EP–a much easier name–is a branch of cardiology that deals with the diagnosis and treatment of heart rhythm disorders. We do an extra year (or two) of training after the standard cardiology fellowship.
EP doctors do three things:
- Ablate (Burn or freeze)
- Implant and manage cardiac devices.
- Take care of patients.
- Electrophysiological Studies
- Why might I need an electrophysiological study?
- What are the risks of an electrophysiological study?
- How do I get ready for an electrophysiological study?
- What happens during an electrophysiological study?
- What happens after an electrophysiological study?
- Next steps
- Electrophysiology Procedure
- After the Procedure
- Returning Home
- When to Call Us
- Do You Need an Electrophysiologist?
- Specialized Training for Electrophysiologists
- When Do You Need An Electrophysiologist?
- Heart, Vascular and Thoracic Care
- Electrophysiology (EP) Tests
- What is an Electrophysiology Study?
Catheter ablation is a procedure in which a small catheter is placed inside the heart (via a leg vein). The catheter has a 4-8 mm metal tip through which radio-frequency (or cryothermal) energy is delivered to selected parts of the heart. (The area to ablate is selected primarily by two simple strategies: vector analysis of the how the arrhythmia activates the heart (ie…north-south, east-west) and secondly, by moving the ablation catheter in a “warmer-colder” trial-and-error manner.) The 4-8 mm ablation lesions can eliminate rogue cells that have electrically run amok, or in the case of AF, isolate areas of the heart.
Catheter ablation is the only cardiac procedure that can be correctly called curative. (No, stents do not cure atherosclerosis.)
I learned ablation in the mid-1990s but did not start using it for atrial fibrillation until 2004. Over the past few years, AF-ablation has emerged as electrophysiology’s most exciting therapy. Here is a link to my atrial fibrillation page.
The other procedural aspect of electrophysiology is implantation of cardiac devices. Pacemakers, Defibrillators (ICDs) and Cardiac Resynchronization Therapy (CRT=BiVentricular) are placed under the skin in the upper chest and are connected to wires that are snaked through veins and positioned into the heart for sensing, pacing and shock delivery.
Although it takes time to learn the surgical installation process, and attention to detail to do it well, the far greater challenge in device management is skillfully applying these complex therapies in the management of patients–the judgment part.
In a selected group of patients, ICDs lower the risk of death. They are, however, associated with substantial risk to the patient. Here is the link to my ICD/Pacemakers archives. Also of interest are these posts on ICD complications. (I urge those interested in understanding the limitations of the ICD trials to read, Mark Josephson’s Critical Appraisal of ICDs in JACC-2008
Electrophysiologists are not just proceduralists and installers. We are real medical doctors.
In many cases, a heart rhythm problem results from a random event–a fluke. Supra-ventricular tachycardia (SVT), lone-AF in a young healthy person, and congenital AV-block are just three examples of many such hiccups of nature. These non-acquired (congenital) problems comprise a substantial portion of our practice. EP doctors are fortunate because we get to treat a wide range of patients: from the very young, with congenital disease, to the aged with the disease of excessive birthdays, and everywhere in between.
In other cases, the heart’s rhythm is affected by environmental factors, both cardiac and non-cardiac. For instance, hardening of the arteries and heart attacks cause heart rhythm problems. So does long-standing high blood pressure, diabetes, sleep disorders and bad lifestyle choices.
Understanding whether to use a catheter, a device, a medicine, or in some cases, none-of-the-above, requires us to listen to, exam, and talk with our patients. In other words…be a doctor. The verb for this is doctoring, which I write about frequently. (Tags of archived posts similar to doctoring are at: ‘Joy of Medicine,’ medical-decision making, and General Medicine.)
Electrophysiology is a beautiful field because it mixes pharmacology, procedures, and old-fashioned doctoring to help people.
Why might I need an electrophysiological study?
Your healthcare provider may advise an EP study for these reasons:
To evaluate symptoms such as dizziness, fainting, weakness, palpitation, or others to see if they might be caused by a rhythm problem. This may be done when other tests have not been clear and your doctor strongly suspects you have a heart rhythm problem
EP studies can be used to get information related to abnormally fast or slow heart rhythms
To find the source of a heart rhythm problem with the intent to do ablation once the source is identified
To see how well medicine(s) given to treat a rhythm problem are working
There may be other reasons for your healthcare provider to recommend an EP study.
What are the risks of an electrophysiological study?
Possible risks of an EP study include:
Bleeding and bruising at the site where the catheter(s) is put into a vein
Damage to the vessel that the catheter is put into
Formation of blood clots at the end of the catheter(s) that break off and travel into a blood vessel
Rarely, infection of the catheter site(s)
Rarely, perforation (a hole) of the heart
Rarely, damage to the heart’s conduction system
For some people, having to lie still on the procedure table for the length of the study may be uncomfortable or painful.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the test.
How do I get ready for an electrophysiological study?
Your healthcare provider will explain the test to you and give you a chance to ask questions.
You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if anything is not clear.
Tell your healthcare provider if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthetic agents (local and general).
You will need to fast (not eat or drink anything) for a certain period before the test. Your healthcare provider will tell you how long to fast, usually overnight.
If you are pregnant or think you may be, tell your healthcare provider.
Tell your provider if you have any body piercing on your chest or abdomen (belly).
Be sure your healthcare provider knows about all medicines (prescription and over-the-counter), vitamins, herbs, and supplements that you are taking.
Tell your provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop some of these before the test.
Your provider may request a blood test before the test to determine how long it takes your blood to clot. Other blood tests may be done as well.
A sedative (a drug to make you relax) is often given before the test, so you will need someone to drive you home afterwards.
Based on your medical condition, your healthcare provider may request other specific preparation.
What happens during an electrophysiological study?
You may have an EP study on an outpatient basis or as part of your stay in a hospital. Testing may vary depending on your condition and your healthcare provider’s practices.
Generally, an EP study follows this process:
You will be asked to remove any jewelry or other objects that may interfere with the test.
You will remove your clothing and put on a hospital gown.
You will be asked to empty your bladder before the test.
If there is a lot of hair at the area of the catheter insertion (often the groin area), the hair may be shaved off. This will help in healing and reduce the chance of infection after the test.
An intravenous (IV) line will be started in your hand or arm before the test. This is so that medicine and IV fluids can be given, if needed.
A member of the medical team will connect you to an electrocardiogram (ECG) monitor to record the electrical activity of your heart and monitor your heart during the test using small electrodes that stick to your skin. The team will also monitor your vital signs (heart rate, blood pressure, breathing rate, and oxygen level).
There may be several monitor screens showing your vital signs and the images of the catheter being moved through your body into your heart.
You will likely be given a sedative in your IV before the test to help you relax. However, you will be somewhat awake during the test.
Your doctor may check and mark your pulses below the IV site to check the circulation to the limb below during and after the test.
A member of the medical team will inject a local anesthetic into the skin at the site where the catheter and wires are to be put into the vein. You may feel some stinging at the site for a few seconds after the local anesthetic is injected.
Once the local anesthetic has taken effect, your doctor will insert a sheath, or introducer, into the blood vessel. This is a plastic tube through which the catheter(s) will be put into the blood vessel and advanced into the heart. Catheters are long, thin hollow tubes that provide a path through the blood vessels to protect the surrounding blood vessel from trauma of the equipment passing through the vessel.
One or more catheters will be put into the sheath and into the blood vessel. The doctor will thread the catheters through the blood vessel into the right side of the heart. Fluoroscopy (a special type of X-ray that is displayed on a TV monitor), is used to help advance the catheters to the heart. Your doctor may let you watch this process on the screen.
Once the catheter(s) is in the right place, your doctor will send very small electrical impulses to certain areas within the heart. You may feel your heart beat stronger and faster. If a heart rhythm abnormality is started, you may feel lightheaded or dizzy. Medicine may be given or a shock may be delivered to stop the arrhythmia. You may be sedated before a shock is given.
If a certain area of tissue is found to be causing a rhythm problem, the doctor may do an ablation to destroy the abnormal tissue. This is done with heat (radio waves, called radiofrequency ablation) or cooling (called cryothermy or cryoablation).
Sometimes adrenaline type medicines are given to help induce arrhythmia. You may feel your heart beating more rapidly and forcefully. You may feel some anxiety.
If you notice any discomfort or pain, such as chest pain, neck or jaw pain, back pain, arm pain, shortness of breath, or breathing difficulty, let the doctor know right away.
Once the EP study is done, the catheter(s) will be removed. Pressure will be put on the insertion site so that a clot will form. Once the bleeding has stopped, a very tight bandage will be placed on the site. A small sandbag or other type of weight may be placed on top of the bandage for extra pressure on the site, especially if the groin was used.
The staff will help you slide from the table onto a stretcher so that you can be taken to the recovery area. If the catheter was put in the groin, you won’t be able to bend your leg for several hours. To help you remember to keep your leg straight, the knee of the affected leg may be covered with a sheet and the ends will be tucked under the mattress on both sides of the bed to form a type of loose restraint.
The results of the study may also help your healthcare providers decide whether more treatment is needed and which treatment would be best. You may need a pacemaker or implantable defibrillator, receive or change medicines, undergo an ablation procedure, or receive other treatments.
What happens after an electrophysiological study?
In the hospital
After the test, you may be taken to the recovery room for observation or returned to your hospital room. You will stay flat in bed for several hours after the test. A nurse will monitor your vital signs, the insertion site, and circulation or sensation in the affected leg or arm.
Let your nurse know right away if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site.
Bed rest may vary from 2 to 6 hours depending on your specific condition.
In some cases, the sheath or introducer may be left in the insertion site. If so, you will be on bed rest until the sheath is removed. After the sheath is removed, you may be given a light meal.
After the specified period of bed rest, you may get out of bed. The nurse will help you the first time you get up, and may check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the long period of bed rest.
You may be given pain medicine for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.
You may go back to your usual diet after the test, unless your healthcare provider tells you otherwise.
When you have recovered, you may be discharged to your home unless your doctor decides otherwise. If this test was done on an outpatient basis, you must have another person drive you home.
Once at home, check the insertion site for bleeding, unusual pain, swelling, and abnormal color or temperature change. A small bruise is normal. If you notice a constant or large amount of blood at the site that can’t be contained with a small dressing and stopped by putting pressure over the area, contact your doctor right away.
It will be important to keep the insertion site clean and dry. Your doctor will give you specific bathing instructions.
You may be advised not to participate in any strenuous activities for a few days after the test. Your doctor will tell you when you can return to work and go back to your normal activities.
Contact your healthcare provider if you have any of the following:
Fever with a temperature higher than 100.4°F (38.0°C) or chills
Increased pain, redness, swelling, or bleeding or other drainage where the catheter was inserted
Coolness, numbness or tingling, or other changes in the affected leg
Chest pain or pressure, nausea or vomiting, profuse sweating, dizziness, or fainting
Your healthcare provider may give you other instructions after the test, depending on your situation.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how will you get the results
Who to call after the test or procedure if you have questions or problems
How much will you have to pay for the test or procedure
There are two parts to the EP study:
- Recording the heart’s electrical signals to assess the electrical function
- Pacing the heart to bring on certain abnormal rhythms for observation under controlled conditions
Medications are sometimes used to stimulate your arrhythmia. You may feel your heart racing or pounding. This may make you anxious, but you needn’t be alarmed. The doctors want to induce the abnormal rhythm causing your problem, so they can treat the arrhythmia. If you have any uncomfortable symptoms — such as chest pain, dizziness, shortness of breath, nausea and pain — tell your nurse or doctor.
Your Role During the Study
Try to remain calm and relaxed. Don’t move your arms or legs in the sterile working area. If you feel any discomfort, let your doctors or nurses know immediately, so they can help you get comfortable.
In the controlled environment of the EP laboratory, induced arrhythmias are handled by well-trained personnel with state-of-the-art equipment. This is an important tool that allows your doctor to gain information about your arrhythmia that will help prevent future occurrences.
After the Procedure
Once the EP study is over:
- Catheters are removed and pressure applied to the groin and neck areas to prevent bleeding.
- You’ll lie still in bed for four to six hours to allow the catheter sites to seal. Don’t move or bend your leg.
- You will be checked frequently. If you feel sudden pain or see bleeding at the site, call the nurse immediately.
- Your doctor may share some of the preliminary findings after the test.
- If you feel well enough, you may be able to eat and drink.
Before leaving the hospital, your doctor or arrhythmia nurse coordinator will provide instructions regarding medications and follow-up care and any restrictions in your normal activities.
After you’re discharged from the hospital and return home, please follow these guidelines:
- Limit your activity for the first 24 hours. Don’t strain or lift heavy objects more than 10 pounds for the first week.
- If traveling home takes several hours, stop every hour, stretch your legs and walk a few minutes to prevent formation of blood clots in your legs.
- If you notice new blood on the dressing, press firmly on the incision site for about 20 minutes. If bleeding continues, call your doctor or go to the nearest emergency room while still applying pressure.
- Leave the dressing on until the day after the study. Your nurse will show you how to remove it.
Don’t worry if you see a bruise or small lump under the skin at the insertion site. It will disappear within three to four weeks.
When to Call Us
Call your doctor or arrhythmia nurse coordinator if:
- The site, where catheters were inserted, becomes painful or warm to the touch.
- You have chest pain, palpitations, shortness of breath or lightheadedness.
Do You Need an Electrophysiologist?
Your heart has two basic functions. One is to pump blood throughout your body, and the other is to remember to pump blood throughout your body, explains Bruce Wilkoff, MD, president of the Heart Rhythm Society and director of Cardiac Pacing and Tachyarrhythmia Devices and a heart doctor on staff at the Cleveland Clinic.
“Pumping blood is essentially a plumbing system,”.Dr. Wilkoff says. And the way the heart remembers to pump blood, he explains, is electrical.
People can have medical issues with one or both systems. Cardiologists focus on the heart’s plumbing system. They deal with diseases of the cardiovascular system, the heart, and blood vessels, and focus on preventing and treating heart disease and heart attacks. You go to this heart doctor for cardiac tests such as stress tests and echocardiograms and if you need an angiogram or angioplasty.
Specialized Training for Electrophysiologists
Some cardiologists have one to two years of extra training in electrophysiology. Cardiac electrophysiologists focus on your heart’s timing, or electrical, system and on diagnosing and treating irregular heartbeats or arrhythmias. Electrophysiologists are qualified to perform special tests of your heart’s electrical system, such as an electrophysiology study or an ablation. In addition, this heart doctor can implant a pacemaker or a defibrillator, which is similar to a pacemaker but can shock your heart back into rhythm should you need it.
“Not all electrophysiologists are cardiologists,” Wilkoff notes. “Some come from other disciplines, such as anesthesiology or surgery. However, the majority are cardiologists who went on and did further sub-specialization in electrophysiology and pacing after internal medicine and cardiology.”
Often, cardiology groups have electrophysiologists in their practice. Electrophysiologists also might have their own practice. “If your cardiology group doesn’t have an electrophysiologist, they may refer you to one,” Wilkoff says. Some nurse practitioners and advance practice nurses specialize in electrophysiology, too, Wilkoff adds.
There are many more cardiologists than electrophysiologists. “But there are plenty of electrophysiologists in most parts of the country,” Wilkoff says. The Heart Rhythm Society, to which many electrophysiologists belong, has 5,400 members.
When Do You Need An Electrophysiologist?
In a normal, healthy heart, the upper chambers (the atria) and lower chambers (the ventricles) work together, alternately contracting and relaxing to pump blood. Sometimes the rhythm is thrown off and you have an irregular heartbeat — one that’s too fast (more than 100 beats per minute) or too slow (fewer than 60 beats per minute). An electrophysiologist can help you deal with an arrhythmia, the most common being atrial fibrillation, where the two upper chambers quiver rather than coordinate their contractions.
One of the causes of arrhythmia is injury from a heart attack. Others include recovering from heart surgery, coronary artery disease, valve disorders, an imbalance of sodium or potassium, and stress. An electrophysiologist may order a number of different tests to confirm you have an arrhythmia and to determine its cause. Your arrhythmia may be treated with lifestyle changes, medications, and invasive therapies if necessary.
If medications and lifestyle changes don’t help, an electrophysiologist might perform an ablation to disconnect the electrical pathways that aren’t working properly. This heart doctor can also perform other surgical operations such as implanting a pacemaker or defibrillator. Two surgeries sometimes used to correct atrial fibrillation are the Maze and modified Maze procedures. These require the surgeon to cut a pattern in your upper heart chambers, like a maze, and then stitch up the cuts to create scars. Scars interfere with the stray electrical impulses that cause atrial fibrillation.
You and an electrophysiologist will discuss the options and determine the best treatment for you. “Electrophysiologists are more than just physicians who see patients,” Wilkoff says. “We work to understand the disease and develop new therapies. We have lots of tools that we can use to help people with irregular heartbeats manage their condition, and we work as a team to provide the best care possible.”
For the latest news and information on living a heart-healthy lifestyle, follow @HeartDiseases on Twitter from the editors of @EverydayHealth.
Heart, Vascular and Thoracic Care
Electrophysiology (EP) Tests
How do physicians refer patients?
Fast Heart Rate (Supraventricular Tachycardia – SVT)
Long QT Syndrome (Inherited Arrhythmias)
Slow Heart Rate (Bradyarrhythmia)
Sudden Cardiac Death (Ventricular Tachycardia/Fibrillation)
UW Health Heart, Vascular and Thoracic Care doctors perform electrophysiology tests (EP tests) to determine how the heart is affected by an arrhythmia. What are electrophysiology (EP) tests? Due to the unpredictability of arrhythmias, it can be difficult for doctors to prescribe medications or surgery without actually seeing how the arrhythmia starts or behaves once it has started. In order to determine how the heart is affected by an arrhythmia, doctors may try to replicate a brief episode of the arrhythmia. This can be done with electrical stimulation of the heart during an electrophysiology (EP) test. EP studies are often recommended to diagnose arrhythmias, or to determine the exact cause of and plan treatment for a previously-identified arrhythmia. During an EP test, doctors can monitor the heart’s electrical function or stimulate the heart with electrical impulses in order to produce and observe the effects of an arrhythmia and map the site it comes from. The map of damaged areas can be used by doctors during a corrective procedure, such as ablation. EP tests are also used to investigate further when it appears a person may need a Pacemaker or an Implantable Cardioverter Defibrillator, or ICD. Basically, the EP study is performed by doing two things:
- Recording electrical signals: Electrode catheters sense electrical activity in various areas of the heart and measure how fast electrical impulses travel.
- Pacing the heart: Electrode catheters can also be used to deliver tiny electrical impulses to pace the heart. By doing so, doctors try to induce certain abnormal heart rhythms so they can be observed under controlled conditions.
The results of an EP test complement the information a doctor gains through knowledge of a person’s medical history, a physical exam and non-invasive tests such as chest x-rays, echocardiograms, electrocardiograms or heart monitors.
Preparing for an EP Study
If you are scheduled for an electrophysiology (EP) study at University of Wisconsin Hospital and Clinics, you should not eat or drink anything for eight to 12 hours before the test. You may be asked to hold certain medications such as blood thinners or anti-arrhythmic medications for several days prior to the procedure.
Local anesthetic is used to numb the area where the catheters are to be inserted, so most people feel only a slight pressure or a sensation of mild tugging. Other than a sedative, people having an EP study may not receive any other drugs because some anesthetics can alter how the heart functions.
An EP test can take anywhere from one hour up to five or six hours. Because of the unpredictable length of the test, it is often recommended that people scheduled for an EP test use the bathroom immediately before the test begins.
The Electrophysiology (EP) Study Procedure
Results and Treatment
When your EP study is complete, the sheath and catheters are withdrawn and pressure is applied to the insertion point to control bleeding. The patient is usually asked to remain lying down for four to six hours. Patients are asked to refrain from heavy lifting for approximately five days. With some restrictions, most people can resume normal activity within eight hours of the procedure.
The results of an EP study can be used to prescribe or adjust anti-arrhythmic medication. When an EP test confirms the presence of a slow or erratic heart rhythm, pacemaker implantation may be indicated.
An Implantable Cardioverter Defibrillator (ICD) – a device that constantly monitors the heart rate and electrically stimulates or shocks the heart when the device detects ventricular tachycardia or fibrillation – may be required for people with ventricular arrhythmias. Surgery may also follow EP testing.
For isolated or benign arrhythmias that do not present a serious danger to normal heart function, no further treatment may be necessary.
What is an Electrophysiology Study?
What is an Electrophysiology Study?
An Electrophysiology (EP) test or study looks at the conduction or electrical system of your heart by recording electrical activity from within the heart chambers. Thin wires are advanced into the heart through a small tube similar to cardiac catheterization to see if the irregular heartbeat can be reproduced. An EP study allows the doctor (Electrophysiologist) to study heart rhythm disturbances (arrhythmias) in a controlled setting.
What does the test show?
The EP study results can help your doctor determine if you have a heart rhythm disturbance or diagnose your abnormal heart rhythm. It can show how well medications work. This information helps determine the best treatment. The test also can be used to see how well your defibrillator (ICD) operates during your abnormal heart rhythm.
In order for your heart to beat, it needs an electrical impulse to generate a heart beat (More information about heart anatomy). Your heart’s natural pacemaker (sinoatrial node) normally makes your heart beat 60-100 times per minute. This is called sinus rhythm. There are conditions when the electrical impulse becomes blocked in its route down the conduction system that cause an abnormal slowing of your rhythm. This is called Bradycardia and refers to a heart rate of less than 60 beats per minute.
In other conditions, an abnormal or “irritable pacemaker” outside the sinoatria node may cause a very fast heart rhythm to occur. This is called Tachycardia and refers to a heart rate of greater than 100 beats per minute. If the tachycardia comes from the upper chambers of the heart it is called Supraventricular Tachycardia (SVT). If it comes from the lower chambers it is Ventricular Tachycardia (VT).
Either too slow or too fast a heartbeat may cause the following symptoms:
- Dizziness or lightheadedness
- Palpitations (a fluttering or pounding in the chest)
- Fainting spells
- Shortness of breath
How do I prepare for the test?
- Do not eat or drink anything after midnight the night before your procedure because you need to be fasting for at least 8 hours.
- Medications should be taken as scheduled with a sip of water unless special instructions are given to stop your meds. Your doctor may advise you to stop taking certain medications before your EP study to obtain more accurate test results.
- Be sure to mention to the doctor or nurse if you have any allergies
- Make arrangements with a family member or friend to drive you home after the procedure – you probably will not be permitted to drive. Family members and friends can wait in an assigned area.
- Pack a small bag in case your doctor decides to keep you overnight in the hospital. You may want to include a robe, slippers, toiletries, and a book / word games (something to pass the time).
- Leave money, jewelry, and valuables at home unless a family member or friend can hold them for you during the procedure.
- Bring a list of all medications you are currently taking. Your doctor may want to continue them while you recover from your procedure.
- Tell your doctor if you take aspirin or a blood thinner because they may need to be stopped several days before the procedure.
- Several routine tests are done before the EP study:
- EKG (electrocardiogram)
- Blood tests
- Medical history and exam
- Chest x-ray
Who gets arrhythmias?
Arrhythmias are usually a byproduct of damage to the heart from disease or age. People with otherwise healthy hearts can develop an arrhythmia, but it is rare. Many things can damage your heart’s electrical system and lead to an electrical problem: diseases of the heart valves, enlargement of the heart, coronary artery disease, high blood pressure, lung disease, congenital heart problems (existing at birth) and scarring from a heart attack.
What happens during an Electrophysiology Study?
The Electrophysiology Study may be done as an inpatient or in many cases, as an outpatient. If you are an outpatient, arrive 1-1/2 hours to 2 hours before your procedure pending on blood work needed. After you go through admitting, you will go to the pre op area (Ambulatory Surgery) – located on the ground floor Outpatient Care – unless other arrangements have been made. You will change into a hospital gown. An intravenous line (IV) will be started in a vein in your arm and you will be given consent to sign for the procedure. You will be transported to the EP laboratory located on the ground floor operative/cardiology unit. You will arrive to the laboratory approximately 30 minutes before your procedure begins, so our highly trained staff can prepare you and get you relaxed for the procedure. Sometimes a scheduled procedure time must be changed because of an emergency case. Please keep in mind that we try our best to remain on schedule however, sometimes some procedures do take longer than we may expect.
Pending on the outcome of your procedure if you are scheduled to return home that day you will be taken to post op (Ambulatory Surgery) – located on the ground floor Outpatient Care for recovery until you are discharged. If you are scheduled to stay overnight our specialized trained cardiology nurses for Cardiac Lab and Electrophysiology Procedures will care for you on our new Cardiovascular Care Unit on the second floor of the main hospital building.
Once in the EP lab, you will be transferred to a table. Electrodes (sticky patches) will be placed on your chest, back, arms, and legs. You may need to be shaved so the electrodes will stick. You will also be hooked up to other monitoring devices such as a blood pressure cuff and oxygen monitor. You will need to lie still and relax during the test because movement or muscle tensing can interfere with the electrical signals.
The area where the catheters are to be placed (in the groin, arms or neck) will be cleansed with an antiseptic solution. Sterile towels and sheets will be placed over you, leaving exposed only the area where the catheters will be inserted. The doctor will inject a numbing medicine in the areas where the catheters will be inserted. You will feel some stinging at that time. Once the medication takes effect, you should not feel any discomfort.
Once the areas are numb, one to four special insulated wires (called catheters) are inserted into different parts of your heart using a special x-ray machine. This machine allows the doctor to watch the catheters as they move into the correct places. Part of the x-ray machine will be placed directly over your entire body. You will receive only intermittent low dose x-rays.
After the catheters are in position, the doctor evaluates your heart rhythm disturbance by giving your heart small electrical impulses by an artificial pacemaker through one of the catheters. This will make your heart beat at different rates. You may feel your heart beating quickly, or experience fluttering or palpitations. If you feel chest pain or discomfort, let the doctor know.
You may be asked questions during the test such as:
“Do you feel faint?”
“Do you feel your heart pounding?”
“Is this feeling similar to one you have had before?”
“Do you feel dizzy or lightheaded?”
“Are you short of breath?”
“Do you have chest pain or pressure?”
Some patients pass out when the doctor is inducing a rapid heart rhythm. If you do pass out, it will be for a very short period of time. A small electrical shock may be required to bring back your normal heart rhythm. Most patients report that they do not experience any pain. Some patients do not even realize they have passed out.
If you do have an irregular rhythm, the doctor may prescribe a cardiac medication. This drug will be given through your IV. You blood pressure, heart rate, oxygen levels will be monitored during this time. Once an adequate dose of the drug is given, the doctor will check to see how effective it is in controlling your irregular rhythm.
When the EP study is completed, the doctor will remove the catheters. To prevent bleeding, pressure will be applied to the catheter insertion site until the bleeding stops. A small sterile dressing will be applied which will be removed the next day. No stitches will be required. You will return to a recovery area on a stretcher.
The catheter insertion areas require time to heal, so you will need to follow these steps:
- Bed rest for 3-6 hours.
- Do not cross your legs and keep the legs straight if the catheters were inserted in the groin. To sit up or bend your knees may cause bleeding at the site.
- Report any symptoms to your nurse such as chest pain, swelling in the insertion sites, warmth, anything unusual.
The nurse will make sure you are given something to eat or drink, make sure you are comfortable, answer any questions or concerns, check your blood pressure and heart rhythm (EKG), help you with urination, etc.
What is Catheter Ablation?
The EP study and ablation procedure are very similar. In fact, your doctor may decide to do both procedures, one after the other, while you are in the EP lab. This possibility will be discussed with you prior to the study.
Catheter ablation is a non-surgical technique that is used to destroy heart muscle cells responsible for an arrhythmia. The procedure can be quite lengthy. An ablation procedure can last for 2-4 hours. This procedure is the preferred treatment for many types of arrhythmias.
During catheter ablation, a doctor guides a catheter through a vein in your leg to your heart. The catheter is positioned in the area of your heart responsible for the arrhythmia. Electrodes at the tip of the catheter emit radio frequency (heat) energy through it that destroys the heart muscle cells responsible for the arrhythmia.
Drug therapy for arrythmias
Medication: If the doctor diagnoses you with a heart rhythm disturbance (arrhythmia) after the study, he/she will prescribe a medication (antiarrhythmic) to control your arrhythmia. Antiarrhythmic medications can help alleviate symptoms and prolong life. Some sample medications include:
Quinidine – used to treat patients with Supraventricular (SVT) and Ventricular Arrhythmias (VT), such as Atrial Fibrillation (afib) or flutter, Paroxysmal Supraventricular Tachycardia (PSVT), and Premature Ventricular Contractions (PVCs). The drug comes in several forms, including Quinidine Sulfate (Ci-Quin) and Quinidine Gluconate (Duraquin).
Propranolol (Inderal) – decreases heart rate and contractility. Reduces the incidence of sudden cardiac death after a heart attack.
Sotalol (Betapace) – decreases heart rate, slows AV conduction, decreases cardiac output, and lowers blood pressure.
Amiodarone – used to treat SVT, PSVT, VT, Wolff-Parkinson-White (WPW) syndrome.
*Medications may not be the answer for treating your arrhythmia. If this is the case, your doctor will discuss other ways of treating your problem, such as a pacemaker or defibrillator (AICD).
Where is the test performed?
St. Mary has two state-of-the art Electrophysiology Labs, performing more than 1,200 procedures annually.
How long does this test take?
An EP study usually takes 1-4 hours.