Electrophysiology studies, or EPS, use cardiac catheterization techniques to study patients who have irregular heartbeats (called arrhythmias). EPS shows how the heart reacts to controlled electrical signals. These signals can help doctors find out where in the heart the arrhythmia starts and what medicines will work to stop it. EPS can also help doctors know what other catheter techniques could be used to stop the arrhythmia (see Arrhythmia for more about the catheter techniques used to treat arrhythmia).
The electrophysiology study (EP study) performed in Indian Hospitals is a special catheterization test, in which electrode catheters (flexible, insulated wires with metal electrode tips) are inserted in to the heart in order to study the cardiac electrical system. The cardiac electrical system is important, because it controls the heart rhythm and because abnormalities in the electrical system are responsible for most heart arrhythmias.
How does it work?
EPS uses electrical signals to help doctors find out what kind of arrhythmia you have and what can be done to prevent or control it. Doctors will perform a cardiac catheterization procedure in which a long, thin tube (called a catheter) will be put into an artery in your leg and threaded into your heart. This catheter can be used to send the electrical signals into your heart. Stimulating the heart will cause an arrhythmia, and doctors can record where in the heart it started. In some cases, you might be given a medicine to cause an arrhythmia. Certain medicines can also be given through the catheter to see which ones will stop the arrhythmia.
What should I expect?
Do not eat or drink anything after midnight the night before your test. If you have diabetes, you should talk to your doctor about your food and insulin intake, because not eating can affect your blood sugar levels.
Talk to your doctor about any medicines that you are taking, because he or she may want you to stop taking them before the test. Also, it may be helpful to make a list of your medicines and bring it with you to the procedure, so that doctors know exactly what you are taking and how much. You will most likely have blood tests, an electrocardiogram, and a chest x-ray taken before the procedure. Once you are in the catheterization laboratory (also called the cath lab), you will see television monitors, heart monitors, and blood pressure machines. You will be asked to lie down on an examination table.
Electrodes will be placed on your chest. These electrodes have wires called leads, which hook up to an electrocardiogram machine. This machine will monitor your heart rhythm during the test. To prevent infection, you will be shaved and cleansed around the area of your leg where the catheter will be inserted.
How the Test is Performed ?
The study involves placing wire electrodes in the heart to measure electrical activity along the heart's conduction system and in heart muscle cells themselves. The procedure is done in a hospital laboratory by a trained staff that includes cardiologists, technicians, and nurses. The environment is safe and controlled to minimize any danger or risk to the patient.
An EP study may be performed for the following reasons : -
To evaluate a symptomatic patient (a patient having dizziness, fainting, weakness, palpitation, or other symptoms) for a rhythm problem when other noninvasive tests have been inconclusive
To locate the source of a rhythm problem
To assess the effectiveness of medication(s) given to treat a rhythm problem
To evaluate the effectiveness of a pacemaker
A health care provider will clean your groin area and apply a numbing medication (anesthetic). The cardiologist will then place several IVs into the groin area. Once these IVs are in place, tubes (catheters) can be passed through the IVs into the body. The doctor uses moving x-ray images to carefully guide the catheter up into the heart and place the electrodes into the proper areas.
The electrodes detect the heart's electrical activity and map out any abnormal heartbeats. This helps the doctor see the type of arrhythmia you have and where the problem starts in your heart. Abnormal electrical activity can occur anywhere along this heart's conduction system ("the heart's wiring"). Normally, the heart's electrical signals move through the the two chambers on the top of the heart (the atria), to the atrioventricular (AV) node, and then to the lower chambers of the heart (the ventricles).
How to Prepare for the Test :-
Test preparations are similar to those for a cardiac catheterization. Food and fluid will be restricted for 6 - 8 hours before the test. The procedure will take place in a hospital, and you will wear hospital clothing. You must sign a consent form for the procedure. Your health care provider will give you instructions regarding any changes to your normal medications. Do not stop taking or change any medications without consulting your health care provider. A mild sedative is usually given 30 minutes before the procedure. You may not be able to drive home yourself if you are discharged the same day.
How the Test Will Feel ?
During the test, you will be awake and able to follow instructions. A simple EPS generally lasts from 20 minutes to 1 hour. It may take longer if other procedures are involved.
Why the Test is Performed ?
Your doctor may order this test if you have signs of an abnormal heart rhythm (arrhythmia). Information from this study helps your doctor determine the severity of the arrhythmia as well as the best treatment. Before this test is done, your cardiologist may have tried other, less invasive tests such as ambulatory cardiac monitoring.
An EPS may be done to:-
Pinpoint a known arrhythmia that is beginning in the heart and help decide the best therapy
Determine whether you are at risk for future heart events, especially sudden cardiac death
See if medicine is controlling an abnormal heart rhythm
Evaluate the need for a pacemaker or implantable cardioverter-defibrillator (ICD)
How does the EP study help to direct treatment of arrhythmias ?
Insertion of a pacemaker:-
If the EP study confirms the presence of significant bradycardia, a permanent pacemaker can often be inserted immediately, during the same procedure.
If supraventricular tachycardia (SVT) — and some forms of ventricular tachycardia (VT) — are found, radiofrequency ablation is often the treatment of choice. The ablation procedure is usually carried out during the same procedure, immediately following the EP study.
If rapid forms of VT and/or ventricular fibrillation (VF) are identified during the EP study, most commonly an implantable defibrillator is the treatment of choice. This device can now often be inserted in the EP laboratory, immediately following the EP study. In earlier years, the EP study was used to identify the "best" anti-arrhythmic drug for patients with VT or VF, but today it is known that no anti-arrhythmic drug is as effective as the implantable defibrillator in preventing sudden death from these arrhythmias.
The procedure is generally very safe. Possible risks include:
- Blood clots that lead to embolism
- Cardiac tamponade
- Heart attack
- Injury to the vein
- Low blood pressure
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