Electrophysiology

Electrophysiology [ee-LEK-troh-FIZ-ee-AH-luh-JEE] is the study of the electrical signals in the heart and cardiovascular system that pumps blood throughout the body. This area of medicine includes tests like electrocardiograms (ECGs), as well as treatments like pacemakers and cardiac ablation.

What Is cardiology?

Cardiology [kahr-dee-OL-uh-jee] is the branch of medicine that deals with the heart.  Your heart is the center of your cardiovascular system, which brings blood to and from all of the organs in your body, supplying them with oxygen and nutrients. Arteries bring oxygen-rich blood to your organs, while veins bring oxygen-poor blood back to the heart.

Your heart itself pumps, or beats, every day of your life. Your heartbeat is controlled by very small electrical impulses in your body. Sometimes, these electrical impulses can be too strong, too weak, or get sent in the wrong way, which can cause problems such as:

• Atrial fibrillation [FIB-rill-AY-shun], also called Afib, is a type of abnormal heart rhythm that happens in the heart’s upper chambers. 
• Ventricular [VEN-trik-YOU-luhr] fibrillation is a very fast and abnormal heart rate that causes sudden death.
• Ventricular tachycardia [ta-kih-KAR-dee-UH] is a very fast hearth rhythm in the heart’s lower chambers.
• Arrhythmia [UH-rith-MEE-uh] is an irregular heartbeat that you might feel as a skipped beat or fluttering in your chest.

What is electrophysiology?

Electrophysiology, or EP, is the study of these problems, and an electrophysiologist is a special doctor with training in this area of medicine. Electrophysiologists study the problems in the heart’s electrical system and also look for treatments to help people with these problems. If your child has electrical problems in their heart, they might see an electrophysiologist as part of their medical care team.

EP treatments and tests

EP includes many different procedures to treat conditions and tests to diagnose problems with electrical signals in the heart. Some EP tests include:

• An electrocardiogram [ih-LEK-trow-KAR-dee-oh-GRAM] (ECG) is a non-invasive test that records your child’s heartbeat.
• An EP study will help your doctor figure out how easy it is for your child to fall into an abnormal heart rhythm.

Some common EP treatments include:

• Pacemaker. This is a device implanted near your child’s heart that creates regular electric signals that keep your child’s heart beating regularly when their body can’t do this on its own.
• Defibrillator [dee-FAHY-bruh-ley-ter]. If your child’s symptoms persist or are severe, an implantable cardioverter [KAHR-dee-oh-VER-ter] defibrillator (ICD) may be recommended.
• Cardiac ablation [ahb-LAY-shun]. This process destroys the cells in the heart that are causing abnormal electrical signals.

Risks of EP

EP procedures are usually safe, but they all have risks, especially when a doctor cuts or makes changes inside of your child’s body as part of the procedure.

Side Effects of EP

Side effects from EP procedures are usually mild, but you should call your doctor right away if your child has any of the following:

• A fever over 101°F
• Redness, swelling, drainage, bleeding, or severe pain near the catheter site
• Coldness or numbness in the arm or leg
• Severe tiredness or tiredness that continues
• Difficulty swallowing or eating
• Fainting, lightheadedness, or dizziness
• Very fast or slow heartbeat
• Difficulty getting enough breath
• Swelling in the hands or ankles
• Call 911 if your child has chest discomfort that is severe or is not relieved by medicine for chest pain.

The benefits of EP treatments or tests vary depending on the specific procedure your child needs. EP tests can help your doctor:

• Get better information about the electrical system in your child’s heart.
• Diagnose the cause of your child’s heart rhythm problem.
• Find out what part of the heart is causing the problem.
• Test different medicines that can treat it.

EP treatments also vary, but can reduce or eliminate your child’s heart rhythm problem if they are successful. These procedures can also help your child lower or stop their dose of heart medicine.

Your doctor will have specific instructions on how to prepare your child for the EP procedure, but there are some basic steps you should plan for no matter what kind of test or treatment your child is having:

• Follow the doctor’s directions about medicines. Your child may need to stop taking blood thinners and other medicines for several days before. Always check with your child’s doctor before stopping any medicines.
• Arrange for a ride. Give your child a ride to and from the hospital, or arrange for someone else to do this.
• Have your child fast (no food or drink) for 6 to 8 hours before the procedure. If the procedure is in the morning, your child should not eat or drink anything after midnight the night before.
• Tell the doctor if your child is sick the day of the procedure with a cold, the flu, or anything else.
• Bring a list of all your child’s current medicines. List everything, including over‑the‑counter medicines, herbal supplements, and vitamins.
• Tell the doctor if your child has allergies to any medicines or dyes.

How Is EP Done?

Two common procedures, an EP study and a cardiac ablation treatment, are described in more detail below. Your child’s doctor will have more information about the specific procedure your child needs. For many of these procedures, your child’s doctor will take the following steps:

• Your doctor will get your child ready for the procedure, placing them on a table and making them comfortable.
• If the procedure requires anesthesia, an anesthesiologist will give this medicine to your child so they don’t feel the procedure.

EP Study

An EP study uses one or more catheters (flexible tubes) threaded through a vein into your child’s heart. The catheters are fitted with tiny sensors that measure the precise flow of electric signals through your child’s heart.

During an EP study, a doctor can also use a catheter to provoke (cause) the unstable heart rhythm. Measurements recorded while your child’s heart is in an unstable rhythm can help doctors determine its cause, where it starts, and even what medicines will control it best.

Cardiac Ablation

During cardiac ablation, your doctor will find the heart tissue that is causing problems for your child. To do this, they will start by inserting a catheter, a very thin tube, into one of your child’s veins. This catheter can be moved through the vein to reach your child’s heart.

Once the catheter is in place, the doctor will use radio waves or liquid nitrogen to ablate (destroy) the heart tissue that is causing problems.

Your doctor should be able to tell you right away if the EP procedure itself was successful. For procedures that are used to test for a problem, it might take your doctor a few days or weeks to interpret the test results.

For procedures that treat a problem with the electrical system in your child’s heart, it might take a few weeks to recover from the surgery and a few months to know how well the surgery worked.

You should ask your doctor how long it will take to know the results.

Your doctor might have specific follow-up steps for you to take after an EP procedure. They will probably want your child to come back in for monitoring or follow-up tests to see how successful the procedure was or to have other tests or treatments if needed.

You and your child can prepare for an EP procedure by knowing what to expect and what steps to take after the procedure.

• What your child will feel. Your child might feel sore from several hours of lying flat — this will go away in a day or so. The catheter site will be bruised, but this should go away in a week or so. Your child’s heartbeat might feel strange to them while their heart muscle adjusts to the healthier heartbeat.
• What to look for. Watch for swelling or bleeding at the catheter site, difficulty breathing, or swallowing problems. Also, tell your child’s doctor if they have fatigue or chest discomfort that is severe or continues after the first few days.
• Cautions and steps to take. Make sure your child does not bend or squat. Keep your child from doing intense activity such as climbing stairs, running, or lifting objects that are heavy for them. Have your child take short walks of 5 to 10 minutes, several times a day. Give your child an appropriate stool softener, if necessary, to relieve constipation.
• Caring for the catheter site. Avoid baths, hot tubs, or swimming pools for the first 5 days or until the wound is closed. Showers are okay after 48 hours.
• Returning to school. When your child can go back to school depends on their physical condition and school activities. Many patients can go back to work or school within a week. Check with your child’s doctor.
• Ongoing medication, monitoring, or both. If your child’s doctor prescribes medicine on the basis of an EP study, have them take it as prescribed, even after they feel better. Keep follow-up appointments so your child’s heart can be monitored.