What Is an Intracardiac Electrophysiology Study?

    An intracardiac electrophysiology study is a minimally invasive procedure that helps cardiologists diagnose heart rhythm problems, which are also known as arrhythmias.

    During the study, your doctor threads catheters (or long, thin wires) into your heart. Next, an electrical signal or a special medication causes an arrhythmia. At the same time, the catheters record your heart’s electrical signals to find out:

    • what type of arrhythmia you have
    • where it originates
    • your best treatment options

    An intracardiac electrophysiology study is commonly referred to as an electrophysiology study, or EPS.

    When Do You Need an EPS?

    Arrhythmias can be hard to diagnose because they don’t happen on command. Standard noninvasive tests—like electrocardiograms (EKGs)—only work if an arrhythmia happens during the test. Even specialized EKG devices or Holter monitors, which you wear for an extended period of time, may not be able to capture the information your doctor needs.

    In this case, the EPS is the next step. Because part of the procedure involves causing an arrhythmia, your doctor will be able to pinpoint the problem and decide the right course of treatment. Your treatment might include:

    • medications
    • cardiac ablation—which applies radiofrequency energy to treat the source of abnormal heart rhythms
    • use of implantable devices, such as a pacemaker, to control your heart rhythms

    Preparing for Your EPS

    To help prepare for the procedure, your doctor may order blood tests, an electrocardiogram, and a chest X-ray. You should discuss any medications you are currently taking with your doctor. He or she may want you to stop taking them for a short period of time before the EPS.

    Also, you should not eat or drink anything after midnight on the night before the test.

    What Happens During an EPS?

    The test is performed in a special procedure room called an electrophysiology laboratory. An electrophysiologist (a cardiologist who specializes in heart rhythm problems) will administer the test.

    You will receive a local anesthetic and a medicine that will make you sleepy. During the test, you may feel some discomfort. However, let your doctor know if you feel any pain.

    During the procedure, the electrophysiologist—also known as an EP—inserts catheters into a blood vessel in your groin or neck. A fluoroscope (a type of X-ray that provides real-time images of the inside of your body) helps the EP to guide the catheters to your heart.

    Once the catheters are placed on your heart muscle, the EP will either use medication or an electrical signal to cause an arrhythmia. During the study, your doctor may move the catheters to test other areas of heart muscle. In addition, he or she may give you different medications or other electrical signals to test their ability to stop or control an arrhythmia.

    Your doctor might also ask you questions about the feelings you experience throughout the test.

    Typically, the entire procedure takes between one and two hours. Based on the results of the EPS, your doctor will be able to recommend further treatment.

    What Risks Are Involved?

    During the test, your doctor stimulates your heart to create an abnormal heart rhythm. While this may sound risky, an electrophysiology study is actually very safe and complications are rare. An entire healthcare team is available throughout the study. They are specially trained to assist your doctors if necessary.

    Remember, if you experience pain or any unusual symptoms during or after the study, make sure to tell your doctor. Unusual symptoms can include:

    • numbness or tingling in your arms or legs
    • bleeding
    • chest pain
    • chills
    • fever

    After Your EPS

    After the EPS, you will need to lie still for about four to six hours. This reduces the risk of bleeding from the catheter insertion site. Afterwards, a bandage will be applied to the site.

    You can resume normal activities 24 hours after the procedure. Swelling and bruising at the insertion site is common, but it should go away in a month. Contact your doctor if you see signs of infection, including tenderness or increased pain at the insertion site.

    Your doctor will meet with you to discuss the results of the EPS and your treatment options.