Cardiac Electrophysiology Test (EPS)

Introduction

A Cardiac Electrophysiology Study (EPS) is a specialized test used to evaluate the electrical activity of your heart. It is primarily performed to diagnose abnormal heart rhythms (arrhythmias) and assess the risk of sudden cardiac events. This test helps doctors determine if you need further treatment, such as medications, a pacemaker, or an ablation procedure.

When is an EPS Needed?

Doctors may recommend an EPS if you have: - Unexplained fainting (syncope) - Palpitations or irregular heartbeats - A history of sudden cardiac arrest - Wolff-Parkinson-White (WPW) syndrome or other pre-excitation syndromes - Atrial fibrillation (AFib) or other tachycardias needing ablation

How is the Test Performed?

1. Preparation: You may be asked to stop certain medications before the test and to avoid eating or drinking for several hours.
2. Procedure: A doctor inserts thin, flexible wires (catheters) into a vein, usually in the groin, and guides them to your heart using X-ray imaging.
3. Electrical Mapping: These catheters measure the electrical signals in the heart and stimulate different areas to detect abnormal conduction pathways.
4. Possible Intervention: If an abnormal rhythm is found, the doctor may perform catheter ablation, using heat or cold energy to destroy the tissue responsible for the arrhythmia.
5. Recovery: The test usually takes 1-4 hours. Afterward, you will need to rest, and your healthcare provider will monitor you for a few hours.

Risks and Benefits

Potential Risks: - Bleeding or infection at the catheter site - Blood vessel or heart damage (rare) - Induced arrhythmia, which may require emergency treatment

Benefits: - Accurate diagnosis of arrhythmias - Helps determine the best treatment - Can prevent life-threatening heart rhythm disorders

Conclusion

An EPS is a highly effective method for diagnosing and treating electrical problems in the heart. If your doctor recommends this test, follow the preparation instructions carefully and discuss any concerns with your medical team.

Source recommendations

1. American Heart Association: 2023 Guidelines on Evaluation and Management of Arrhythmias

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000628
2. https://professional.heart.org/en/science-news/periprocedural-management-and-multidisciplinary-care-pathways-for-patients-with-cardiac-implantable
3. https://www.ahajournals.org/doi/10.1161/cir.0000000000000499
4. https://www.jacc.org/doi/10.1016/j.jacc.2017.03.003
5. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042434

2. European Society of Cardiology: 2022 Guidelines for the Management of Atrial Fibrillation

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Atrial-Fibrillation
2. https://academic.oup.com/eurheartj/article/45/36/3314/7738779
3. https://www.escardio.org/static-file/Escardio/Guidelines/Documents/ehaa612.pdf
4. https://academic.oup.com/eurheartj/article/42/5/373/5899003
5. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193