In the past, patients suffering from recurrent palpitations and their physicians have found the problem very frustrating to manage. Although seeming like an eternity, each episode might only last a few seconds and never show up on an EKG. Even with wearing a Holter monitor for 24 hours or longer, you may not detect the abnormal rhythm. Meanwhile the patient, who remembers the headlines about the young athlete who collapses suddenly and dies of a cardiac arrhythmia, wonders whether their bouts of racing pulse or missed beats portends something just as serious.
Electrophysiology studies or EPS have been in use for some years and help to overcome some of the shortcomings of the traditional Holter monitoring and EKG. Patients are referred by their cardiologist to a cardiac investigation center, where they will have a full blood screen done and be given a mild oral sedative such as diazepam. The groin is shaved and they are then transported to the cardiac laboratory. Here an intravenous line is inserted and their groin prepped with antiseptic solution. Various monitor leads are placed on their chest and limbs and a combination of drugs given to induce a light anaesthesia.
Under some local anaesthetic, a sheath is inserted into their femoral vein and up to four catheters inserted. Under x-ray control, the catheters are threaded up the venous system into the right side of the heart.Recordings can be taken that give a display of the normal electrical activity of the heart. Either by administering drugs or by artifical pacing of the heart through one of the catheters, the cardiologist attempts to reproduce the abnormal rhythm which is causing the patient’s symptoms. This procedure can take 1-2 hours, and if an abnormal rhythm is detected it may be possible to treat it by using radio-frequency ablation.
After the procedure is completed the patient will need to lie flat for at least three hours. While there can be some discomfort when palpitations are replicated and a slight burning sensation if radio-ablation is used, the procedure is relatively painless. It is also safe and the main complication is some bruising from the puncture site in the groin. No sutures are required to close the wound and a firm pressure dressing is left in place for at least 24 hours.
EPS has become a vital tool in diagnosing and managing cardiac arrhythmias and, in many cases, enables patients to cease taking the medication that had been prescribed to treat their palpitations.
