Wockhardt Guide on Electrophysiology


If you or a member of you family has been diagnosed with irregular heart rhythms and recommended for electro physiology study and radiofrequency ablation by your doctor, We at Wockhardt take this opportunity to educate you on electro physiology study.

What is EP study?

Normally, electricity flows throughout the heart in a regular, measured pattern. This electrical system brings about heart muscle contractions. This electrical impulse or spark fires first in an area of the heart called the sino-atrial (S-A) node. The S-A node gives of electrical impulses that make your heart may beat 60-100 times per minute under normal conditions.

A problem anywhere along the electrical pathway causes an arrhythmia, or heart rhythm disturbance. By accurately diagnosing the precise cause of an arrhythmia, it is possible to select the best possible treatment.

Why an EP study?

While electrocardiograms (ECGs) are important tests of the heart's electrical system, they are brief tests that record only the events that occur while the tests are running. Arrhythmias, by their very nature, are unpredictable and intermittent, which makes it unlikely that an ECG or electrocardiogram will capture the underlying electrical pathway problem. Even tests that stretch over longer time lengths may not capture an event. EP studies most often are recommended for patients with symptoms indicative of heart rhythm disorders or for people who may be at risk for sudden cardiac death.

The value of an EP study

An electrophysiologic, or EP, study provides information that is key to diagnosing and treating arrhythmias. Although it is more invasive than an electrocardiogram (ECG) or echocardiogram, and involves provoking arrhythmias, the test produces data that makes it possible to:

  • diagnose the source of arrhythmia symptoms
  • evaluate the effectiveness of certain medications in controlling the heart rhythm disorder
  • predict the risk of a future cardiac event, such as sudden cardiac death
  • assess the need for an implantable device (a pacemaker or ICD) or treatment procedure (radio frequency catheter ablation)
What is radiofrequency ablation (RFA)?

The radio frequency ablation is a technique that is used to treat palpitations.Radio-frequency energy is low power, high frequently alternating current, which has been used to cut tissue or to stop bleeding. A much smaller dose of radio frequency is used for the treatment of palpitations.

If appropriate, an RFA is used to treat the extra electrical connection or pathway, which runs between the chambers of the heart. The application of radio-frequency energy to these extra pathways destroys them; permanently stopping the short circuit that can make the heart beat 3 to 4 times faster than normal.

The cardiologist may wish to keep a close eye on your heart beat after the procedure, in which case you will be connected to a small, portable cardiac monitor. You will normally be discharged from hospital the following morning after your RFA procedure.

How do you get ready for EP study?

Before the EP study, the electro physiologist will discuss the procedure with you and your family. He or she will ask you to sign a consent form.

It is important for your doctor to know the exact names, dosages, and time intervals of any medicines that you take. Your doctor may advise you to stop taking certain medicines for one or more days before your EP study. This will give the doctor more accurate test results.It is also important to let your doctor know if you are allergic to anything, particularly medicines.

The EP study requires that you have an empty stomach. Unless you are told otherwise. Do not eat or drink after midnight, except for sips of water to help you swallow your pills.

What happens on the day of EP study?

The hair around your groin area and possibly your neck area will be shaved, where the catheters will be inserted. Your nurse may give you a pill to help you relax. Because tense muscles can affect the electrical recordings from your heart.

When it is time for your EP study, someone will escort you to the EP Lab on stretcher.

What happens during the EP study?

The study is performed after giving local anesthesia and conscious sedation (twilight sleep) to keep the patient as comfortable as possible. The procedure involves inserting a catheter - a narrow, flexible tube - attached to electricitymonitoring electrodes, into a blood vessel, often through a site in the groin or neck, and winding the catheter wire up into the heart. The journey from entry point to heart muscle is navigated by images created by a floroscope, an x-ray-like machine that provides continuous, "live" images of the catheter and heart muscle. Once the catheter reaches the heart, electrodes at its tip gather data and a variety of electrical measurements are made. These data pinpoint the location of the faulty electrical site. During this "electrical mapping," the cardiac arrhythmia specialist, an electrophysiologist, may instigate, through pacing (the use of tiny electrical impulses), some of the very arrhythmias that are the crux of the problem. The events are safe, given the range of experts and resources close at hand and are necessary to ensure the precise location of the problematic tissue.

Once the damaged site or sites are confirmed, the specialist may administer different medications or electrical impulses to determine their ability to halt the arrhythmia and restore normal heart rhythm.Throughout the procedure, the patient is sedated but awake and remains still. Patients rarely report pain, more often describing what they feel as discomfort. The procedure usually takes about two hours. The patient will remain still for four to six hours to ensure the entry point incision begins to heal properly. Once the patient is able to move again, they may feel stiff and achy from lying still for hours.

What happens after the EP study?

Now it's time to return to your room. You will be lifted to the stretcher because the catheter insertion sites need to begin healing. It is best that you follow these simple rules:

  • Stay in bed for up to six hours
  • Try to keep your legs straight. It's okay for you to get of your back by rolling from side-to- side with help. Do not bend your knees
  • Keep your head on the pillow.
  • Inform the nurse if you have any warmth, pain or swelling in the groin area.

Your blood pressure, pulse, and catheter insertion sites will be checked frequently after you return to your room. You should be able to get up to walk after your required bed rest.

What about follow-up EP studies?

If you require medicine for a heart rhythm disturbance, it is important for the doctor to make sure that this medicine is working correctly. Therefore you may be brought back to the EP lab for a follow-up EP study.This is different from the first study in that there is usually only one catheter placed in your heart, and the study is completed in approximately one hour.If results indicate that the medicine prescribed after the first study needs some adjustment in order to control your heart rhythm disturbance, you may have to come back to the EP lab again one or more times."Taking it one day at time" is the best way of dealing with your hospital stay.

What are the potential risks of EP studies?

The EP study is a low-risk procedure that has been performed in heart centers for many years.The information it provides can be vital to your life.The risks associated with an EP study is usually similar to that of any cardiac cathetrization and is less than 1%


At Wockhardt, we care for your well being. We strongly recommend practicing prevention and securing health. In a world where lifestyle evolves by the day, it is essential to stay in the pink of health. Wishing you and your family good health and happiness always.

The information in the booklet is not intended as a substitute for medical advice but is to be used as an aid in understanding ailment. Always consult your doctor about your medical condition.

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