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Site FeedbackElectrophysiology Study, EP Study or EPS
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Description | Treatment Options | John Muir Health Capabilities
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Definition
Normally, electricity flows throughout the heart in a regular, measured pattern. This electrical system brings about heart muscle contractions. A problem anywhere along the electrical pathway can cause heart rhythm disturbance called an arrhythmia. By accurately diagnosing the precise cause of an arrhythmia, it is possible to select the best possible treatment.
Description
While electrocardiograms (ECGs) are important tests of the heart's electrical system, they record only the events that occur while the tests are running. Heart rhythm disturbances, called arrhythmias, may be unpredictable and intermittent. It may be unlikely that an ECG will capture the underlying electrical pathway problem. Even tests that stretch over longer time lengths, such as Holter monitoring, may not capture an event.
During an EP study, a specially trained cardiac specialist paces and records the heart rhythms in particular areas in an attempt to duplicate the heart rhythm problem. Data is collected and the flow of the electricity through the heart is evaluated. As a result, EP studies can help locate specific areas of heart tissue causing the abnormal electrical impulses and irregular heart beats. During an EP study, a detailed electrical flow pattern is made. This provides valuable diagnostic clues for the doctor. Using the information, a treatment plan can be made. EP studies are recommended for patients at risk for Sudden Cardiac Death. A comprehensive medical examination help the doctor identify individuals at risk.
An overview of the procedure
Prior to beginning the actual procedure, medication is given to create a "sleepy" state. The procedure is similar to a heart catheterization (heart cath). A small, narrow, flexible tube, called a catheter is inserted into a blood vessel, through a site in the groin or neck. Guided by real-time x-ray images, the catheter is positioned in the heart. Once the catheter reaches the heart, special sensors, called electrodes, gather data. A variety of electrical measurements are taken. These data pinpoint the location of the faulty electrical site. During this "electrical mapping," the cardiac arrhythmia specialist, an electrophysiologist, attempts to produce the problem rhythm by stimulating various areas of the heart. If the rhythm disturbance is produced, special recording takes place. The abnormal rhythm is terminated using special medication or by delivering a shock to the heart.
Once the damaged site or sites are confirmed, the specialist may administer different medications or electrical impulses to determine the best treatment to correct or eliminate the problem. Based upon information obtained, the specialist will insert an implantable cardioverter device (ICD) or a pacemaker to correct the problem. Sometimes the specialist will use a special type of equipment to inactivate the tissue causing the problem. This treatment is called ablation.
Throughout the procedure, the patient is sedated but awake and remains still. Patients rarely report pain, more often describing what they feel as discomfort. Some watch the procedure on monitors and occasionally ask questions. Others sleep. The procedure usually takes about two hours. The patient remains still for four to six hours afterward to ensure the entry point incision begins to heal properly.
Treatment Options
Who performs the test and where?
Since potentially dangerous arrhythmias are produced during an EP study, it's important that specially trained staff are present. A physician electrophysiologist, with advanced training in the diagnosis and treatment of heart rhythm problems, performs the EP study. The electrophysiologist leads a team of specially trained health care professionals, technicians and nurses, who assist during the procedure. The team performs the EP study in an electrophysiology laboratory, or EP lab. The EP lab is equipped with highly technical equipment that allow for rapid recording of all heart related events. As a result, the test is quite safe and complications are rare.
John Muir Health Capabilities
John Muir Health is very proud of its Cardiac Rhythm Center. John Muir Health has eight leading cardiac rhythm specialists in the Bay Area on staff at John Muir Medical Center, Walnut Creek Campus and John Muir Medical Center, Concord Campus. These rhythm specialists are cardiologists that completed special training in the care of individuals with heart rhythm problems. Special equipment and well trained staff at John Muir Health are available to care for those with the complex and life-threatening problems.
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