What does a cardiac electrophysiologist do? Anne Dubin explains her profession.

When Anne Dubin, MD, first meets patients and their families, she likes to demystify her job.

“Other cardiologists are plumbers; I’m an electrician,” said Dubin, who has been a pediatric cardiac electrophysiologist at Lucile Packard Children’s Hospital Stanford for 18 years. “Most cardiologists deal with structural heart disease: how the plumbing works and how the heart pumps. I focus on the electrical system that drives the pump.”

Patients come to Dubin with abnormal heart rhythms — too-fast, too-slow or erratic heartbeat patterns. Knowing that something is wrong with their child’s heartbeat scares parents, who may worry that that they are headed for scenarios they’ve seen on TV, in which physicians position a defibrillator over the patient’s chest and shout “CLEAR!”

“I understand and acknowledge their worry,” said Dubin, who is also a professor of pediatrics at the Stanford University School of Medicine. She works to provide parents with a comforting perspective based on her knowledge of the child’s illness. “Fortunately, for most diagnoses I can reassure families that this isn’t going to be like TV.”

Many of the problems she treats can be managed by observing the patient regularly, giving medication or installing a pacemaker to keep the heartbeat on track.

Dubin’s patients include:

• Newborns with abnormally fast heart rhythms.
• Children who need pacemakers because the electrical connections between their upper and lower heart chambers were disconnected during surgery to fix congenital heart defects.
• Infants born with heart block, in which the heart beats very slowly because the electrical heartbeat signal cannot move properly through the heart muscle.
• School-aged children and teens whose abnormally rapid heart rhythms can be treated with medications.
• Children with genetic channelopathies, a class of inherited diseases that interfere with the transmission of nerve signals, making it difficult for the heart muscle to relax.
• Children whose heart chambers are poorly synchronized. Dubin’s team can sometimes resynchronize the heart so that the four blood-pumping chambers work together again.
• Babies, children or teens whose heart rhythm problems stem from cardiomyopathies, diseases in which the heart muscle becomes dangerously enlarged, thickened and rigid.

“In kids who truly have life-threatening situations, I have to be honest and say ‘It’s not fair that you have this, and our treatments aren’t perfect, but we do have things that will protect you,’” Dubin said.

Dubin loves the mixture of challenges that her specialty provides. Initially puzzled by cardiac electrophysiology as a medical fellow, she decided “I’m going to be stubborn and get it,” she said.

“After a while it was really kind of cool and it made sense. I love solving puzzles, and it’s a field where you get a lot of patient involvement, you get to watch patients long-term, and you get to do hands-on procedures. It’s really the right thing for me.”