Narayana Health provides comprehensive care for patients with heart rhythm problems. Electrophysiologists at Narayana Health Hospitals are experienced medical professionals and their considerable skills and abilities are enhanced by the state of the art facilities and infrastructure at our hospitals. A majority of cardiac patients at Narayana Health get benefitted from the presence of electrophysiology procedure aligned with multiple specialities that complement each other to provide optimal care, treatment and recovery.
Electrophysiologists are Cardiologists who specializes in the electrophysiology study and treatment of rhythm disorders of the heart. They work closely with Cardiac surgeons in the diagnosis and treatment of arrhythmias and are also involved during the surgical implantation of pacemakers and defibrillators.
A common procedure performed by Electrophysiologists is an Electrophysiology study (EP study). It is a minimally invasive procedure and is used to investigate the cause, location and treatment of various rhythm disorders and in particular Cardiac Arrhythmias.
Electrophysiological (EP) study
The Electrophysiology test is one of the fastest-growing procedures used in the field of cardiovascular medicine. It is a specialized procedure that involves studying electrical activities of the heart using an invasive catheter. The detailed study of ep cardiology is aimed at analyzing, diagnosing, and treating multiple heart rhythm disorders.
On average every day, our heart pumps around 4,300 gallons of blood through the complex network of our body’s vascular system. Since this distribution of blood is the primary function that the heart performs, it also actuates and controls electrical impulses to generate beats.
Narayana Health network Hospitals offer comprehensive care and treatment for patients suffering from heart rhythm complications. The Electrophysiology department at NH has a team of devoted electrophysiologists and cardiologists who work efficiently to solve the complexities of cases with abnormal heart rhythms. Our Electrophysiology unit is equipped with state-of-art equipment and machines that facilitate optimal treatment, care, and recovery. We are one of the very few cardiac centers in India with advanced facilities and professionals competent to perform EP study.
Electrophysiology Study: Basis
The regular flow of electrical signals in the heart is followed by a contraction in the heart muscles. However, if any obstruction or slow down occurs in this electrical pathway then it may lead to abnormality in heart rhythms. The electrophysiology of the heart aims to address such heart rhythm disorders.
Heart rhythm disorders/arrhythmias are unpredictable and erratic in nature which makes its identification difficult using ECG or Holter monitor. To precisely identify the heart tissue responsible for causing such complication EP test is performed by an experienced Electrophysiologist.
Electrophysiology Testing Procedures
Basically, the EP study can be performed using two different methods:
- Recording electrical signals: In this method, electrode catheters are used to analyze and measure electrical signals and their speed in different parts of the heart.
- Pacing the heart: In this process, small electrical signals are made to pace the heart using electrode catheters. Through this, doctors try to introduce some abnormal heart rhythms for monitoring them under a controlled environment.
To reach the conclusion, a doctor assesses results of EP test along with the patient’s medical history, physical examinations, and non-invasive tests like echocardiograms, chest x-rays, heart monitors or electrocardiograms.
Purpose of Electrophysiology Test
- Identify the source of arrhythmia symptoms.
- Evaluate the effectiveness of medications used for controlling HRD.
- Diagnose the need for artificial pacemakers or other treatments.
- Predict future risk for cardiac arrest.
Conditions Treatable with Cardiac Electrophysiology
The cardiac electrophysiology test is used by the doctors to monitor and treat a spectrum of arrhythmias conditions such as:
- Atrial fibrillation
- Atrial flutter
- Brady Arrhythmia
- Postural orthostatic tachycardia syndrome
- Supraventricular tachycardia
- Ventricular arrhythmias
- Cardiac arrest/Sudden cardiac death
- Familial arrhythmia syndromes
- Hypertrophic cardiomyopathy
- Idiopathic ventricular fibrillation
Electrophysiology Treatments and Services
Cardiac electrophysiology experts at NH are capable to provide a full range of services and treatment options including:
- Risk identification and therapy to diagnose and treat cardiac arrhythmias
- Pacemakers and defibrillators
- Radiofrequency ablation
- Clinical electrophysiology
- Noninvasive electrophysiology
The Electrophysiology test Procedure
Preparing for an EP Study
A patient scheduled to undergo an electrophysiology test is recommended to stop consuming anything at least 8-12 hours prior to the test. Moreover, one may also be advised to stop certain medications including blood thinners or anti-arrhythmic medications several days before appearing for the test.
In order to alleviate pain during the procedure, doctors use a local anesthetic to the numb area where catheters are to be placed. So, during electrophysiology of heart people only experience mild pressure or tugging. Additionally, people having an EP study may not be advised for any drug because of anesthetics interfering with heart functioning.
An EP study can consume from around one hour up to five or six hours. Due to test duration being unpredictable patients are often recommended to use the washroom before the test commences.
What happens during an EP study?
An EP study is performed in a special room known as catheterization (cath) lab by a cardiac specialist doctor, electrophysiologist. The duration of the test is subjective to change.
- One or more thin flexible tubes, called catheters are inserted into blood vessels in the groin area and guided to the heart. To help relax during the process, the patient is provided anesthetic injection or sedative.
- Since catheters are made to reach up to the heart they tend to instigate arrhythmia (an abnormal heart rhythm).
- You may experience lightheadedness or notice palpitations. There may also be a sensation of discomfort in your chest. If such symptoms persist for longer inform the medical staff.
What happens after an EP study?
Post the completion of the study, catheters are removed and sometimes there may be a small amount of bleeding. To prevent bleeding your doctor may press the area for some time.
After the test, you will be advised to take rest for a few hours. However, most people can return home after the procedure. There may be a feeling of tiredness but you can get back to your normal routine just within a few days.
Furthermore, until a few days, you will observe unusual heart activity. Sometimes you may experience missed or extra beats. This is quite common after EP and will become normal over time.
What can an EP study reveal?
An EP can diagnose and instigate abnormal heart rhythms. It can precisely identify the area affected in your heart.
If the cause responsible for abnormal heart rhythm is found out, your doctor may proceed to treat you using catheter ablation. This treatment procedure can be conducted either through heat (radio-frequency ablation) or freezing (cryogenic ablation). These procedures tend to address symptoms by impairing areas responsible for causing abnormal heart rhythm in the heart. The time duration for these procedures is the same as required in the EP study.
What are the risks of having an EP study?
Post-treatment complications associated with EP study are very rare. Before treatment, your doctor will guide you on this in detail.
If there is bleeding from the area where catheters were inserted, it is likely you may have blood deposition under skin referred to as a haematoma. This can make you feel restless and can result in bruising. However, this will become normal after a few days. In case of an issue contact your doctor for further discussion.
There is a likelihood of experiencing minor discomfort from the EP and catheter ablation procedures due to the use of local anesthetic, undergoing X-rays, catheter injection, and the introduction of abnormal heart rhythm.
To reduce this discomfort, your doctor may prescribe you short-term sedatives depending on your arrhythmia type and treatment procedure.
You can get back to your normal routine soon after the EP test. You can resume your daily activities such as walking, showering, bathing, and so on. However, unless you are instructed by your doctor do not attempt to do anything.
Additionally, until your catheter insertion areas heal completely it is recommended not to lift heavy objects.
Catheter insertion in the EP study is conducted through two large blood vessels. One catheter is inserted into the neck while another one in the groin. The catheter entering blood vessels through the neck enters the top of the heart and the catheter entering blood vessels in the groin enters the bottom of the heart. Thus, by entering catheters through distinct directions doctors are able to assess and diagnose the source of abnormal rhythm in a better way.
Nevertheless, removal of catheters from neck and groin areas will leave back a tiny hole which will appear like a bug bite. There is no requirement of stitches and it will leave no scars.
The electrophysiology study is done to determine the way electrical signals advance through the heart to make it beat. It is performed in people with incorrect heartbeats produced due to disordered and ineffective electrical signals. An EP study is recommended in the following situations.
- Arrhythmia or abnormal heart rhythms: Your doctor may recommend an EP study if you have been diagnosed with arrhythmias, such as atrial flutter, atrial fibrillation, and ventricular or supraventricular tachycardia.
- Undergoing cardiac ablation: An EP study is performed before the cardiac ablation for arrhythmia. The cardiac ablation procedure creates scar tissue in the heart to block irregular and unpredictable electrical signals by using heat or cold energy.
- Syncope or temporary loss of consciousness: In this case, an EP study may be recommended to understand the cause better.
- Risk of sudden cardiac death: An EP study in people with a heart condition that increases their risk of sudden cardiac death can help the doctor get a better understanding of their condition.
- Undergoing heart surgery: EP study may be performed first while the individual is preparing for a heart operation involving cardiac ablation at the same time.
The EP procedure will be carried out in the electrophysiology laboratory, where the patient is let to lie down on an X-ray table. Electrodes are then placed on the chest which is connected to the monitoring equipment. A blood pressure cuff placed on the upper arm helps to monitor the blood pressure. The rest of the procedure is performed as follows.
- The groin or the neck area, where the catheters are to be inserted are cleaned to prevent any possible infection. Following that, sterile sheets will be draped over the body.
- Medications will be given intravenously through the arm to sedate the patient depending on the type of study to be undergone.
- Local anaesthetic may be administered at the site where the catheters are inserted to numb the area.
- One or more catheters will be advanced through the large vein in the groin or neck and then guided to the heart. To insert the catheter, a small incision less than the quarter of an inch is made. The position of the catheter will be monitored on a screen.
After the EP procedure is over:
- The catheters are removed while applying pressure to the site to prevent bleeding.
- To ensure that the catheter sites are properly sealed, the patient needs to be in bed for at least four to six hours.
- Checkups will be done frequently to identify any bleeding at the site. If you feel a sudden pain, call the nurse immediately.
- The doctor may share the preliminary findings after the test.
- The patient may be able to eat and drink if they feel well enough.