INOVA HEALTH SYSTEM : DIAGNOSTIC TESTING : Electrophysiological Studies

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Electrophysiological Studies

What is an electrophysiological study (EPS, EP study)?

An electrophysiology (EP) study is a test that maps the electrical conduction system in the heart. A specially trained Inova cardiologist called an electrophysiologist performs the test.

An EP can be ordered for many reasons:

To identify the underlying cause of symptoms thought to be a heart rhythm disturbance.
To assess abnormally fast or slow heart beats.
To assess the effectiveness of medications that are taken to regulate a heart rhythm disturbance.
To check the functioning of devices such as an implantable defibrillator.
To help answer some of the questions your doctor has about your electrical system to assist him in choosing the best treatment plan.
Special wires are placed in the heart to record the electrical activity of the heart

The procedures that can be performed include:

Inducing a heart rhythm disturbance by sending electrical signals through the catheter to stimulate the heart.
If a heart rhythm disturbance has been induced, different medications will be given to you through an intravenous line to test how they affect the rhythm and whether they can halt the irregularity or prevent it from happening.
Some rhythm disturbances are stopped by using the catheter to pace the heart beat.
Some rhythm disturbances are stopped by using the catheter to give the heart an electrical shock (defibrillation) to stop the disturbance.

Are there any risks?

The risks of an EP study are low and are outweighed by the benefits of learning more about your dysrhythmia. They include bleeding, blood clots, perforation of the heart muscle or a blood vessel, stroke or heart attack (very rare), and death (extremely rare). Click on outcomes to read more about the specifics about having this procedure done at the Inova Heart Center.

Preparing for the procedure

This procedure is completed in the hospital. You will be admitted to the hospital the day before or the day of the procedure.
Your doctor will order lab work (blood tests), an EKG, possibly a chest x-ray, and possibly an echocardiogram. Some of these may be completed in the physician's office, and others will be completed at the hospital. These tests will be completed a few days before the electrophysiology study.
Do not eat or drink anything after midnight the night before the your test.
You may brush your teeth the day of the procedure and take any physician -approved medicines with as little water as possible.
You should arrange for a family member or friend to drive you to the hospital and to pick you up if you get to go home that evening. Your family members are welcome to stay with you before and after the procedure.
You will change into a hospital gown and a nurse will ask you questions about your health, take your blood pressure and check your temperature. The nurse will start intravenous fluids flowing through a needle inserted in your hand or arm. A nurse and a doctor will talk with you about the procedure and the possible risks associated with the procedure. You may ask questions any time. You will be asked to sign consent forms for the procedure.

During the procedure

The electrophysiology study usually takes 1 to 4 hours. You will be brought to the lab and asked to lie down on a thin table. The room will be cool and dimly lit. Cold monitor patches and EKG stickers will be placed on your back and chest. An oxygen monitor will be taped to one of your fingers, and a blood pressure cuff will be put on your arm.
You will be given sedation medication through your IV. This will help you to relax and maybe sleep.
A small mask or tube will be placed on your face to give you some extra oxygen during the procedure.
Your arms will be tucked in at your sides with sheets so they do not slip off the table when you get sleepy. You will need to lie still during the procedure.
There will be a large circular piece of equipment around the table. It holds the X-ray in position above your chest and below the table. There are several TV monitors in the room so that the electrophysiology team can monitor you as they work.
A catheter (thin tube) will be inserted into the blood vessels in your groin (at the top of your leg) and moved toward your heart. You will be given medication (local anesthetic) in the groin to numb the area prior to the insertion of the catheter. You may feel a stinging sensation as the medication is injected. You may feel a little pressure, but it should not be painful. If you feel pain, please let the doctor or nurse know so more medicine can be used.
Special catheters are then placed into your heart through the thin tubes to track the electrical activity as it moves through the heart. You may be given some medicine which will stimulate your heart to beat a little faster or stronger. This is normal.
When the procedure is over, the catheter in your leg will be removed and someone will apply pressure over the site for 10 to 20 minutes.
After the bleeding has stopped, a Band-Aid will be placed on your groin site.
You will then be taken to the recovery room or back to your room. Your family and friends may stay with you in this recovery area.

After the procedure

You will have to remain flat in bed for 4 to 6 hours. Your head on the bed may be raised 30 degrees or less. You must keep your leg straight while on bed rest, and a sandbag will be placed on the insertion site. This is done to allow the insertion site of the catheter to heal and clot.
If you cough, sneeze, laugh, move in bed, or use the bedpan or urinal you will need to hold pressure over the site with your hand. The nurse will assist you with this.
If you have increasing pain at the site; feel something warm, wet, sticky, or swollen at the groin site; or have numbness, tingling, or pain in the foot, call your nurse immediately.
You will be asked to drink lots of fluid to help flush the dye from your body.
After 4 to 6 hours, you will be allowed to use the bathroom and sit in a chair while you are monitored for bleeding. If your pulse and blood pressure remain stable and there is no more bleeding after you have been up for an hour, you will be allowed to go home or, if you are an inpatient, you will be allowed up in the room on your own.
Family or friends are welcome to help monitor the bed rest and assist in encouraging you to drink and eat.

Recovery information for all patients

Follow the guidelines below during the initial stages of your recovery. Minimize activity the evening after your EP study.
You may take acetaminophen (such as Tylenol) for pain; however, do not take aspirin or ibuprofen for 3 days unless your doctor says you can.
Do not lift anything heavier that 15 pounds.
Limit stair climbing for the first 48 hours.
Do not drive the evening after your test. You may drive the following day.
Do not operate heavy machinery for several days.
Do not shower or bathe the evening after your test. You may take a shower the next day.
Check with your Inova physician regarding your activity for the next few days

The day after your procedure
You can expect a small amount of bruising at the catheter insertion site, along with a small, marble-sized knot. If you feel additional discomfort, don't hesitate to call your Inova physician.

Call your physician if any of the following symptoms occurs:
Oozing from the insertion site
Body temperature (fever) greater than 100 degrees
Call 911 if the knot at the insertion site becomes larger, or if bleeding occurs. If you are bleeding, lie down and apply direct pressure the site until you receive emergency care; this pressure will help stop the bleeding.
Call 911 or have someone take you to the nearest emergency department if you lose feeling in an arm or leg.

What about the results?
Your Inova physician will review the results and a treatment plan with you.