If you have any questions about the EP Lab, Let us know. Frequently Asked Questions
The EP Study is a test that checks for problems that happen with the electrical system in your heart. The beating of your heart is caused when an electrical signal that usually originates inside the right atrium causes the muscle to contract and pump blood. The heart naturally produces its own electric signal in an area called the sinus node. The sinus node is the command center of your heart and it determines how fast your heart should beat. This electric signal travels from the sinus node at the top of the heart, through a central channel down to the bottom of the heart. If your heart rate goes to fast or too slow, we will test it to find out why this is happening.
If your doctor has suggested that you have an EP Study, it is probably because you have already had some problems with your heart. The following is a list of general symptoms and the things that we look for during the test.
Palpitations: Many people feel a strange "flip-flop" sensation in their chest from time to time. This may be caused by the bottom section of the heart beating early. Most of us will have early beats from time to time. If however, the palpitations begin to occur on a frequent basis, your doctor may want you to have this test to find out if these early beats may progress to a level where they could make you pass out.
Rapid Heart Beat: Some people who have this type of test have had times when their heart rate has gone very fast for no apparent reason. Normally, your heart won't go above 100 beats per minute unless you are exercising. Every once in a while, people find that their heart rate is going much faster even though they are resting. If you are one of these people, your doctor may want you to have this test to determine why this is happening and what we can do about it.
Feeling Dizzy or Light Headed: There are some people who have periods of dizziness or times when they feel light headed for several minutes or more. Many of us feel this every once in a while. There are some people who have these feelings on a regular basis. This may be caused by your heart rate going to slow or to fast. When your heart rate goes to slow, your body does not get as much oxygen as it needs to work normally. This can cause you to feel lousy and can make you feel dizzy or light headed. If your heart rate goes to fast, the heart becomes less effective at pumping blood. This produces the same type of feeling you may get when your heart goes to slow. This type of test will look for things that may cause either one of these problems.
Passing Out: If you have passed out completely, your doctor will want to run tests to determine why this has happened. One of the things that may cause this is a drop in blood pressure that occurs when the heart goes to slow or to fast. If the doctor feels that you passed out because of problems with the heart, he may suggest that you have this test.
These are some of the main reasons why your doctor may recommend that you have an EP Study. If you have questions about these problems, check with your physician. One of the things that you can do to help your doctor take care of you is to keep a diary of symptoms including the date and time they occurred. You should also keep a complete list of medications you are currently taking,. You should carry this list with you at all times.
When your physician's office schedules you for your appointment, they will give you instructions about what you will need to do. Check with your doctor to see if you should stop taking any of your medications. Some medicines will make it difficult for your doctor to identify what is causing your problem. If you have any questions regarding your test, now is the time to ask your doctor. Don't worry if you think of questions after you leave your doctor's office. You can always call the doctors office with new questions. You will probably be told that you should not have anything to eat or drink after midnight on the day before your test. The office staff will tell you what time you need to be at the hospital and where you should check in.
When you arrive at the hospital, you will be given several forms to fill out. These forms give the hospital permission to take care of you and allows them to bill your insurance for services performed there. You will be asked a number of questions to make sure the hospital has all your personal information correct. Once you are checked in, you will be taken to your room where you will meet the nurse who will be taking care of you before your procedure. The hospital staff will ask you to change into a patient gown which they will provide. When you change into your gown, you should remove all your clothes including your underwear and socks.
You will have a few more forms to sign at this point, including the consent form for your test. The nurse will check your pulse and blood pressure and record this information in your chart. One of the staff members will start an IV line so they can draw blood and give you medications without having to stick you again. A blood specimen will be sent to the lab to make sure there are no problems that may cause your test to be delayed for a few days. It is a good idea at this point to let your nurse know if you think you may be pregnant. The type of test you will be having requires the use of x-rays. If you are pregnant, the staff in the EP lab can take steps to protect your unborn child from the x-rays. Once the lab work has been drawn and your vital signs have been checked, you may have a little wait until the staff from the EP Lab arrives to pick you up. Please don't get concerned if the scheduled time for your procedure passes before someone arrives to take you to the lab. It is very difficult to know how long procedures in the Cardiac Lab may take, and it is not uncommon for scheduled cases to run a bit late.
When the staff from the lab arrive to pick you up, they will verify your identity by checking your arm band. They may also ask you to tell them what your birthday is. This acts as a second form of identification. You may also be asked about allergies, dentures, hearing aids and other valuables that you may have with you when you are brought up to the lab. Don't worry about your dentures, you don't have to take them out.
Once you arrive in the lab, you may be asked to move onto the procedure table. Listen carefully to the staffs instructions and don't be afraid to ask them any questions that pop up. When you are on the table, the staff will hook up a large number of monitoring electrdoes to watch your heart rhythm. An automatic blood pressure cuff will be placed on your arm. This will check your blood pressure every ten to fifteen minutes. The first time the cuff inflates, it will squeeze your arm very tight. After that, it should not squeeze as hard. A small clip will be placed on your finger to check the amount of oxygen in your blood stream. You may also receive oxygen through a small tube called a nasal cannula that is placed just below your nose.
One of the lab staff will prepare you for your study. To do this, they will need to shave the right and left groin areas. Don't worry, they will take great care to preserve your privacy. Once these areas have been shaved, the staff member will scrub your skin with an antiseptic soap. It is also possible that an area on the right side of your neck may also be prepped. When this staff person is finished getting you ready, a second person will cover you with a large sterile drape. It is important that you do not move around to much. Keep your hands by your sides so you do not contact the prepared areas. Once you are covered and the final prepartations have been made, the physician will come in and start the procedure.
Once the procedure has started, you will feel very little discomfort. You will feel a small stinging sensation when the physician gives you the numbing medicine. As the test progresses, you may feel your heart rate going faster than it usually does. This is normal for this type of test and you should not worry about this. You may also feel the same symptoms that brought you to see your physician in the first place. If this happens, let your doctor know. This will help him to identify the cause of your problem. The hardest part about this procedure is lying flat for a long period of time. If you get uncomfortable, let your physican know. There are medications that will make lying there easier.
Once the procedure is completed, all the introducers will be removed. Pressure will be applied to the entry sites to prevent any bleeding. A small dressing will be placed over the site and you will be moved to your room or a recovery area. It is important that you do not move around to much after the test is finished. You should relax and try to get some rest. If you are hungry, a meal can usually be ordered for you.After a few hours, you will be allowed to go home. You should receive instruction on how to take care of the dressings before you go. You should plan to have someone else drive you home. Your physician will have a follow up appointment scheduled for you within a week or two after the test. If you did not recieve information about an appointment, contact the physician's office on the next work day.
What do they do to fix the Problem?
The next major question that patients often ask is, "What do you do if you find something going on in my heart?'. The answer to this question depends entirely on what results we find from the tests performed.
Nothing: There are times when we finish the test yet do not find anything wrong. You may have had a single event that will not happen again. It is also possible that the problem does not involve the heart's electrical system. If this happens, it is normal for you to feel frustrated. If your physician tells you that your EP study is normal, take comfort in knowing that the problem does not lie within your heart. Your doctor may send you to another physician that will check for other causes.
Medications: In some cases, the physician may recommend medications to help you out. Usually, medications are not given alone, but in combination with some of the other therapies.
Permanent Pacemaker Implant: If a block is found in the conduction system, or if the heart is not generating enough signals to provide an adequate blood supply, the doctor may recommend a permanent pacemaker implant. The pacemaker is a small electronic device that monitors the electrical activity in your heart. If your heart does not produce enough signals, the pacemaker will provide a signal to stimulate your heart muscle.
ICD Implant: The ICD, or implantable cardiac defibrillator, is another electronic device that is designed to help keep the electrical signals in the heart under control. Most ICD's act in the same way as a pacemaker does, but they go one step farther. When the heart rate goes too fast, the ICD will provide therapy to slow the heart rate down. It does this using one of two methods. It may try to block the fast rhythm by sending electrical signals faster than the heart is generating them, and then suddenly stopping. The other therapy the ICD may deliver is an electrical shock. This shock "resets" the electrical signals in the heart and gives the normal signals in the heart a chance to take over again.
Ablation: One of the most common ways to fix problems we find from this type of test is called an ablation. This is the most common way to fix a problem with the electrical system. Ablation uses heat to get rid of extra cells that some people are born with. These extra sets of cells in their heart may be what causes your heart rate to suddenly go very fast. Once these excess cells are removed, your heart rate should remain normal.
The previous section tells you what to expect from a standard EP Study. Some times, the physician may be looking for something that can be found using what is called a Tilt Table. This test is really very simple. Like the other type of test, you show up at the hospital and go through the admit process. Most of the same preparations are made to get you ready. One of the primary differences is that you usually don't have to change into a patient gown. This type of test can be done with you wearing the clothes you came to the hospital in.
When you arrive in the room where the test will be done, you will be asked to lay down on a flat table. A large strap will be used to help secure you to the table. A heart rate, blood pressure and oxygen monitor will be hooked up and your vital signs will be recorded. Now you are ready to start. The physician will have the table "tilted" at a steep angle. Your head will be elevated above your feet, almost to the point that you are in a standing position. This is kind of like lying down on a steep hill. The strap will help keep you securely on the table. Your heart rate, blood pressure and oxygen levels will be monitored for twenty minutes. If everything is normal at that point, the physician may choose to give you a medication to help stimulate your heart. After the medicine is given, you will be watched for another twenty minutes. At this time, the test will be over.
What the physician is looking for with this type of test is a drop in heart rate and/or blood pressure. Sometimes the areas in your heart that help to control your heart rate and blood pressure react to strongly to minor stimulation. When this happens, it can cause you to pass out because your heart rate goes to slow, or your blood pressure drops to low. If this happens during the test, medicines may be given to bring things back to normal. You may feel very uncomfortable for a short period of time, but this will pass in a little while. Once this test is completed, you will usually be allowed to go home and will not have to stay in a recovery area.
I was working in the lab when a patient asked me a question that hundreds of patients have asked before. While it has nothing to do with the electrophysiology study directly, it is an important question. So I have added it to the list of patient questions for you. Here is the answer to the question, "Why is the room so cold?".
When someone arrives in a cardiac cath lab or an EP lab for the first time, they are often surprised to find that the room temperature is kept at a nice cool 65 degrees. While 65 degrees is not really that cold, it is pretty chilly when all you have on is a patient gown and those little blue socks.
The cath lab and the EP lab are called procedural areas. We do not perform major surgery in these rooms, but we do use sterile technique with the equipment that comes into direct contact with the patients. When we do a heart cath, an angioplasty or an EP study, specific types of catheters must be advanced through either your arteries or your veins up to the heart. This equipment must be kept sterile to minimize the chance of causing an infection in the blood. Because the nasty little bugs that can cause infections grow better in warmer climates, we discourage them by keeping the temperature colder in the rooms. This, along with sterile technique, allow us to do procedures like this with very few infections. So the next time you have a procedure in one of those refrigerated rooms, think of all those nasty little bugs that have moved elsewhere looking for warmer conditions.
