Electrophysiology Testing (Arrhythmia)

About the Procedure

Electrophysiology testing (EP test) is a procedure to analyze the heart's electrical activity, especially to define the cause and location of rhythm abnormalities. EP can detect whether the heart is having arrhythmias, defined as bradycardias (slow arrhythmias) and tachycardias (rapid arrhythmias). Once they are identified, locating their origin and cause become significant factors in determining treatment. The most common treatment options are: insertion of a pacemaker for bradycardia, ablation (destruction of abnormal cells) for tachycardia, or an implantable defibrillator for tachycardia in a ventricle. Previously, drugs were used as the preferred treatment for abnormal electrical activity but are now considered ineffective.

This three to four hour procedure is performed by an electrophysiologist in an EP laboratory. The patient is given a sedative, and an intravenous line, urinary catheter, ECG electrodes, and a blood pressure cuff are set-up. The doctor numbs the incision site, commonly the groin, and, as he/she watches through a monitor, a vein and artery are located, a catheter is put into each vessel and threaded up into the heart. Using electrodes at the end of the catheters, an arrhythmia is artificially stimulated allowing the electrophysiologist to locate its source and cause. Occasionally, drugs are used to start and stop the electrical impulses. If, based on the test findings, the doctor chooses an ablation procedure, it is done at this time. An ablation may take two to six hours. When the procedure is complete, the catheters are removed and pressure applied to the incision. The patient is then moved to a recovery room or the cardiac care unit where they will lay flat for several hours to discourage bleeding at the incision site.

What to Know Before the Procedure

Risks and complications for this procedure are rare. Some minor complications are: bleeding at incision site, temporary heart rhythm disturbances from the catheters irritating the heart muscles, and blood pressure changes. Complications of major concern include blood clots in the catheterized vessels, stroke, perforation of the heart wall, bleeding within the outer sac of the heart or around the pacemaker implant, and cardiac arrest. Patients are usually discharged the same day but those who have been treated with ablation will stay overnight.

In preparation for the EP, patients may be given blood-thinning medications prior to or at the time of the procedure. Routine blood tests, chest X-rays, ECG, and a health assessment are done a few days to a week before the test. All medications, especially those for heart disease, should be discussed with the physician so they do not interfere with the procedure. Fasting is required before the EP and will be discussed by the doctor. Patients should plan in advance for someone to drive them at discharge and, if possible, someone to stay with them for a day.

What to Know After the Procedure

The patient will be monitored for several hours after the procedure until they are discharged by the physician. Swelling, bruising, and a lump are not unusual at the site of the incision. If an arm or leg becomes numb or painful below the incision, or if the area surrounding the site becomes red, has increased swelling, or a yellow discharge, call the doctor. If the site begins bleeding, call the physician or go to the ER. Patients are to refrain from pushing, pulling, or lifting items over 10 pounds for seven days. Exercise may be resumed but, if there is chest pain or shortness of breath, stop the activity and call the doctor or 911. The doctor will discuss future treatment plans, lifestyle and medication changes.

If you Need to Travel Outside of your Local Hospital

An uncomplicated electrophysiology test does not require a lengthy stay or restrictions on normal activity. As such, short-distance, long-distance, and international travel are all viable options for patients looking to have this procedure performed. The determining factors when choosing where to have this procedure done should be overall cost and experience of the electrophysiologist. Consideration should still be given to the potential for an extended stay if complications or treatment require it.