan. He then completed his cardiology fellowship at Tufts University/ Baystate Medical Center in Massachusetts, followed by a cardiac electrophysiology fellowship at Georgetown University Hospital.

Dr. Santoro attended college at Harvard University, medical school at Columbia University College of Physicians and Surgeons, and completed a medical residency and cardiology fellowship at the University of Chicago, and cardiac electrophysiology fellowship at the University of Oklahoma.