Cardiac Electrophysiology — Patient Information

Atrial Fibrillation

Also referred to as AF or AFib

Overview

Atrial fibrillation is the most common sustained heart rhythm disorder. It occurs when the upper chambers of the heart (the atria) receive chaotic electrical signals, causing them to quiver rather than contract normally. This can allow blood to pool and form clots within the heart, significantly increasing the risk of stroke, heart failure, and other cardiac complications. Some patients experience palpitations, shortness of breath, fatigue, or dizziness; others have no symptoms at all.

Treatment and management

Management focuses on two goals: reducing stroke risk and controlling the heart rhythm. Anticoagulants (blood thinners) are prescribed for most patients to prevent clot formation. Heart rate can be slowed with medications such as beta-blockers or calcium channel blockers. To restore a normal rhythm, options include anti-arrhythmic medications, electrical cardioversion, or catheter ablation. Catheter ablation is a minimally invasive procedure in which targeted energy is used to neutralise the tissue responsible for the abnormal electrical signals — it is effective for many patients and may reduce or eliminate the need for long-term medication.

Pulsed Field Ablation

Also referred to as PFA

Overview

Catheter ablation has been performed at John Fawkner Cardiology for over 20 years, predominantly at Melbourne Private Hospital. Traditionally, ablation used thermal energy — either radiofrequency (heat) or cryoablation (cold) — to neutralise the heart tissue responsible for abnormal electrical signals. While effective, these methods carry a small risk of injury to adjacent structures such as the oesophagus or the phrenic nerve. Pulsed field ablation (PFA) is a newer, non-thermal technology that has largely replaced thermal ablation in many settings.

How PFA works

PFA delivers ultra-rapid, high-voltage electrical pulses directly to the heart tissue. These pulses create tiny pores in the cell membranes of cardiac muscle cells — a process called irreversible electroporation — causing them to cease generating abnormal signals. Critically, this process is highly selective for heart muscle and spares surrounding tissues, substantially reducing the risk of collateral injury to the oesophagus or phrenic nerve.

Advantages of PFA

PFA procedures are typically faster than traditional thermal ablation, reducing anaesthetic time. Clinical data from 2025 and 2026 demonstrate efficacy at least comparable to — and in many respects better than — radiofrequency and cryoablation, with a superior safety profile. For these reasons, PFA has become the preferred approach for AF ablation at this practice.

SVT Catheter Ablation

Also referred to as supraventricular tachycardia ablation

Overview

Supraventricular tachycardia (SVT) is a rapid heartbeat that originates in the heart's upper chambers. Episodes can cause sudden-onset palpitations, chest discomfort, or lightheadedness, and typically terminate on their own or with simple manoeuvres. While not usually dangerous, frequent or prolonged episodes can significantly affect quality of life.

Catheter ablation

For many patients, catheter ablation offers a highly effective and durable cure, often eliminating the need for ongoing medication. Using advanced three-dimensional electrical mapping, the electrophysiologist precisely identifies the "short circuit" or extra electrical pathway causing the rapid heart rate. Targeted radiofrequency energy is then applied to neutralise that small area of tissue. Success rates for SVT ablation typically exceed 95%, and most patients return to normal activities within a day or two of the procedure.

VT Ablation in Structural Heart Disease

Also referred to as ventricular tachycardia ablation

Overview

Ventricular tachycardia (VT) in the context of structural heart disease — such as a previous heart attack, cardiomyopathy, or heart failure — is a complex and potentially dangerous arrhythmia. The electrophysiology team at John Fawkner Cardiology has over 20 years of experience managing this condition. VT in these patients typically arises from areas of scar tissue within the heart muscle, which create abnormal electrical circuits capable of triggering dangerously fast rhythms.

How it is treated

The goal of ablation is to identify and neutralise these abnormal circuits. Using high-density three-dimensional mapping, the electrophysiologist constructs a detailed electrical map of the heart's interior, locating the precise zones of slow conduction within the scar — known as the VT substrate. Ablation energy is then applied to these areas. In patients with reduced heart function, procedures are often performed using a substrate-based approach, targeting the scar during a stable rhythm rather than inducing the dangerous tachycardia. Epicardial mapping and temporary mechanical support may also be used in complex cases to ensure patient safety throughout.

Goals of treatment

Successful VT ablation can significantly reduce or eliminate episodes of dangerous fast heart rhythm and reduce the frequency of ICD (implantable defibrillator) shocks, with meaningful improvements in quality of life for patients with complex cardiac histories.

PVC Ablation

Also referred to as premature ventricular contraction ablation

Overview

Premature ventricular contractions (PVCs) are extra heartbeats that originate in the lower chambers of the heart (the ventricles). They are common and often benign, but when frequent they can cause a troublesome "skipped beat" sensation, fatigue, or shortness of breath. In some patients, a high burden of PVCs over time can gradually weaken the heart muscle — a condition known as PVC-induced cardiomyopathy.

Catheter ablation

When medications are ineffective or not desired, catheter ablation is a highly successful treatment option. Using advanced three-dimensional mapping, the electrophysiologist identifies the exact site in the ventricle from which the abnormal impulse originates. Radiofrequency energy is then applied precisely to that location, neutralising the source of the PVCs. For most patients this substantially reduces or eliminates the PVC burden, with restoration of normal heart function and a significant improvement in symptoms.

Cardiac Implantable Electronic Devices

Also referred to as CIEDs — includes pacemakers, ICDs, CRT devices, and loop recorders

Overview

A cardiac implantable electronic device (CIED) is a small device implanted in or near the heart to monitor and regulate its rhythm. CIEDs are used when the heart beats too slowly, too rapidly, or in an uncoordinated fashion. Implantation is performed under local anaesthetic and sedation as a minimally invasive procedure, and most patients are discharged the following day.

Types of devices

Permanent pacemakers treat abnormally slow heart rhythms by delivering small electrical impulses to maintain an adequate rate. Conduction system pacing (CSP) is an advanced technique that paces the heart's natural electrical pathway — such as the His bundle — to achieve a more physiological and efficient contraction. Cardiac resynchronisation therapy (CRT) devices coordinate the pumping action of the left and right ventricles, and are used in selected patients with heart failure. Leadless pacemakers are a newer option for suitable patients: a small, self-contained device implanted directly inside the heart chamber, eliminating the need for a surgical pocket or traditional leads. Implantable cardioverter defibrillators (ICDs) monitor for dangerously fast rhythms and can deliver a targeted shock to restore a normal heartbeat. Insertable loop recorders (ILRs) are small monitors placed just under the skin of the chest for patients with infrequent symptoms such as unexplained blackouts or palpitations that are difficult to capture on a standard ECG — they record the heart's electrical activity continuously for up to several years.

Remote Cardiac Monitoring

Also referred to as remote device monitoring or telemonitoring

Overview

Remote cardiac monitoring allows patients with implantable devices — such as pacemakers, ICDs, or loop recorders — to have their device data reviewed by our specialist team without needing to attend the clinic in person. Using a small bedside transmitter or a smartphone application, the device automatically sends technical and clinical information to our team on a regular basis.

Benefits

Rather than relying solely on scheduled six- or twelve-monthly check-ups, remote monitoring provides continuous oversight. It can detect the early onset of arrhythmias such as AF, signs of fluid congestion, or technical issues with the device well before symptoms develop. This allows earlier intervention, fewer urgent hospital visits, and a reduced risk of stroke or heart failure hospitalisation. For patients, it provides reassurance that their heart is being monitored around the clock by a specialist team, with expert support available promptly if a concern is identified.