Cardiac & VascularCardiac and VascularTreatments and Procedures

Electrophysiology Study (EP)

(EPS)
  • Definition

    Electrical signals in your heart make the heart muscles contract, which pumps blood to your body. If the electrical signals are not flowing well through the heart, this can create serious problems.
    An electrophysiology study is a test where electrode wires are passed through a blood vessel and into your heart. This electrode can record or create electrical activity. This can help find any problems with the flow of electricity in your heart.
    The Heart
    Heartbeat: Anatomy of the Heart
    Copyright © Nucleus Medical Media, Inc.
  • Reasons for Procedure

    An electrophysiology study is performed to:
    • Find the cause of abnormally slow heart rhythms ( bradycardias )
    • Find the source of abnormally fast heart rhythms ( tachycardias )
    • Provoke and diagnose heart arrhythmias (irregular heart beats) that occur infrequently
    • Reveal suspected arrhythmias
    • Evaluate a person’s risk for sudden death
    • Assess symptoms of unknown cause, including:
      • Fatigue
      • Dizziness/fainting ( syncope )
    • Assess your:
      • Response to anti-arrhythmic therapy
      • Need for a pacemaker
      • Need for an implantable cardioverter defibrillator
      • Need for cryoablation (destruction of some heart cells by freezing)
  • Possible Complications

    If you are planning to have an electrophysiology study, your doctor will review a list of possible complications, which may include:
    • Bleeding
    • Infection
    • Blot clot formation
    • Injuries to blood vessels or the heart
    • Abnormal heart rhythm
    • Heart attack
    A person’s risk level is very individual. It may relate to the specific arrhythmia suspected and any underlying medical conditions.
  • What to Expect

    Prior to Procedure
    Follow your doctor’s instructions.
    Do not drink or eat anything after midnight the night before the procedure.
    You doctor may order:
    • Blood tests
    • Electrocardiogram —recording of the heart's electrical activity
    • Chest X-ray
    Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
    Anesthesia
    A local anesthetic will be given by needle. It will numb the area where the catheter will be inserted. You will also receive a mild sedative through an IV in your arm. This will help you to relax during the test.

    Description of the Procedure

    You will be asked to lie down on an examination table. Electrodes will be placed on your chest. The electrodes will help to monitor your heart rhythm during the test. An area on your thigh, neck, or just below your collarbone will be cleaned. A thin electrical wire will be inserted into a blood vessel in that area.

    The electrode will be passed through the blood vessel and into your heart. Your doctor will be able to see the progress of the catheter with the help of X-rays on a screen. The tip of the electrode can send electrical signals to your heart. The signals will make the heart beat at different speeds. Your heart rhythm will be recorded to look for abnormalities. The tip of the electrode can also record electrical activity at specific spots in your heart muscle. 
    How Long Will It Take?
    The length of the test will vary based on what your doctor is investigating. The test may take 2-4 hours or more to complete. 
    Will It Hurt?
    You may feel some mild discomfort with the initial injection. As the doctors induce an arrhythmia, you may feel palpitations, shortness of breath, chest discomfort, or you may even lose consciousness. The medical team can usually control arrhythmias with medicines, but they may need to administer a shock to stop some rhythms. If they need to do this, you will receive more sedation so that you do not feel pain. 
    Average Hospital Stay
    If your doctor does not need to do additional procedures, you may be able to go home after about six hours. However, you may need to remain in the hospital for up to 24 hours if additional procedures are done during the study. 
    Post-procedure Care
    At the Care Center
    • EKG and blood studies may be done.
    • You will likely need to lie still and flat on your back for a period of time. A pressure dressing may be placed over the area where the catheter was inserted to help prevent bleeding. It is important to follow the nurses' directions.
    • You will need to rest in bed until the sedative has worn off. Your heart rate and blood pressure will be monitored. You will also be checked for swelling or infections. If necessary, you may be given pain medicine. After resting for at least 4-6 hours, your doctor will let you know if you can go home that day or if you need to be admitted for more treatment or observation. If you are discharged on the same day as the test, you should have someone drive you home.
    The results of the study may be available before you leave the hospital or in the next few days. Your doctor will notify you if you need any treatment.
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • Do not lift heavy objects or engage in strenuous exercise or sexual activity for at least 24 hours.
    • Change the dressing around the insertion area as instructed.
    • Take medicines as instructed.
    • Ice may help decrease discomfort at the insertion site. You may apply the ice for 15-20 minutes each hour, for the first few days.
    • Be sure to follow your doctor's instructions .
  • Call Your Doctor

    After arriving home, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the insertion site
    • Cough, shortness of breath, or chest pain
    • Your leg feels cold, turns white or blue, or becomes numb or tingly
    • Discomfort in the jaw, chest, neck, arms, or upper back
    • Dizziness or weakness
    In case of an emergency, call for medical help right away.
  • RESOURCES

    American Heart Association http://www.americanheart.org/

    Texas Heart Institute http://www.texasheartinstitute.org/

    CANADIAN RESOURCES

    Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca/splash/

    University of Ottawa Heart Institute http://www.ottawaheart.ca/

    References

    HeartCenter Online website. Available at: http://www.heartcenteronline.com . Accessed November 22, 2004.

    North American Society of Pacing and Electrophysiology website. Available at: http://www.hrspatients.org/patients/heart%5Ftests/electrophysiology%5Fstudy.asp . Accessed November 22, 2004.

    Texas Heart Institute website. Available at: http://texasheartinstitute.org/ . Accessed November 22, 2004.

    Revision Information

    • Reviewer: David N. Smith, MD
    • Review Date: 12/2011
    • Update Date: 12/30/2011
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    The following Steward Centers for Cardiac and Vascular Care offer this procedure:

    Good Samaritan Medical Center, Brockton

    Morton Hospital, Taunton

    St. Elizabeth's Medical Center, Brighton

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