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Electrophysiology Testing (Arrhythmia)


Intracardiac electrophysiology study (EPS) involves placing wire electrodes within the heart to determine the characteristics of heart arrhythmias.

How the test is performed

The study is performed 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. The cardiologist inserts a catheter into a vein through a small incision in the groin after cleansing the are and numbing it with a local anesthetic. This catheter is equipped with an electrode connected to electrocardiographic monitors.

The catheter is then carefully threaded into the heart using an x-ray imaging technique called fluoroscopy to guide the insertion. Electrodes are placed in the heart to measure electrical activity along the heart's conduction system and within heart muscle cells themselves. Normal electrical activity is signaled from the heart's natural pacemaker known as the sinoatrial (SA) node. It then travels through the atria (the two chambers on the top of the heart), the atrioventricular (AV) node (connecting the atria to the ventricles), and the ventricles (the lower chambers of the heart).

Abnormal electrical activity can occur anywhere along this conduction system, including in the muscle cells of the atria or ventricles. The electrodes inserted during EPS will map the type of arrhythmia you have and where the problem arises in your heart. This information will allow your cardiologist to determine the severity of the problem (including whether you are at risk for sudden cardiac death) as well as appropriate treatment.

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 beawake 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

Before performing EPS, your cardiologist will try to identify a suspected arrhythmia using other, less invasive tests such as ambulatory cardiac monitoring. If the abnormal rhythm is not detected by these other methods, and your symptoms suggest you have an arrhythmia, EPS may be recommended. Additional reasons for EPS may include the need:

What abnormal results mean

The exact location and type of the arrhythmia must be determined so that specific therapy can be applied appropriately. The arrhythmia may originate from any area of the heart's electrical conduction system.

For example:

What the risks are

The procedure is generally very safe. Possible risks include the following:

Special considerations

A catheter ablation may be performed at the same time to treat the arrhythmia.

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