Cardiac Electrophysiology - Indications, Procedure, Preparations, and Risks

Introduction

The heart is a muscular organ; it pumps blood through the blood vessels and carries oxygen and nutrients to the parts of the body. The human heart is the size of a fist. Divided into four chambers, blood flows from one chamber to the other through the heart valves, which prevent backflow. The wall of the heart is made of three layers: myocardium, epicardium, and endocardium. The heart follows a rhythmic pattern. The rhythmical heartbeat is sinus rhythm. The signals created by the heart tissue are carried by Purkinje fibers and transmit electric charge. The study of this heart’s electrical activity is cardiac electrophysiology.

What Is Cardiac Electrophysiology?

The detailed study of the electrical activity of the heart by a series of tests is cardiac electrophysiology. The heart produces impulses that control the timing of the heartbeats; electrophysiology creates a detailed activity map based on these impulses between each heartbeat. This study helps in determining the cause of irregular heartbeat and predicts the risk of heart disease and death. This test is conducted by a trained physician known as an electrophysiologist.

What Are the Indications of Cardiac Electrophysiology?

Electrophysiology gives a detailed description of the electrical signals produced by the heart. This test is indicated in conditions like

• Arrhythmia: To determine fast heartbeat, irregular heartbeat, or any type of tachycardia, electrophysiology tests are done.

• Loss of Consciousness: To determine the cause of loss of consciousness, an electrophysiology test is performed.

• Cardiac Ablation: Here, heat or cold energy is used to correct heart rhythm issues. The electrophysiology test is done prior to cardiac ablation in order to pinpoint the areas of irregular rhythm. In cases of heart surgery, both electrophysiology and cardiac ablation can be done on the same day.

• Sudden Cardiac Death: This test helps in determining the risk of sudden cardiac death.

What Is the Risk of Cardiac Electrophysiology?

Like many other tests, electrophysiology has some risks. Some can be very serious that include:

• Heart attack.

• Stroke.

• Death.

• Blood clot in lungs and legs.

• Bleeding.

• Infection.

• Bleeding due to perforation of heart tissue.

• Damage to the electrical system of the heart may require pacemakers to correct.

• Damage to blood vessels and heart valves.

How to Prepare for Cardiac Electrophysiology?

Prior to the test, certain instruction needs to be followed:

• Avoid drinking and eating anything 6 to 8 hours before the test.

• Inform the provider regarding any herbs, vitamins, and over-the-counter medications taken prior to the test.

• Accompany a family member to drive for the appointment.

• If the individual wears a hearing aid or glasses, they can continue wearing it during the appointment.

What Happens During Cardiac Electrophysiology?

During the procedure, the room is fully equipped with all instruments.

• An IV line is given in the arm; this will sedate and relax the individual. Follow all the instructions provided by the provider.

• The nurse will shave and prepare the area and site of the procedure. It is usually the groin or arm, or neck.

• A local anesthesia shot is given, and a small-sized tube called a sheath is inserted in the vein or artery.

• Many specialized EP catheters are inserted in the blood vessel through the sheath and advance them to the heart.

• A video screen will help in positioning the catheters. Pressure is felt in the area where the sheath is inserted, but the pain should not be felt.

• Small electric pulses are sent through the catheters to make the heart beat at different frequencies and speeds. Heart beating faster and stronger can be felt by the individual.

• The heart may pick up these electrical signals, and this is recorded, known as cardiac mapping, which will locate the arrhythmias.

• The provider may remove the IV line and catheter. Pressure on the puncture site is applied to stop bleeding.

• This procedure may last up to 1 to 4 hours.

• Once the location and type are identified, the insertion of a pacemaker, cardiac ablation, or heart surgery is performed right after the electrophysiology study.

What Happens After the Electrophysiology Procedure?

After the procedure, the individual is asked to stay in the recovery room for 1 to 3 hours. During this time, the provider may ask to keep the leg or arm used for the procedure straight (not changing any positions). The provider may check for any swelling or bleeding at the site, and instructions are given that need to be followed back home.

What Are the Steps to Be Followed After Reaching Home?

After discharge and reaching home, the following guidelines need to be followed:

• If a long journey is required back home, stop every hour and stretch your legs for a few minutes; this helps in preventing blood clots in your legs.

• Limit any activity for 24 hours, don’t lift heavy objects.

• Don’t take any stress or strain.

• If any bleeding is noticed on the incision site, contact the provider immediately.

• Don’t try to open the dressing on your own. Take the help of the provider. Any lump or bruise on the site may disappear within three to four weeks.

What Are the Points to Watch for After the Procedure of Cardiac Electrophysiology?

After the procedure, any symptoms of pain and tightness in the chest, symptoms like

• Arm Weakness.

• Speech difficulties.

• Face drooping.

• Bleeding that does not slow after applying pressure on the site.

• A sudden increase in swelling at the puncture site.

• Fever.

• Shortness of breath.

• The puncture site is more bruised.

• Swelling and fluid discharge from the puncture site.

• Change in color and very cold hand and foot.

• Numbness and tingling sensation in legs.

Conclusion

Cardiac electrophysiology is one of the most useful procedures to test heart arrhythmias, any type of questions or difficulties during the procedure, do not hesitate to ask the provider. Electrophysiology and catheter ablation is considered safe procedures, with potential risks. The healthcare care provider can guide better on the risk before the procedures. In most cases, the results are delivered soon, and the following appointments are booked along. And in some cases, the procedure is followed by heart surgery or cardiac ablation.