Electrophysiology Study
What is Electrophysiology?
Electrophysiology (EP) is a subspecialty of cardiology that examines the
electrical behavior of the heart by recording electrical activity from
within the heart chambers. Specially trained cardiologists (called
electrophysiologist) use catheters inside the heart to evaluate certain
symptoms a patient may be experiencing. EP studies enable the doctor to
look for explanations for such symptoms as passing out or to evaluate
certain arrhythmias (too fast, too slow or irregular heart beats).
Patients may need to have an EP study after surviving a cardiac arrest or
heart attack. Another reason might be ECG (EKG) findings that may place
them in a high-risk category.
Preparing for the EP
study.
Your doctor may advise you to stop taking certain medications before your
EP study to ensure more accurate results. If you have any questions about
any other medications be sure to ask. Prior to the EP study a
pre-admission visit will be scheduled so a chest x-ray, electrocardiogram
(ECG) and blood work can be obtained. During this visit, you will be able
to ask questions, or express any concerns you may have. EP studies require
that you have an empty stomach. In most cases you will not be permitted to
eat or drink anything after midnight. It’s important to get a good night’s
sleep.
Hospital admission usually occurs the same day as your test. You will be
asked to remove all clothing and jewelry and to put on a hospital gown.
The nurse will need to start an intravenous (IV) line for fluids and
medications. When it is time for your procedure the EP Lab staff
will explain the procedure to you and answer any questions you may have.
During the EP procedure you will be awake, but will be given medications
to help you relax. Staff members present for the procedure are a scrub
technician or scrub nurse, and a nurse to monitor and care for your needs.
The Electrophysiologists will perform the study.
During
the examination
The staff will position you on the exam table and connect you to a blood
pressure cuff and an oxygen monitor. A R Lead ECG monitor will be applied.
This may require that some areas be shaved in preparation. The Electrophysiologist
will administer a local anesthetic and then make a small nick in your skin
so that a catheter can be inserted. Through this sheath, temporary pacemaker
catheters (about the size of a piece of spaghetti) are placed in strategic
areas of the heart, although you may not feel the catheters as they are
being placed. These catheters record electrical activity inside the heart
and allow the physician to artificially “pace” your heart. For
some EP procedures the side of the neck is also sterilized and numbed so a
catheter can be inserted. An x-ray machine will be placed directly over
your body to allow the physician to watch the catheters and see that they
are properly placed. You will receive only intermittent low doses of
x-rays. The physicians will artificially create different heart rates and
monitor for arrhythmias. During the test you may experience no symptoms
whatsoever, or you may feel your heart beating at different speeds.
What does the test show?
- If no arrhythmia is found, the
catheters are removed, the test is concluded, and you will be
returned to a hospital room.
- If your physician is successful in
reproducing your arrhythmia you may need one of the following
treatment options.
Treatment options
- Medication: after diagnosis is
made by EP study, drugs may be prescribed to prevent arrhythmias
from recurring.
- Pacemaker Therapy: EP studies may
reveal a conduction disturbance and demonstrate the need for a
permanent pacemaker.
- Radio Frequency Ablation: radio
frequency ablation (RFA) has become the treatment of choice for
specific rhythm disturbances. High frequency radio waves use
thermal heat to burn and eliminate the precise location in the
heart from, which an arrhythmia originates.
- Implantable Cardioverter
Defibrillator: An implantable cardioverter defibrillator is a
miniature implantable device that monitors the heart rate and in
life threatening situations administers a shock to the heart to
restore normal rhythm.
Post examination
information
EP studies usually last from three to
four hours. After the catheters are removed, pressure will be applied to
the puncture site just long enough to stop the bleeding. No stitches are
required but a sterile dressing will be applied and can be removed the
next day. Your physician will explain the findings and recommendations
following your study. However, don’t be afraid to ask questions at any
time before, during or after the procedure! After the EP study you will be
transferred to a room and you will be given the following instructions:
- Remain in bed with your leg
straight for 4-5 hours; nurses will assist you when it is OK to
get up.
- Keep your head on the pillow.
- Inform the nurse if you have any
warmth, pain or swelling where the catheters were removed.
- You will be permitted to eat and
drink.
- Your vital signs and catheter
insertion site will be checked frequently.
Going home
The exact length of your hospital stay is
determined by your diagnosis and the treatment option prescribed by your
physician. A normal EP study usually requires only a one night stay in the
hospital. ‘When the bandages are removed from the catheter insertion
site, you may notice a small bruise no larger than a quarter. You may also
feel a small lump there. The bruise may become slightly larger and/or
darker after you return home. Both of these are part of the body’s
natural healing process and should disappear completely within two weeks.
Call your doctor if you have any bleeding, or signs of infection (redness
or oozing) at the insertion site.
What are the
risks?
There can
be some risk involved with certain diagnostic procedures. These risks will
be discussed by your physician prior to the procedure.
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