Unbeknownst to many, the human heart is equipped with its own complex and finely tuned electrical system which is responsible for its rhythmic, orderly beating. Disturbances of normal heart rhythm may cause annoying symptoms (palpitations, lightheadedness, dizziness) that pose no serious threat to life. Other rhythm disturbances, however, can be associated with profound and dangerous risks (loss of consciousness, seizures, stroke or death). These varying symptoms can occur whether the heartbeat is seriously slowed, dangerously rapid, or just highly irregular. Heart rhythm disorders can be part of almost any type of heart disease, can be provoked by various medications or electrolyte (minerals) abnormalities, but can also occur in the absence of readily identifiable underlying heart problems.
When a heart rhythm disturbance is present, an electrophysiologist, a physician specially trained and board examination certified in the electrical disorders of the heart, will perform an electrophysiologic study (EP test).
The general purpose of an electrophysiologic (EP) study is to determine whether the heart's rhythm disturbance is dangerous, and if so, what treatment should be applied. The EP study is performed in a specially equipped hospital laboratory that has x-ray fluoroscopy and dedicated EP computers, and is frequently performed on an outpatient basis.
Patient preparation:
Prior to an EP study, blood tests are done to check for any blood component abnormalities or serious bleeding tendencies. A chest x-ray is obtained to detect any unusual anatomic problems, and a baseline ECG is performed. All eating, drinking and smoking must cease at least 6-8 hours pre-test. Detailed information about the test, including the reason(s) the test is being performed, procedural technique, and potential serious test-related complications are provided to the patient (and/or family members) before a consent form is signed.
Procedure:
In order to test the heart's electrical system, several thin, flexible, electrical catheters (fancy wires each about the thickness of a strand of spaghetti) must be inserted into various parts of the heart. To provide maximal patient comfort and to assure sterility of the catheters being inserted, adequate sedative medication is given to make the patient sleepy, a local anesthetic is applied to the skin at the catheter insertion site(s), and these insertion sites are thoroughly cleansed and covered. Most catheters are inserted via needle punctures through anesthetized skin, making cutting and stitching unnecessary. Once the catheters are carefully positioned inside the heart, the electrophysiologist mans the computer equipment, making recordings of the heart's intrinsic electrical properties. Occasionally, electrical stimuli are administered to the heart to check its response.
Safety:
Whenever catheters are inserted into the blood stream and heart, there is a small risk of developing potential complications which may include bleeding, infection, blood vessel damage or induction of potentially life-threatening heart rhythm disturbances. The EP laboratory is staffed by skilled personnel and equipped with devices and medications needed in the event any of these complications occur. Deaths attributable to an EP study are very rare.
Radiofrequency Catheter Ablation (RF ablation)
Whereas in the past the detection of certain slow or fast heart rhythm disturbances meant a life of medications or even dangerous open-heart surgery, it is now possible to permanently cure many of these problems via an EP catheter. Once the precise focus for the electrical abnormality is identified (mapped) during the EP study, a special catheter, connected to a radiofrequency (RF) generator, is positioned precisely at that focus, and a jolt of RF energy is delivered to that spot. With the abnormal electrical focus burned in this manner, the irregular heart beating can no longer occur.
After the Procedure:
Upon completion of the study, all catheters are removed, pressure is applied to the insertion sites for 10 to 30 minutes to seal the punctures, and the patient is then monitored several hours. Discussions of the EP test findings and any further treatment recommendations are held later between the patient, his/her family physician, and the electrophysiologist.
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