Electrophysiological (EP) Study
Who Needs an EP study
When to see a cardiologist
The EP study procedure
Recovering from an EP study
Complications of an EP study
Who Needs an EP Study
Electrophysiological studies (EPS) are common medical procedure that a cardiac electrophysiologist (heart rhythm specialist) may recommend to diagnose the cause of palpitations or fainting episodes. In some heart conditions an EP study can be useful even if there are no symptoms, to “risk stratify” for problems in the future.
An EP study can be a safe and effective way to diagnose various heart rhythm problems including supraventricular tachycardia (SVT), Wolff Parkinson White syndrome (WPW), ventricular tachycardia (VT) and some forms of slow heart beat (bradycardias) particularly atrio-ventricular block.
A further advantage of an EP study is that many abnormal heart rhythms can be treated during the same procedure with an ablation.
When to See a Cardiologist
Symptoms such as palpitations, a racing heart beat, episodes of sudden breathlessness, and chest tightness unrelated to exertion may be suggestive of an intermittent heart rhythm problem. Many of these can be diagnosed with the aid of an EP study.
The EP Study Procedure
Most EP studies are carried out under local anaesthetic. The patient is awake but may receive sedative medications to make the procedure more pleasant.
Access is gained to one or more veins at the top of the leg and this is used to feed wires up to the heart. These wires can then be used to manipulate the heart beat (speed it up, add extra beats, etc) to try to “trip up” the rhythm and highlight abnormalities in the heart’s electrical wiring.
For example, a common abnormality is the presence of two electrical connections rather than one between the upper chambers (“atria”) and lower chambers (“ventricles “). An extra electrical connection here can allow a short circuit to occur leading to a continuous racing called a supraventricular tachycardia (SVT). Once the extra electrical connection has been diagnosed at EP study, it can generally be burned away during the same sitting.
An EP study generally lasts an hour or so, during which various patterns of electrical stimulation will be applied and different medications may be used to make electrical abnormalities more obvious. At the end of the procedure a stitch will generally be placed at the top of the leg and the wires removed. Most patients are discharged home the same day.
Recovering From An EP Study
Recovery from an EP study is generally very quick. The only real concern is bleeding from the puncture wounds used to access the vein at the top of the leg(s). For this reason patients are generally advised against running, swimming, and heavy lifting for a week or so after the procedure.
The DVLA stipulate a driving ban after all EP procedures. The length of the ban depends on the licence held. For example, group 1 (car and motorbike) drivers are currently subject to a two day ban.|
Complications of an EP Study
EP Study is a generally safe procedure. Around one in 100 patients will experience significant problems from the puncture wounds at the top of the leg and in extreme cases this may need surgery though the rate of this is much lower (around one in 1000). Other complications including stroke and even death are possible but are very rare if ablation is not carried out at the same sitting.