What is Cardiac Electrophysiology?

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Cardiac electrophysiology refers to the practice of diagnosing, managing and treating disorders associated with heart rhythm and abnormal heartbeat. Electrophysiology is an assessment that measures the heart's electrical system, which is used to determine arrhythmia or an abnormal heartbeat. Cardiac electrophysiologists conduct two major procedures to treat conditions related to an irregular heartbeat.

These are:

Catheter ablation

During catheter or heart ablation, the cardiologist places a catheter into the heart, which delivers radio-frequency energy to various parts of the heart through a small metal tip. The catheter identifies the areas that need to be destroyed, and particular cells or, in the case of atrial fibrillation (AF), entire areas of tissue are then removed. Read more information on atrial heart fibrillation.

Installing Cardiac electrophysiologists are also able to insert cardiac devices and work on the installation of pacemakers, defibrillators (ICDs), and cardiac resynchronisation devices. These cardiac devices are connected to wires that stretch through the veins to the heart and are inserted under the skin in the upper chest. The devices are used for sensing, pacing and delivering shock impulses to the heart. Read more information about pacemakers.

Besides conducting the procedures above, cardiac electrophysiologists also diagnose, manage, and treat a range of heart conditions. These include:

  • Arrhythmia (including bradyarrhythmias and tachyarrhythmias, and malignant ventricular arrhythmias)
  • Supraventricular tachycardia (SVT)
  • Heart failure as a result of arrhythmia left ventricular dyssynchrony and other aetiologies.
  • Arrhythmia
  • Arrhythmias related to specific conditions
  • Congenital AV-block
  • Lone atrial fibrillation

What is an electrophysiology study?

An electrophysiology study is conducted in order to assess the electrical functioning of the heart. The study allows the cardiologist to properly diagnose and manage heart disease. Cardiologists use cardiac catheters and computer equipment to create electrocardiogram (EKG) measurements from the inside of the heart. The electrophysiology study has a number of purposes, including:

  • To determine what is causing the arrhythmia (irregular heartbeat)
  • To determine in which area of the heart the arrhythmia originates
  • To determine which method of treatment is most appropriate for the particular patient
  • To look at means of heart disease prevention in the future


Do I need an electrophysiology study?

If your cardiologist is unable to acquire enough information about your arrhythmia, some of the following tests may be performed:

  • Standard electrocardiogram (ECG)
  • Holter monitor
  • Event recorder
  • Stress test
  • Echo
  • Angiogram


What do I need to know about having an electrophysiology test?

Take note of the following before undergoing the test:

  • Speak to your doctor about your medication. In some cases, it is necessary to stop taking certain medicines or adjust your prescriptions before your procedure. If you are on prescription medication, bring a day's supply with you, but remember to check with your doctor before taking it.
  • Don’t eat after midnight the night before your procedure. Avoid all food and liquids at this time.
  • Wear comfortable clothing Make sure you wear something comfortable. Remove any jewellery, make-up or nail polish before the procedure.


What will happen during the procedure?

First, you will be given medication through an intravenous line to relax you. Your groin will be shaved and cleaned with a sterile solution, and you will be covered in sterile sheets.

When your groin has been anesthetised, your cardiologist will insert several catheters into your vein, which will be guided to your heart. The catheters will pick up the electrical impulses in the heart and allow your cardiologist to assess and treat your heart condition.

During the procedure, your blood pressure and heart rhythm will be monitored. You will be monitored by a number of machines, including:

  • Fluoroscopy: An x-ray machine, which allows your doctors to see the catheters on a screen.
  • Defibrillator/pacemaker/ cardioverter: This device is attached to your back and chest so that your doctors can monitor your heart rate.
  • Electrocardiogram (ECG): This machine is attached to the chest and inside of the heart and monitors the electrical impulses in the heart.
  • Blood pressure monitor: A blood pressure cuff is attached to the arm.
  • Oximeter monitor: This device is attached to the finger and monitors the oxygen level of the blood.


What do I need to know after the procedure?

After the procedure, only light mobilisation is recommended. You should not climb stairs or drive, and no heavy physical exertion is allowed for the first 48 hours after the procedure.

It's important that you report any abnormal swelling, pulsations or tenderness at the puncture site to your doctor.

If you experience any swelling or tenderness of the calf or veins of the limb in which the puncture site was performed in the first couple of weeks after the procedure, let your doctor know, as it could be early signs of a clot (deep vein thrombosis).

Read more information about what to expect after catheter ablation.