Understanding Electrophysiology Studies

If you have a problem with your heart rhythm (the speed and pattern of your heartbeat), your doctor may suggest a procedure called an Electrophysiology Study . This procedure can help diagnose what is causing your heart rhythm problem and how best to treat it. Your doctor is recommending an EP study because other tests may not have provided enough information about your heart rhythm problem. EPS can help determine exactly what your heart rhythm problem is and what can be done to control it. A specially trained doctor (electrophysiologist) performs your EP study.

During an EP study, wires are inserted into the heart. The cells causing your rhythm problem are found. Electrical signals can be sent through the catheters to stimulate the heart. If these signals bring on (induce) an arrhythmia, it is monitored. If you're awake, you may feel your heartbeat changing or your heart racing from time to time.

If an arrhythmia is induced, medications may be given to you through your IV line to test how they affect your heart rhythm and whether they can stop the arrhythmia or keep it from happening.

Arrhythmias may be stopped by using the electrode catheters to regulate (pace) the heartbeat. Sometimes the heart is given an electric shock (defibrillation) to stop an arrhythmia.

In some cases, a catheter ablation may be performed during the EP study to treat an arrhythmia. The entire procedure takes from 1 to 4 hours. Your doctor or nurse can discuss the procedure with you and answer your questions.

Before the procedure:

•   Tell your doctor what medications you take, and ask if you should stop taking them before the procedure. Also mention if you are allergic to any medications.
•   Have any routine tests that your doctor prescribes. These may include blood tests or an electrocardiogram (ECG).
•   Don't eat or drink anything (including water) after midnight the night before your procedure.

The day of the procedure, the skin on your groin, neck, shoulder or arm will be washed and may be shaved.

The risks of catheter ablation are low. They are likely outweighed by the benefit of treating your heart rhythm problem. Once you understand the risks, you'll be asked to sign a consent form. This gives your permission to have the procedure done. The risks of catheter ablation include:

•   Bleeding
•   Blood Clots
•   Perforation of the heart muscle, blood vessel or lung
•   Heart block (requiring a permanent pacemaker)
•   Damage to a heart valve
•   Stroke or heart attack (rare)
•   Death (extremely rare)

When you're ready, you'll be taken to the electrophysiology (EP) lab. You'll receive medications through an intravenous (IV) line or in pill form. Some of these medications relax you and help you "sleep" through part or all of the procedure.

Catheters (thin, soft, coated wires) are inserted into a vein or artery through a site in your groin, neck, shoulder, or arm. First, the area is numbed with a local anesthetic so you won't feel pain. Then, a small puncture is made in the vein or artery. The catheter is inserted and moved toward your heart. This movement is viewed on a video screen. After the catheters are inserted, they are used to study your heart rhythm problem. They also help pinpoint the area or areas which are causing your problem.

During EPS, the electrode catheters read where signals begin in the heart an how often these signals are sent. An EPS gives an electrical "map" of your heart.

After the EP study, all catheters are removed from your body and pressure is applied to the insertion site for 10 to 20 minutes to stop the bleeding. You'll need to remain lying down for 4 to 6 hours to allow the insertion site to seal. A nurse will check this site and your blood pressure often. Before you go home, you may have an x-ray and other tests. You may leave the hospital that day or you may stay one or more days, depending on your condition.

Your doctor or the electrophysiologist will discuss your results with you and how best to treat your heart rhythm problem. You may be placed on medications to control your arrhythmia.

Have a family member or friend drive you home from the hospital. Most people can return to normal activities a day or two after they come home. It's a good idea to avoid heavy lifting and only engage in light activities for a few days. You may find a small bruise or lump about the size of an olive under your skin at the insertion site. Also, the skin in that area will usually bruised. These are common side effects and should disappear within a few weeks.

Call your doctor if:

•   The insertion site begins to bleed or pain at the site increases
•   You feel any shortness of breath or chest pain
•   The arm or leg in which the catheter was inserted feels cold, swollen or numb
•   The bruising or swelling increases
•   You have a fever over 100 degrees Fahrenheit
•   You feel the symptoms of your heart rhythm problem return

If you have any questions or concerns, please call the Cath Lab (Little Rock - 501.202.2196; North Little Rock - 501.202.3685) or ask your doctor.

Be sure to see your doctor as recommended for follow-up visits.