Patients with arrhythmia may be required to undergo an electrophysiologic study (EPS). This is to determine which part of the heart is causing the disturbance in rhythm. This helps the cardiologist to decide the best course of medication, procedure or a device that may improve the pace to return to normal.
As a part of the EP study, the cardiologist reproduces the abnormal rhythm by recording the electrical activity and electrical pathways in the heart. In some cases, the cardiologist may recommend ablation procedure, which can be performed during the testing process itself. This procedure makes use of electricity to neutralize cells in the heart muscle that appear to be the cause of the arrhythmia.
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Preparation for the EPS Testing
Before the test, the patient must consult with the doctor regarding any ongoing medication for another disease such as diabetes or hypertension, or any anti-inflammatory medication. In case the patient has an allergy to any numbing medicines such as lidocaine, or any heart medications, it must be informed to the doctor so that any necessary adjustments to the medication may be made.
The doctor will also usually perform a blood test in advance to ensure that the patient is not at a high risk for bleeding complications. He will also advise the patient to remain on an empty stomach at least 12 hours before the test. The doctor will determine after the test if the patient may need to stay overnight at the hospital. The patient should have a companion to drive him back home.
How the EP Study is Performed
The EP study may take anywhere between two and three hours to complete. However, the duration may be extended if the doctor decides to perform ablation treatment during the test. The patient is required to wear a hospital gown and lie on the back while the procedure is in progress. An IV line is placed in the vein to facilitate administration of fluids or medication during the test. Sophisticated cameras and equipment are used during the procedure to monitor the heart. The electrophysiologist threads several catheters to the patient’s heart with the guidance of a fluoroscope. These catheters assess the conduction system of the heart.
The doctor will make use of a pacemaker to induce rhythm changes in the heart. It may result in the patient experiencing palpitations. Some patients may also feel shortness of breath in this condition. Due to the numbing medication, the patient is not likely to experience any pain during the procedure. Some patients find it uncomfortable to lie still on their back during the testing process, while some others may experience anxiety.
Risks and Complications of EP Testing
The awareness of the patient is critical for them to know considerable risks involved with electrophysiological testing. It is essential to understand those specific arrhythmic episodes can pose a threat to the patient’s life. The test may purposely require the patient to experience a few extra episodes of such abnormal rhythms. The patient should note that the doctor is in the best position to do the risk-benefit analysis. And if he recommends the test, it is only for the betterment of the patient.
If the doctor decides to perform an ablation procedure during the test, it may carry some added risk. Ablation involves causing a minor scarring of a minuscule portion of the heart muscle. Although any complications from this procedure are rare, they may still occur, resulting in new rhythm changes in the heart. In a very rare situation, the ablation instrument may cause a hole through the heart, requiring emergency surgery.