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Electrophysiology Study (EPS)

Human heart has a specialized electrical system which regulates the heart beat. Any disorder (arrhythmia) in this system can cause the heart to beat either too slow (bradycardia) or fast (tachycardia) which can sometimes be life threatening.
Electrophysiology is a subspecialty of cardiology which deals with diagnosis and treatment of such electrical disorders of the heart. This involves various diagnostic modalities and therapies. Electrophysiologist is a cardiologist who is trained to perform these procedures.
Electrophysiology study (EPS): EPS is a diagnostic study during which specialized electrical tubes (catheters) are inserted into the heart through leg or arm blood vessels and positioned at various locations to analyse and find out the problems with the electrical system. It's done in fasting state under local anaesthesia and mild sedation.

Who needs EPS?

People having recurrent episodes of palpitations (abnormal awareness of one's own heart beat), giddiness, loss of consciousness and those with documented arrhythmia in the form of an ECG need to consult an electrophysiologist who will decide about the need for EPS.

  • Radiofrequency ablation (RFA): Once the cause of rapid heart rates are identified through EPS, the area of tissue which is causing the problem is disconnected from rest of heart by delivering high frequency current called as radiofrequency energy through specialized catheters using same access as used for EPS. In most of the cases its curative and patient need not be on lifelong medications.
  • Pacemakers: when the heart electrical system undergoes wear and tear due to various causes, the heart beats too slowly and can lead to loss of consciousness, effort intolerance. If no correctible cause is found then such patients need an artificial pacemaker which has to be implanted in patient's heart. This is a minor surgical procedure done under local anaesthesia and mild sedation.
  • Automatic Implantable Cardiac Defibrillators (AICD): Sometimes lower chambers of the heart can beat too rapidly causing fall in blood pressure and even cardiac arrest. If no treatable cause is found, a specialized pacemaker which can detect this fast heart rate and give a shock to restore normal rhythm has to be implanted. The device which does this function is called as automatic implantable cardiac defibrillator.
    • What Happens during EPS?

    • An electrophysiology (EP) study is an invasive diagnostic test to evaluate the electrical system of the heart. The EP study can last between one and two hours.
    • During the procedure, the electro physiologist will insert special electrode catheters (thin flexible wires) through a large vein in the groin.
    • The catheters are advanced into the heart to record and measure the electrical signals. Fluoroscopy, a special type of X-ray, will help the physician place the wires in the heart. During the study, the heart will be placed in various ways to test for arrhythmias.
      What Happens during RFA?

    • During an EP study, sometimes an arrhythmia is found that can often be cured by radiofrequency (RF) ablation.
    • This procedure may be performed under a local or general anesthetic.
    • A small incision is made in the groin.
    • During the EP study, a special catheter is used that delivers radiofrequency energy to the area of the heart causing the arrhythmia. The radiofrequency energy heats up the tissue in contact with the catheter and destroys the tissue causing the arrhythmia.
      Post Procedure Information:

    • Most patients can go home on the same day but occasionally, the patient may require to stay overnight at the hospital.
    • Watch out for swelling, bruising, bleeding at the insertion site.
    • Do not drive for 24 hours after the procedure and should avoid strenuous activity for two to three days.

    Manipal Heart Institute offers full range of above mentioned electrophysiology services including Holter recording, Event recorders and Tilt Table test. The Heart Institute is equipped with state of the art EP lab equipped with three dimensional mapping systems (Ensite NavX system) to accurately localize and treat various arrhythmias. This system helps to perform ablation of complex arrhythmias arising from both upper and lower chambers of the heart. Ensite Array system can locate electrical activities from 3000 locations within the chamber simultaneously and a single beat of tachycardia is enough to locate the abnormal focus.

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