Diagnosis

Electrophysiology

Your heart has its own electrical system. Signals from this system regulate your heart’s rhythm. Normally the heart beats at an even, steady pace. However, if there is a problem with this electrical system, the heart may beat too fast, too slowly or in an irregular manner. Heart rhythm problems, called arrhythmias, can affect how well your heart is able to pump blood.

Patients who show symptoms of a rhythm problem, such as palpitations, lightheadedness, arrhythmias or fainting spells are often candidates for an electrophysiology (EP) study. This highly effective tool has been used for several years in larger metropolitan settings to help physicians locate areas within the heart that may be causing an abnormal rhythm and determine the best treatment.

Now EP studies are available at Shaw Heart and Vascular Center under the direction of Ajay Tripuraneni, M.D., a heart specialist with board certifications in electrophysiology, internal medicine, cardiology, echocardiography and nuclear medicine.

HOW EP STUDIES ARE DONE

During an EP study, conducted in the Shaw Heart catheterization lab, physicians insert special electrode catheters (long, flexible wires) through a vein and into the heart. The catheters can sense electrical activity in different parts of the heart. They also can be used to deliver tiny electrical impulses to pace the heart (cause it to beat).

WHY EP STUDIES ARE DONE

EP studies are generally done after other tests, such as electrocardiogram, echocardiogram and holter monitoring, have failed to provide the information needed to pinpoint the source of an abnormal heart rhythm. The EP study provides the most accurate and detailed information about how the heart’s electrical system is working.

In general, an EP study is done for one or more of the following reasons:

  • To diagnose the cause of symptoms.
  • To pinpoint the location of a known arrhythmia and decide the best treatment.
  • To see how severe an arrhythmia is and predict the risk of a future cardiac event, such as dying from a heart-related problem.
  • To determine how well medications are working to control an arrhythmia.
  • To decide whether an implantable device (such as a pacemaker or defibrillator) or a treatment procedure (such as catheter ablation) is necessary.

HOW TEST RESULTS ARE USED

The results of EP studies help physicians prescribe the best treatment based on the type of arrhythmia, severity of symptoms and whether or not other heart problems are present. Treatment options include:

Cardiac Ablation:

This is a procedure used to destroy, or ablate, parts of an abnormal electrical pathway that is causing a rapid heart rhythm. An ablation is sometimes performed during an EP study. During the procedure, doctors guide an ablation catheter into the heart close to the abnormal pathway. Radiofrequency energy is passed through the catheter to a small area of heart tissue where the fast heart rhythm may start or where abnormal pathways are located. The energy destroys only the problem cells so they can no longer send signals that are causing the irregular rhythms.

Anti-arrhythmic Drugs:

Medications may help restore a normal heart rhythm and prevent arrhythmias from recurring. Most of these work by changing the pattern of electrical signals in the heart. This helps keep abnormal sites in the heart from starting rapid or irregular heart rhythms.
Pacemaker

A pacemaker is a small electronic device prescribed for people who have a slow heartbeat. It is implanted under the skin, usually in the upper chest, near the left or right shoulder, with leads attached to the heart. The pacemaker keeps track of the heart’s electrical activity and, when necessary, delivers electrical impulses that keep the heart beating at the proper pace.

Implantable Cardioverter-Defibrillator (ICD)

The ICD is small electronic device prescribed for people who have had, or are at risk of having, dangerously rapid heart rhythms, or tachycardias. Implanted in the body, the ICD monitors heart rhythm at all times. If it senses a dangerously rapid rhythm, the device delivers pacing impulses or shocks to restore a normal rhythm.