Diagnostic EP study
An electrophysiology (EP) study may be required to diagnose arrhythmias. It is minimally invasive and provides valuable data in selected patients with suspected arrhythmias such as SVT or syncope. In some cases, it can be used to risk stratify patients who are at risk of developing abnormal rhythms such as ventricular tachycardia. An EP study is often used together with a loop recorder implant to diagnose difficult to document arrhythmias.
Generally, it is important to have documentation of rhythm by non-invasive means prior to embarking on invasive treatments.
What are the risks of having a diagnostic EP study?
They include but are not limited to the following.
Common risks and complications (< 5%) include:
- Bruising bleeding at the puncture site. Bruising can extend beyond the puncture site and can take a few weeks to improve in some cases.
Uncommon risks and complications (<0.5%) include:
- Tamponade – Hole in the heart causing bleeding requiring surgery.
- Major bleeding related to the groin puncture site or injury to an artery in the groin. This (rarely) may need surgery and or blood transfusion.
- Blood clot in the leg (DVT) causing pain and swelling. In rare cases part of the clot may break off and go to the lungs called pulmonary embolus.
What happens during the procedure?
Local anaesthetic is administered at the groin which numbs the area. Small tubes called sheaths are passed into the vein in the right groin through which catheters are inserted and gently passed up until they reach your heart. An X-ray machine guides the catheters to your heart. The wires are used to transmit electrical signals to the heart to evaluate the electrical system and to induce abnormal rhythms if applicable. The diagnostic EP study procedure can take about 30mins or more hours in some cases.
If an abnormal rhythm is found, your doctor may proceed to a therapeutic intervention called ablation based on the clinical circumstances of your case. Please refer to the catheter ablation section for general information about the admission process and requirements.
What happens after an EP study?
At the end of your procedure, your doctor will remove the catheters and apply pressure, followed by a dressing. You may have a little device applying pressure at the puncture site for a few hours. You’ll be watched closely in a recovery area, and depending on how you feel, you might need to rest in bed for a while. You will be admitted to the ward for observation overnight with rhythm monitoring. You may be required to lay flat on your back for about 4 hours after your procedure. People are usually discharged the next day.
What happens after discharge?
Your specialist will speak to you about the procedural findings and next course of action.
Follow up:
- An appointment will be made for you to be seen in clinic about 2 months after the procedure
- You will need to have follow up appointment with your usual pacemaker clinic
- If you do not receive a date for an appointment within 8 weeks, please call the clinic and ask to speak to the secretary
Medications:
- Continue your medications as instructed. If you are uncertain about your medications, please ring the rooms for clarification
Postoperative care:
- Avoid strenuous exercise for 1 week
- Start with gentle exercise after 2-3 days – e.g. long walks.
Symptoms to monitor:
- It is not uncommon to have a bruise at the groin that extends / spreads after the ablation. This usually resolves over time without any other problems.
Bleeding:
- It is rare to have severe bleeding from the puncture site once you are at home. If bleeding does occur you must: lie flat, apply pressure to the site for 10 minutes. If it continues, call an ambulance for assistance.
Please contact the rooms if you have any questions or concerns at any time.
In recommending this procedure your doctor has balanced the benefits and risks of the procedure against the benefits and risks of not proceeding. Your doctor believes there is a net benefit to you going ahead. This is a very complicated assessment.
