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Intracardiac electrophysiology study (EPS)

Electrophysiology study - intracardiac; EPS - intracardiac; Abnormal heart rhythms - EPS; Bradycardia - EPS; Tachycardia - EPS; Fibrillation - EPS; Arrhythmia - EPS; Heart block - EPS

Intracardiac electrophysiology study (EPS) is a test to look at how well the heart's electrical signals are working. It is used to evaluate abnormal heartbeats or heart rhythms.

How the Test is Performed

Wire electrodes are placed in the heart to do this test. These electrodes measure electrical activity in the heart.

The procedure is done in a hospital laboratory. The staff will include a cardiologist (heart doctor), technicians, and nurses.

To have this study:

  • Your groin and/or neck area will be cleaned and numbing medicine (anesthetic) will be applied to the skin.
  • The cardiologist will then place several IVs (called sheaths) into your groin or neck area. Once these IVs are in place, wires or electrodes can be passed through the sheaths into your body.
  • The doctor uses moving x-ray images (fluoroscopy) to guide the catheter into the heart and place the electrodes in the right places.
  • The electrodes pick up the heart's electrical signals.
  • Electrical signals from the electrodes may be used to make the heart skip beats or produce an abnormal heart rhythm. This can help the doctor understand more about what is causing the abnormal heart rhythm or where in the heart it is starting.
  • You may also be given medicines that may also be used for the same purpose.

Other procedures that may also be done during the test:

  • Placement of a heart pacemaker
  • Procedure to modify small areas in your heart that may be causing your heart rhythm problems (called catheter ablation)

How to Prepare for the Test

You will be told not to eat or drink for 6 to 8 hours before the test.

You will wear a hospital gown. You must sign a consent form for the procedure.

Your health care provider will tell you ahead of time if you need to make changes to the medicines you regularly take. Do not stop taking or change any medicines without first talking to your provider.

In most cases, you will be given medicine to help you feel calm before the procedure. The test can last from 1 hour up to several hours. You may not be able to drive home afterward, so you should plan for someone to drive you.

How the Test will Feel

You will be awake during the test. You may feel some discomfort when the IV is placed into your arm. You may also feel some pressure at the site when the catheter is inserted. You may feel your heart skipping beats or racing at times.

Why the Test is Performed

Your provider may order this test if you have signs of an abnormal heart rhythm (arrhythmia).

You may need to have other tests before this study is done.

An EPS may be done to:

  • Test the function of your heart's electrical system
  • Pinpoint a known abnormal heart rhythm (arrhythmia) that is starting in the heart
  • Decide the best therapy for an abnormal heart rhythm
  • Determine whether you are at risk for future heart events, especially sudden cardiac death
  • See if medicine is controlling an abnormal heart rhythm
  • See whether you need a pacemaker or implantable cardioverter-defibrillator (ICD)

What Abnormal Results Mean

Abnormal results may be due to abnormal heart rhythms that are too slow or too fast. These may include:

There may be other causes that are not on this list.

The provider must find the location and type of heart rhythm problem in order to determine the proper treatment.

Risks

The procedure is very safe in most cases. Possible risks include:

Open References

References

Ferreira SW, Mehdirad AA. The electrophysiology laboratory and electrophysiologic procedures. In: Sorajja P, Lim MJ, Kern MJ, eds. Kern's Cardiac Catheterization Handbook. 7th ed. Philadelphia, PA: Elsevier; 2020:chap 7.

Nattel S, Tomaselli GF. Mechanisms of cardiac arrhythmias. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 62.

Olgin JE. Approach to the patient with suspected arrhythmia. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 49.

  • Cardiac conduction system

    Cardiac conduction system

    Animation

    •  

    Cardiac conduction system - Animation

    A network of specialized muscle cells is found in the heart's walls. These muscle cells send signals to the rest of the heart muscle causing a contraction. This group of muscle cells is called the cardiac conduction system. The main parts of the system are the SA node, AV node, bundle of HIS, bundle branches, and Purkinje fibers. Let's follow a signal through the contraction process. The SA node starts the sequence by causing the atrial muscles to contract. That's why doctors sometimes call it the anatomical pacemaker. Next, the signal travels to the AV node, through the bundle of HIS, down the bundle branches, and through the Purkinje fibers, causing the ventricles to contract. This signal creates an electrical current that can be seen on a graph called an electrocardiogram, or EKG. Doctors use an EKG to see how well the cardiac conduction system works. Any changes on the EKG can mean serious problems.

  • Cardiac arrhythmia: Additional tests

    Cardiac arrhythmia: Additional tests

    Animation

    •  

    Cardiac arrhythmia: Additional tests - Animation

    Additional tests are sometimes used to evaluate patients with arrhythmia. The most common tests are long-term ECG recording, exercise testing, heart rate variability, electrophysiological studies, echocardiography and Doppler ultrasound tests, and blood tests. The choice of which test to use depends on the clinical circumstances.

  • Heart - front view

    Heart - front view - illustration

    The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

    Heart - front view

    illustration

  • Conduction system of the heart

    Conduction system of the heart - illustration

    The intrinsic conduction system sets the basic rhythm of the beating heart by generating impulses which stimulate the heart to contract.

    Conduction system of the heart

    illustration

  • Cardiac conduction system

    Animation

    •  

    Cardiac conduction system - Animation

    A network of specialized muscle cells is found in the heart's walls. These muscle cells send signals to the rest of the heart muscle causing a contraction. This group of muscle cells is called the cardiac conduction system. The main parts of the system are the SA node, AV node, bundle of HIS, bundle branches, and Purkinje fibers. Let's follow a signal through the contraction process. The SA node starts the sequence by causing the atrial muscles to contract. That's why doctors sometimes call it the anatomical pacemaker. Next, the signal travels to the AV node, through the bundle of HIS, down the bundle branches, and through the Purkinje fibers, causing the ventricles to contract. This signal creates an electrical current that can be seen on a graph called an electrocardiogram, or EKG. Doctors use an EKG to see how well the cardiac conduction system works. Any changes on the EKG can mean serious problems.

  • Cardiac arrhythmia: Additional tests

    Animation

    •  

    Cardiac arrhythmia: Additional tests - Animation

    Additional tests are sometimes used to evaluate patients with arrhythmia. The most common tests are long-term ECG recording, exercise testing, heart rate variability, electrophysiological studies, echocardiography and Doppler ultrasound tests, and blood tests. The choice of which test to use depends on the clinical circumstances.

  • Heart - front view

    Heart - front view - illustration

    The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

    Heart - front view

    illustration

  • Conduction system of the heart

    Conduction system of the heart - illustration

    The intrinsic conduction system sets the basic rhythm of the beating heart by generating impulses which stimulate the heart to contract.

    Conduction system of the heart

    illustration

Tests for Intracardiac electrophysiology study (EPS)

 
 

Review Date: 5/8/2024

Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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