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electrophysiology treating your heart rhythm

if you, or a member of your family has been diagnosed to have irregular heart rhythms you may have questions about the disease and its treatments especially if your doctor has recommended electrophysiology study and radiofrequency ablation.

this booklet has been written in a friendly ‘question answer’ format to provide you with information on what is involved in an E.P. study and allow you to prepare for the procedure, if necessary.

if you have any additional questions after reading this communication, please discuss them with your doctor.

what is the electrical conduction system of the heart?

in order for the heart to pump blood through your body, it needs a spark or electrical impulse to start a heartbeat. this electrical impulse begins its journey in the upper right chamber of the heart (the right atrium) and is relayed along the heart’s conduction or wiring system. this causes the heart muscle to contract evenly, with the two upper chambers 9the atria) squeezing a little earlier than the two lower chambers (the ventricles).

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 off electrical impulses that make your heart beat 60-100 times per minute under normal conditions.

if you are exerting yourself or are under emotional stress, your heart may beat faster. if you take certain medicines such as beta blockers, your heart may beat slower.

sometimes the electrical impulse becomes blocked or starts in an area outside the S-A node. if the electrical impulse becomes blocked, the heart may beat so slowly that the blood does not provide enough oxygen to meet the needs of the body. if the electrical impulse starts in an area of the heart other than the S-A node, the heart may beat so fast that it is unable to squeeze sufficient blood out of it chambers. too sow or too fast a heartbeat may cause the following symptoms:
♦ dizziness or lightheadedness
♦ fatigue (tiredness)
♦ palpitations (pounding in your chest)
♦ shortness of breath
♦ chest pain or pressure
♦ a fainting spell

some fast heart rhythms or beats which start in the lower chambers of the heart (ventricular tachycardias) can result in ventricular fibrillation, a life-threatening heart rhythm. if this rhythm is not reversed, or if cardiopulmonary resuscitation (CPR) is not performed, it can prove fatal within four to six minutes. other fast heart rhythms that involves the atria are usually not life threatening but can make life uncomfortable. it is hard to predict when these fast or slow heart rhythm disturbances will occur and, without special testing, it is difficult to treat them. specific testing on the electrical system of your heart provides information that can be vital to your health.

what is an electrophysiology laboratory?

the electrophysiology laboratory is a set of technologically advanced equipments which have facility for recording the hearts electrical signals and for elastically stimulating the heart. the electrophysiology lab works in conjunction with the cardiac catheterization laboratory utilizing its fluoroscopic equipment for varying the position of the catheter electrodes in the heart. the software controlled monitor panels provide 32 channels of ECG monitoring, while the ablation unit generates heat for ablating the nodes which arrhythmias.

what is an electrophysiology (EP) study?

the EP study is a low risk cardiac procedure that has been performed in major heart centers of the world for many years. the EP study makes it possible to study your heart rhythm disturbance under controlled circumstances. the electrophysiologist (the interventional cardiologist who performs these studies) places special catheters (thin tubes) inside your heart to record the electrical activity. these catheters may also be used to reproduce abnormal heart rhythms.

once the nature of your heart rhythm disturbance is identified, the doctor may start you on a medicine to decrease your likelihood of having these abnormal rhythms. after two or more days of treatment with this medicine in the hospital, you may be brought back to the EP lab for what is called a follow-up EP study. this short study is designed to evaluate the effectiveness of the medicine. it may take more than one follow-up EP study to find the best medicine for the treatment of your abnormal heart rhythm.

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 frequency alternating current which has been used for decades by surgeons 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.

how do you get ready for EP study?

before the EP study, the electophysiologist will discuss the procedure with you and your family. this is a good time for you and your family to ask questions and concerns about the EP study. after the doctor has answered all your questions and you feel you have a good understanding of the procedure, 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 nay medicines that you take. it is a good idea to make a list or bring them with you to the hospital.

it is also important to let your doctor know if you are allergic to anything, particularly medicines. various tests may be done including an electrocardiogram (ECG), chest x-ray, and blood tests. several people may be responsible for your care, including doctors and staff members. they will ask questions and examine you.

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. you will be given something to eat and drink after your EP study is complete.

what happens on the day of EP study?

the hair around your groin area hand possible your neck area will be shaved. where the catheters will be inserted. a nurse will place an intravenous (IV) catheter in your arm. attached to this catheter will be tubing and an IV bag.

1. it provides a reliable way to give you medicines
2. it can be used to give extra fluid if you need it

your nurse may give you a pill to help you relax. it is important during the EP study that your muscles be relaxed because tense muscles can affect the electrical recordings from your heart.

what happens during the ep study?

after being positioned comfortable on the table in the EP lab, cables which get attached to monitors will be put along with two large sticky pads on your chest and back. these pads may feel cool to you when applied. these pads are hooked upto a heart monitoring. your heart rhythm will also be monitored by a second machine. the ep nurse or technician will place electrodes onto your limbs or trunk. the areas where the electrodes will pick up your heart’s electrical signal, which is then sent over to the ECG machine. you may which is then sent over to the ECG machine. you may hear the ECG monitor beep in time with your heartbeat.

a cuff will be placed on one or both arms so your blood pressure can be measured during the EP study. some blood pressure cuffs will automatically squeeze your arm periodically to measure your blood pressure.

the oxygen level of your blood will be measured during the EP study. a plastic device, like a clothespin, will be attached to your finger for this purpose. oxygen tubing may be placed in your nose with a small amount of oxygen flowing through it.
as soon as you are hooked up to all the monitors, the nurse at your side may begin to give to give you medicine in your IV to help you relax. you can expect to feel sleepy from this medicine. your nurse will be right at your side to answer your questions and give you support throughout your EP study.

a sterile towel will be placed over your groin, your neck area or both. a cool, brown antiseptic cleansing liquid (betadine) will be used to clean the skin where the catheters are to be inserted. betadine kills germs and helps prevent infection.

the doctor will prepare the area of catheter insertion by injecting medicine. you will feel some stinging for thirty seconds or so but, once the medicine takes effect, you should not feel any pain. after the area is numb, the doctor will use a special needle for locating the vein. you may feel some pressure, but if you feel any pain during this step, please inform the doctor so more medicine can be given.

the catheter, which is a thin tube will be threaded gently up your vein and into the chambers on the right side of your heart. occasionally, one may feel some brief discomfort as the catheter is moved up to the heart.

in order to record all the electrical impulses, three or more catheters may be used. the catheters are guided to their correct positions in the heart using a special x-ray machine called a fluoroscope. part of the machine will be placed directly over your body. this machine allows the doctor to watch the catheters as they are being moved into place. you will be able to see the catheters in your heart on a TV screen. the table you are lying on may be moved as the catheters are being positioned in your heart.

after the catheters are in position, the doctor will evaluate your heart rhythm disturbance by giving your heart small electrical impulse to make it beat at different speeds. you may feel your heart beat very quickly. the doctor is doing this and you should not be alarmed.

the procedure may take 2-6 hours. after the electrical recordings have been made, the doctor will re-establish your normal heart rhythm. often this can be done by pacing (giving the heart small electrical impulses through the catheter). some people faint and do not even realize that they have fainted.

not everyone faints, but there is no way of predicting if this will happen. if you do faint, you may not know where you are or what has happened when you first wake up. your nurse will be right at your side to comfort and reassure you.
although it may be frightening, to think about these aspects of the procedure, most patients do not report experiencing nay pain. remember, if we initiate such rapid heart rhythm disturbance, we can hopefully use this information to prevent such an occurrence in the future.

if a heart rhythm disturbance is initiated, the EP team may give you some medicine through your IV line to treat your abnormal heart rhythm. This medicine will be tested for effectiveness’ during this EP study.

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. if’s okay for you to get off 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 nurse will be reminding you of these rules. your nurse will also make sure that you have something to eat and drink, that you are as comfortable as possible, and that nay questing or concerns you may have a answered. 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 a time” is the best way of dealing with your hospital stay.

what can i do to help my condition?

you may have turned this question over in your mind again and again, perhaps finding solutions to our condition. you cannot change the past nor predict the future, but your present feelings and emotions can work either to help or to hinder your progress. that’s why it is important to share your thoughts with your doctors, nurses, and family members. these shared thoughts, either good or bad, will help you get through these EP studies a little easier.

what are the potential risks of EP studies?

the EP study is a low-risk procedure that has been performed in heart centres for many years. the information it provides can be vital to your life. most people undergoing EP studies do not experience any complications.

is it worth it?

the EP study is the most comprehensive method available for evaluating and treating your heart rhythm disturbance. radiofrequency ablation offers a permanent cure for a number of arrhythmia with very low risk. this obviates the need for regular long term medication.

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