What is an Electrophysiology (EP) Study?
An electrophysiology (EP) study, is a specialized procedure that evaluates the electrical system of the heart. The procedure takes few minutes and its goal is to pinpoint an irregular heart rhythm that may be leading to your symptoms. The EP study can show which area of the heart is causing the arrhythmia, which allows the physician to create a treatment plan. During the EP study, the patient is sedated, and small catheters are advanced into different areas of the heart. The catheters have the ability to read the electrical activity within different areas of the heart, and small amount of electricity can be delivered through these catheters in an effort to induce the arrhythmia. The internal recording of your heart’s electrical activity is often compared to the external recording (electrodes on the patient’s chest) in order to correctly diagnose the arrhythmia.
Why might you need an EP Study?
Your heart should beat in what is called Normal Sinus Rhythm, which is at a normal rate (60-100 beats per minute) with normal electrical conduction through the heart. Arrhythmias (abnormal heart rhythms) are sometimes found in patients – some are congenital, and some arise from different lifestyle factors. In these arrhythmias, the normal electrical conduction in the heart is disrupted and the heart does not function at its full potential. These abnormal rhythms can lead to many symptoms including: fatigue, dizziness, palpitations, sweating, light-headedness, shortness of breath, fainting, and chest pain. Identifying the root cause of the symptoms can be done with the EP study as your physician can ascertain which area of your heart is acting up.
What are the possible outcomes of an EP Study?
There are 4 possible outcomes:
- The test was inconclusive: Though the rarest outcome, it is possible that the physician cannot reproduce the irregular rhythm that is leading to your symptoms. In the event this happens, your doctor may decide to send you home with some type of monitoring device. There are Holter monitors, which are portable monitors that externally observe your heart rhythm for 1-2 days. There are event recorders which are another external monitoring device that observe your heart rhythm for up to 1 month. Finally, there are implantable loop recorders that may be implanted for up to 2-3 years. This is a small device that is placed under the skin for a more reliable recording of your heart rhythm when you experience symptoms.
- An arrhythmia was induced in the EP lab, but the physician decides that it is best if it is medically managed: In this case, the doctor will send you home with a prescription to control the arrhythmia and in turn help with your symptoms.
- A radiofrequency ablation is necessary at this time: If the culprit area in the heart is easily fixed with cardiac ablation, the physician will advance another catheter into the heart. This catheter will heat up and cauterize the misfiring tissue, which will put you back into normal sinus rhythm. That tissue will then be unable to misfire anymore, and your symptoms will resolve.
- Finally, the EP study may show that you need one of two implantable devices: If it shows that your natural pacemaker is showing signs of disease and sickness, then it is in your best interest to receive an implantable pacemaker. This device can automatically send electrical signals into the heart to ensure that your heart is beating at a normal rate, so it can function at the optimal level. If the EP study shows that your heart is susceptible to ventricular tachycardia or ventricular fibrillation, then it is in your best interest to receive an implantable cardiac defibrillator. In other words, the lower chambers of your heart may be susceptible to beat at very chaotic and high rates. When this occurs, blood is not properly ejected and supplied to the rest of your body. If this happens and you do not spontaneously convert back to normal rhythm, your implantable defibrillator can shock the heart back to its normal rhythm and rate.
How do I prepare for the procedure?
Prior to your procedure, check with our office to see what medications you are allowed to take. If you are taking them, we may ask you to discontinue your blood thinners few days before your scheduled procedure. Also, if you have diabetes, check with the office to see if these medications need to be adjusted.
- Do not eat or drink anything after midnight on the evening before your procedure. You are only allowed a sip of water with your medications – no other liquids or solids are permitted.
- You will be changed into a hospital gown prior to your procedure, so you may wear comfortable clothes into the hospital. Please leave any of your valuables, including jewelry at home.
What is the process of the procedure?
This test is done to study your heart’s electrical function. Your physician will be able to locate different areas in the heart that are causing abnormal rhythms that lead to your symptoms.
Your procedure will take place in a specialized lab called the electrophysiology (EP) lab. You will be connected to several monitors for heart rhythm observation.
You will be placed under light sedation during this procedure to help you relax. Once relaxed, your physician will insert several catheters into the blood vessels in your groin, and these catheters will be advanced into the right atrium. A local anesthetic is used at this site to ensure you have minimal pain during the procedure.
You will likely be lightly sedated during this study, but you should be comfortable and you will not feel these catheters moving through your vessel with the help of the sedatives and local anesthetics. A nurse or anesthesia provider will always be at the head of your bed to monitor your heart rate, blood pressure, and oxygen level. They will also ensure you are comfortable throughout.
Once the catheters are placed in the appropriate regions of your heart, your physician will send electrical impulses from these catheters in order to induce the abnormal rhythm that is causing your symptoms. Different medications may also be used to help in this arrhythmia induction. You will likely feel your heart racing as well as chest pressure/pain during this study. Be sure to communicate with the nurse or anesthesia provider if your symptoms continue.
It is possible that the physician will be unable to reproduce the arrhythmia that is leading to your symptoms, but this is uncommon.
If the arrhythmia is induced during the testing, your physician may decide to proceed with an ablation, or they may decide to implant a pacemaker or defibrillator. This decision all depends on what type of arrhythmia is induced.
What is the recovery process of the procedure?
Once the procedure is complete, the catheters will be removed from your groin and pressure will be held at the incision site for several minutes to prevent bleeding. You will then be sent to a recovery unit where you will remain on bed rest for 3-4 hours.
- You will be permitted to eat and drink at this time, but it is very important that your legs remain straight during this time in order to prevent bleeding from the groin.
- You will likely go home on the same day as your procedure depending on what the results are. The outcomes of the procedure will be discussed with you prior to your EP study so you are properly consented for the appropriate treatment before you begin the procedure.
EP Study Discharge Instructions
You will need a 1-2-week post-procedure follow-up appointment with us. Please call us at (602) 698-5820 to schedule this appointment if one was not made for you at the time of your discharge from the hospital. Your follow-up will consist of a reassessment of your symptoms and the electrical activity in your heart with EKG and cardiac monitoring.
What To Expect At Home
- Bruising of the trunk, groin and leg around the puncture site is normal and should resolve in a few days.
- You will be sent home with a bandage over the area which can typically be removed the day after the procedure.
- Shower as usual after the bandages are removed. You may gently wash the area with soap and water but do not scrub the puncture site.
- If you discontinued any medications pre-procedure, resume taking them unless told otherwise by your physician upon discharge from the hospital.
- Do not lift over 10 lbs. for 5 days post-procedure.
- You may resume physical activity after 1-2 days but avoid any strenuous activity such as exercise for 1 week post-procedure.
- Do not take a tub bath, Jacuzzi or swim for 7 days.
- Discuss with your physician prior to discharge about when it is appropriate for you to return to work.
Call If You Experience:
- Significant redness, heat, swelling, drainage or severe pain at your puncture site. If any bleeding occurs, hold direct pressure at the site with gauze or a band-aid. If the bleeding continues past 10 minutes, call your physician and seek immediate medical attention.
- Fever of 100 degrees or higher. A high temperature can be early signs of infection.
- Lightheadedness, dizziness, numbness, tingling or double vision.
- Difficulty swallowing.
- Significant shortness of breath.