An electrophysiology procedure is a series of tests that doctors use to evaluate the electrical activity of your heart. It’s often the first step in diagnosing an arrhythmia or determining if there is another reason for a change in your heart’s rhythm.
A complex electrical system usually coordinates your heart’s rhythm and keeps the upper chambers and lower chambers contracting and relaxing steadily. But sometimes, an atypical rhythm, or arrhythmia, develops.
To determine the nature of an arrhythmia, your doctor may advise you to undergo an electrophysiology procedure. There are a few different types of electrophysiology procedures, just as there are several types of arrhythmias. The specific test you undergo will depend on the type of arrhythmia your doctor suspects you may have.
While the procedure involves the placement of a catheter through a blood vessel and into the heart, the test is typically safe and relatively painless.
This article will take a closer look at what an electrophysiology procedure involves and when you might need it.
An arrhythmia may cause symptoms that prompt your doctor to order an electrophysiology procedure. Symptoms of a possible arrhythmia could include:
- dizziness
- episodes of fainting
- heart palpitations or other noticeable changes in your heart rate
- weakness
Before having an electrophysiology procedure, you may have an electrocardiogram (ECG). This is a noninvasive screening that involves a doctor placing electrodes on your chest to help assess the electrical activity of your heart.
Although an ECG can detect an atypical heart rhythm, doctors often need further tests to find the source of the arrhythmia. An arrhythmia can originate just about anywhere along your heart’s electrical network.
This is when a doctor may suggest an electrophysiology test. An electrophysiology procedure can be helpful in diagnosing any of the following
- atrial fibrillation, the chaotic beating of the upper heart chambers
- bradycardia, an unusually slow heart rate
- conduction disorder, a problem with the electrical signal traveling through the heart
- tachycardia, an uncommonly rapid heart rate
- ventricular fibrillation, rapid beating of the lower heart chambers
An electrophysiology procedure can reveal a lot about the way your heart’s electrical system functions. For example, your doctor can learn whether you have extra signals causing an atypical heart rhythm or whether there is a blockage or disruption of electrical signals as they move through your heart.
The test may also reveal where exactly the electrical disruption originates in your heart. This is essential before you have an ablation procedure. This involves your doctor using radiofrequency waves or extremely cold liquid to destroy a small amount of heart tissue that causes the unusual rhythm.
Doctors may also perform electrophysiology procedures to gauge the effectiveness of medications that they prescribe to help keep your heart beating typically.
A standard electrophysiology test involves a doctor placing electrodes on your skin to help evaluate your heart’s rhythm. The doctor also inserts a thin, flexible tube into a blood vessel, which can help them guide the catheter into your heart.
The types of tests done can vary, depending on what your doctor is looking for. Tests may involve:
- cardiac mapping, which is performed to find the precise part of your heart that needs an ablation
- electrical signals moving through the catheter to make your heart beat slower or faster, which is helpful in finding the source of an arrhythmia
- an intracardiac electrogram, which measures how electrical impulses travel through your heart
- medication delivery via the catheter to interfere with or slow electrical activity, which is helpful in learning more about the nature of your arrhythmia
The ECG portion of an electrophysiology procedure is completely noninvasive. However, the catheter insertion into a blood vessel, which helps the doctor guide the catheter to your heart, is minimally invasive and requires careful observation during and after the procedure.
A healthcare professional numbs the injection site of the catheter insertion. But as the local anesthetic wears off, you may experience some soreness.
The only other discomfort you may feel is the change in your heart rate as electrical impulses or medications move to the heart to speed up or slow down your heart’s rhythm. These changes shouldn’t usually hurt, but they may feel a little uncomfortable.
A doctor usually performs an electrophysiology procedure in a cardiac catheterization lab, and they perform it on an outpatient basis. If you’re admitted to the hospital for cardiac issues or other concerns, and your doctor feels the procedure is necessary, they can perform it as part of in-patient care.
Before the procedure
Before an electrophysiology procedure, talk with your doctor about any medications you take. You may need to stop taking certain medications for 1 or 2 days leading up to the procedure.
Be sure to get specific instructions from your doctor’s office. Always speak with your doctor first before discontinuing medications.
Your doctor will usually advise that you to avoid eating or drinking for 6 to 8 hours before the test. Plan on having someone drive you to your appointment and back home again after it finishes.
What happens during the procedure?
- Once you’re in the cardiac catheterization lab, you’ll be given an intravenous (IV) sedative to help you relax.
- Depending on where the doctor will insert the catheter, a nurse may need to shave the area before cleaning and prepping it.
- Your doctor will place ECG electrodes on your chest and elsewhere on your skin to monitor your heart rhythm.
- You’ll then be given a local anesthetic shot to numb the insertion site.
- Once the area is ready, your doctor will make a needle puncture in the skin and thread one or more catheters into a blood vessel.
- A special X-ray will display the location of the catheters on a nearby monitor. This will help your doctor carefully guide the catheter to your heart.
- Depending on the test, your doctor may administer a variety of electrical impulses through one catheter to make your heart beat at different rates. Another catheter may “map” the heart to discover the site of the arrhythmia’s origin.
- Once the test is complete, your doctor will remove the catheters.
- They will apply brief pressure to the incision site before dressing and bandaging it. They will also remove your IV, and you’ll need to lie quietly.
- The entire process can take up to 4 hours.
After the procedure
You’ll likely need to spend 1 or 2 hours in the recovery room. If there are no complications, you’ll be allowed to go home, but you will need someone to drive you.
Once you’re home, continue to rest. You can eat the foods you commonly eat and take your medications as per usual.
Avoid driving and heavy lifting for 24 hours. If you notice swelling or symptoms of infection, or if you experience any heart rhythm changes or other symptoms, notify your doctor immediately.
An electrophysiology procedure is a fairly routine procedure, with a low risk of serious complications. Some potential risks include:
- catheter injection site bleeding or bruising
- blood clot formation near the tip of the catheter
- incision site infection
- injury to the vein at the catheter injection site
In rare cases, an electrophysiology procedure may cause a small hole in the heart or a problem with the heart’s electrical system. These are usually treatable complications.
An electrophysiology procedure may not be appropriate for
- acute coronary syndromes or severe heart failure
- conditions affecting heart function that may interfere with test results, such as electrolyte level differences or hyperthyroidism
- bleeding disorders
Having to lie flat on your back for several hours may also be difficult for some individuals.
A doctor usually orders an electrophysiology procedure when they believe you have a heart arrhythmia. This procedure can provide more information about the severity of an arrhythmia and where it originates in the heart.
Doctors may also use an electrophysiology procedure to determine the exact part of the heart that needs an ablation or to determine how well anti-arrhythmic medications work for you.
Overall, many people tolerate the procedure well. An electrophysiology procedure can be an important tool to help get an accurate diagnosis or understand how manageable arrhythmias are.