Delving into the realm of Electrophysiology, commonly referred to as EP, one encounters a highly specialized surgical domain centered on scrutinizing and addressing the heart's electrical activities. As a pinnacle of medical innovation, this practice harnesses cutting-edge tools and methodologies to pinpoint and ameliorate issues linked to the heart's rhythmic and electrical intricacies. St. Elizabeth’s Medical Center reveals the impressive success rates of this approach: 95% for Wolff-Parkinson-White Syndrome, 91-96% for Supraventricular Tachycardias, and 88-95% for Atrial Flutter. (1) (2)
Within the vast expanse of cardiology, EP represents a niche that specifically hones in on the detection and rectification of aberrant heart pulsations, or arrhythmias, through the implementation of minimally invasive stratagems. Cardiac electrophysiologists—connoisseurs of this specialized arena—have undergone supplementary training to refine their expertise. (3) (4)
Definition and Overview
Doctors perform a series of tests called electrophysiology procedures to assess the electrical activity of patients' hearts. It is frequently the initial step in making an arrhythmia diagnosis or figuring out whether a change in heartbeat has a different cause. Typically, the procedure entails introducing a catheter into the heart through a blood vessel.
A complex electrical system frequently regulates the heart's rhythm and triggers the upper and lower chambers to contract and relax in a regular manner. However, occasionally an abnormal rhythm or arrhythmia occurs.
The electrophysiology procedure's ECG component is fully non-invasive. However, placing a catheter into a blood artery to assist a doctor in guiding the catheter into the heart is a minimally invasive surgery that needs to be closely watched both during and after. The catheter port's injection site is numbed by a healthcare expert. However, once the local anesthetic's effects wear off, it's common to experience some pain.
The doctor might recommend the patient to get an electrophysiological test to identify the type of arrhythmia. There are numerous distinct electrophysiological procedures, just as there are numerous different forms of arrhythmias. Depending on the type of arrhythmia the doctor suspects the patient may have, the type of testing the patient will undergo is determined. (5)
Electrodes are typically applied to the skin during a conventional electrophysiological test to assess the patient's heart rhythm. Additionally, the doctor places a small, flexible tube into a blood vessel so that the catheter can be guided to the heart.
Depending on what the doctor is searching for and suspecting, different test types may be performed. Tests may include:
- cardiac mapping
Cardiac mapping is used to find the exact part of your heart that needs an ablation.
- electrical signals moving through the catheter
Electrical signals pass through the catheter to make the heart beat slower or faster, which helps locate the source of an arrhythmia.
- intracardiac electrogram
An intracardiac electrogram is used to measure how electrical impulses travel through the heart.
- medication delivery via the catheter
Administering medication through the catheter to interfere with or slow down electrical activity helps to learn more about the nature of the arrhythmia. (6)
An arrhythmia may trigger symptoms that prompt the doctor to request an electrophysiology procedure. People who experience the following signs of a possible arrhythmia may be candidates for electrophysiology testing:
- fainting events
- heart palpitations or other visible changes in your heart rate
An electrophysiology procedure can be helpful in diagnosing the following types of arrhythmias:
- atrial fibrillation, chaotic beating of the upper heart chambers
- bradycardia, unusually slow heart rate
- conduction disorder, a problem with the electrical signal passing through the heart
- tachycardia, rarely a fast heart rate
- ventricular fibrillation, rapid beating of the lower heart chamber (7)
Risks and Side Effects
A standard electrophysiological procedure carries little risk of serious complications.
- bleeding or bruising
- blood clot formation near the catheter tip
- incision site infection
- vascular injury at the catheter injection site
Rarely, an electrophysiology procedure may result in a tiny hole in the heart or an issue with the electrical system of the heart. These problems are typically curable.
Electrophysiology procedure may not be suitable for certain people, including:
- acute coronary syndromes or severe heart failure
- conditions that affect heart function that may affect test results, such as electrolyte level differences or hyperthyroidism
- bleeding disorders
- having to lie on their back for several hours can also be difficult for some people. (8)
Post-Procedure and Follow-up
When the EP test is complete, the catheters are removed and pressure is applied to the groin and neck areas to prevent bleeding. Lying in bed for four to six hours to allow the catheter sites to close. The legs are not moved and are kept stationary.
After the operation, the doctor monitors the patient and is checked frequently. In case of sudden pain or bleeding in the area, you should have the health teams.
The doctor may share some preliminary findings with the patient after the test. Before leaving the hospital, the doctor or arrhythmia nurse coordinator will provide instructions on medications and follow-up care and restrictions on normal activities. (9)
The patient should follow the instructions given by the doctor after being discharged from the hospital and returning home. During the recovery period, activities should be limited for the first 24 hours. Heavy objects over 10 kilos should not be lifted in the first week. It is good to walk for a few minutes to prevent blood clots forming in your legs. It is good to walk for a few minutes to prevent blood clots forming in your legs.
If new bleeding is noticed on the dressing, the incision should be pressed firmly for approximately 20 minutes. If the bleeding continues, apply pressure to the doctor or go to the nearest emergency room. If you see a bruise or a small lump under the skin at the entry site, there's no need to worry, it's normal. It disappears in three to four weeks. (10)
The final results of this procedure can also assist healthcare professionals in determining whether more therapy is required and which treatment would be most beneficial. It can be necessary to use a pacemaker or implantable defibrillator, or to take medication. The patient might have an ablation operation or get other medical care.
(1) - https://www.mayoclinic.org/tests-procedures/ep-study/about/pac-20384999
(2) - https://www.sciencedirect.com/topics/neuroscience/electrophysiology
(3) - https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis--monitoring-of-arrhythmia/electrophysiology-studies-eps
(4) - https://www.semc.org/services-directory/heart-vascular-center/electrophysiology
(5,6,7,8)- Healthline. What Is an Electrophysiology Procedure? (https://www.healthline.com/health/heart/what-is-an-electrophysiology-procedure)
(9,10) - UCSF Health. Electrophysiology Procedure. (https://www.ucsfhealth.org/education/electrophysiology-procedure#:~:text=An%20electrophysiology%20(EP)%20study%20is,vessels%20that%20enter%20the%20heart.)