Electrophysiology - Diagnostic test for heart diseases

An Electrophysiology Study (EPS) is a procedure used to evaluate and record the electrical activity of your heart. It is not a surgical procedure. It is a diagnostic test that provides a considerable amount of information about your heart rhythm (the speed and pattern of your heartbeat).

During the EPS, special thin, long, flexible insulated wires (electrode catheters), are inserted in the veins in your groin and/or neck. Sometimes the physician will insert the wire in a vein on the side of your neck or in a vein in the area just below your collarbone. The catheters' movements are monitored by x-ray pictures on a video screen. These catheters are used to locate the site of the abnormal rhythm. Then the doctor will place a special catheter at the insertion site (neck and groin)..

Electrical signals will be sent through the catheters to stimulate your heart. The electrophysiologist will try to reproduce the rhythm disturbances which you might have had before the study.

What is an abnormal heart rhythm?
Your heart's electrical system creates signals that tell the chambers of the heart to contract. Sometimes problems with the heart's electrical signals lead to abnormal heart rhythms, rate, or both. These are referred to as "arrhythmias". Some of these conditions are life threatening without treatment.

You may have an arrhythmia called "ventricular tachycardia" (VT or V-tach). This consists of very fast but regular heart beats originating from the lower chambers of your heart. Your heart will not pump as efficiently as it does during a normal rhythm. You may feel it pound. You may feel faint or dizzy.

You may have an arrhythmia called "atrial fibrillation". This occurs when the atria (upper chambers of the heart) rapidly quivers. This may last for a few seconds to hours or may be continuous all the time.

Another type of arrhythmia is called, "ventricular fibrillation" (VF) . VF is an unstable heart rhythm during which your heart doesn't beat, but quivers. Your heart will stop pumping blood and you will suffer a temporary loss of oxygen. You will usually pass out within a few seconds.

There is another type of arrhythmia that is called, "Paroxysmal supraventricular tachycardia. This consists of rapid heart beat of sudden onset and termination.

Sometimes the heart beats too slowly. This is called, "bradycardia". If you have bradycardia, your blood may not move through the heart and to the body the way it should.

One form of bradycardia, called "heart block", occurs when electrical signals fail to travel from the upper chambers of the heart to the lower chambers.

You may have Wolff-Parkinson-White Syndrome, wherein an extra pathway exists between the upper and lower chambers of the heart. Electrical signals may pass back and forth via this abnormal connection between the upper and lower chambers. This can cause the heart to speed up.

You may have an arrhythmia which is not presented here. Your doctor can discuss your condition with you and address your questions and concerns.

What are the symptoms of arrhythmia?
Arrhythmia can produce the following symptoms: fainting, dizziness, weakness, shortness of breath, palpitations, anxiety, chest pain or chest discomfort.

Why did my doctor ordered this test for me?
Your doctor ordered this test because other tests may not have provided sufficient information about your heart rhythm problem. The other diagnostic tests you might have had include: Holter monitoring, an electrocardiogram, an echocardiogram or a signal averaged electrocardiogram (amplified electrocardiogram).

An Electrophysiology Study can often determine exactly what your rhythm problem is and what should be done to control it.

There are many reasons for performing an EPS. These include:

to learn the origin of your heart rhythm disturbance;
to learn the nature of your heart rhythm disturbance;
to find a possible cause of your dizzy spells or blackouts.;
to evaluate how well your medication or medications are controlling your arrhythmia; or.
to find out the best treatment modality for your arrhythmia.

Does this procedure involve any risks?
The risks for this procedure are low. They include: bleeding, blood clots, perforation of the heart muscle or a blood vessel, stroke, heart attack, and death. These events are rare. After explaining the risks to you, the electrophysiologist will ask you to sign a consent form..

What preparations should I make before the EPS?
Consult your physician about your current medications well in advance. He may tell you to stop taking certain medications 2-3 days before the procedure.

Don't eat or drink anything after 12 midnight on the day before the procedure. You may take approved medications with a small sip of water.

You will probably have blood tests, an electrocardiogram, and a chest x-ray taken prior to the procedure.

You should leave all valuables and money at home or with a relative. Do not wear any jewelry to the hospital. You may wear dentures or dental bridges. Empty your bladder prior to the test. You may receive a mild sedative to help you relax. You will stay awake throughout the study.

Bring someone with you to drive you home after the procedure.

What happens during the Electrophysiology Study?
Electrodes will be placed on your back, shoulders, and chest area to monitor your heart rhythm at all times. A blood pressure cuff will be placed around your arm so that your blood pressure may be monitored, as well. You will have an intravenous line to give you fluids and medication, if necessary.

The catheter site(s) will be shaved and cleansed. You will be covered with sterile sheets. The electrophysiologist will give you medication to numb the catheter insertion area(s). The numbing medicine will cause you feel stinging for a short while, but you won't feel any pain. When the electrophysiologist uses a special needle to find the vein, you will feel some pressure. Let her know if you feel pain at that point. If you do, you will receive more medication.

Part of the x-ray machine that guides the electrophysiologist, will be placed directly over your body.

After the catheters are in place, the electrophysiologist will evaluate your heart rhythm by giving your heart small electrical impulses to make it beat at different speeds. it's very important to let her know how you feel throughout the procedure.

You may feel your heartbeat changing or your heart racing from time to time. Some people faint when their hearts beat fast. If this occurs, the electrophysiologist may give you some medication, or she may deliver an electrical impulse called a countershock to change your heart rhythm back to normal.

When the procedure is complete, the electrophysiologist will remove the catheters from your groin and apply pressure to the area for 5 to 10 minutes to prevent bleeding. Then a dressing will be applied to the area.

How long does the procedure take?
An EPS usually takes 2 to 4 hours.

What happens after the procedure?
After the procedure, your blood pressure, heart rate and maybe catheter insertion sites will be checked at regular intervals.

You will rest for about 4 hours. You must keep your legs straight; do not bend your knees. You are allowed to roll back and forth on the bed. You may move your feet and wiggle your toes to relieve stiffness.

You will leave with a dressing on the catheter insertion site(s).

Your doctor will review your test results and discuss them with you. She will explain your treatment options.

Usually, you will be able to go home on the day of the procedure.

What are the treatment options?
If arrhythmias have been found, the treatment may include: medication, surgery, ablation, an antitachycardia pacemaker, or an automatic implantable cardioverter defibrillator.

Medicine The electrophysiologist may have tested the effectiveness of certain medications during the EPS. Your doctor will choose the best one for you.

Aneurysmectomy This procedure manages ventricular tachycardias by removing necrotic (non-functioning) tissue at the site of a prior heart attack.

Catheter Ablation This technique selectively destroys tissue by use of electrical current or radio frequency current . This approach eliminates the site of origin of tachycardia or interrupts the pathway through which the arrhythmia travels. Sometimes consent is obtained for this procedure prior to the Electrophysiology Study, and is then the ablation is performed immediately after the study.

Anti-tachycardia Pacemaker This approach involves the insertion of a special type of pacemaker. At the precise moment during the tachycardia, the arrhythmia can be interrupted with bursts of rapid pacing from the pacemaker.

Automatic Implantable Cardioverter Defibrillator (AICD) This device selectively and automatically delivers an electrical shock to interrupt recurrent and malignant arrhythmias.

What should I do at home?
When you are at home, contact your doctor if you notice any bleeding at the insertion site, shortness of breath, coldness or numbness of your arm or leg, increase in bruising or swelling, a fever over 100 degrees F; or if you feel chest pain.

Avoid heavy lifting for a few days

You will probably be able to resume your normal activities in a day or two.