What is Electrophysiological Study (EPS) and in what situations is it applied?

What is Electrophysiological Study (EPS)?

Electrophysiological study (EPS) is an invasive diagnostic method used to examine the heart's electrical conduction system in detail. The heart needs to receive electrical impulses (stimuli) regularly in order to function properly. Irregularities can lead to serious problems such as arrhythmia (palpitations), fainting, or sudden cardiac arrest. EPS helps determine the cause of these disorders.

EPS is a diagnostic tool and also facilitates transition to treatment in some cases. For example, if an abnormal condition is detected during EPS, ablation can be performed simultaneously. Therefore, it is a very important procedure both for diagnosis and treatment planning. 

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Why is an Electrophysiological Study (EPS) Performed?

An electrophysiological study is generally performed to diagnose problems related to heart rhythm and determine the appropriate treatment method. Disorders in the electrical conduction system of the heart can cause serious health problems. In this regard, EPS helps to understand the underlying causes of life-threatening symptoms. The main reasons for EPS are as follows:

• Investigation of the cause of palpitations (arrhythmia): The location of recurrent or sudden onset-end palpitations, the type of arrhythmia involved, and the associated risk are determined.
• Investigation of the cause of fainting (syncope): Rhythm disturbances that may cause unexplained fainting are identified.
• Evaluation of life-threatening rhythm disorders: The examination assesses serious rhythm disorders such as ventricular tachycardia, atrial tachycardia, and Wolff-Parkinson-White syndrome that develop after a heart attack or heart failure.
• Determining the need for a pacemaker or ICD (defibrillator): In cases such as bradycardia (slow heartbeat), it is determined whether a pacemaker or defibrillator is necessary for patients at risk of sudden death.
• Determining suitability for ablation: During EPS, it can be determined whether ablation is necessary. If the patient has recurrent palpitations that cannot be controlled with medication, ablation can also be performed in the same session.

How is an Electrophysiological Study (EPS) Performed?

An electrophysiological study is performed in the angiography unit. After taking the patient's detailed medical history prior to the procedure, necessary preliminary evaluations such as blood tests and ECG are performed. The patient usually needs to fast for 6-8 hours. If blood-thinning medications are being used, they may need to be discontinued beforehand.

On the day of the procedure, the patient is placed in a special EPS bed, and ECG electrodes are placed on areas such as the arm, chest, and leg to continuously monitor the heart rhythm. Sedatives are usually administered, but the patient remains awake during the procedure.

The procedure is usually performed by entering through a large vein in the groin area (femoral vein). Thin, specialized catheters are guided to the heart through the vein. These catheters are placed in various areas with the help of fluoroscopy (X-ray imaging). Electrical impulses are delivered to the heart through catheters. This procedure is called electrophysiological mapping. With these impulses, palpitations are consciously triggered; thus, the source and type of arrhythmia are identified. Sometimes ablation therapy can also be performed during the procedure. 

When the procedure is complete, the catheters are removed and the patient is allowed to rest. The patient is usually discharged the same day. However, if ablation was performed, an overnight observation may be required. It is a very safe procedure that takes approximately 1-2 hours.

In What Situations Is Electrophysiological Study (EPS) Applied?

EPS is not only used to diagnose problems with the heart's electrical system; it also guides the determination of which patients require what type of treatment. It is of vital importance, especially in terms of the early detection of rhythm disorders that could threaten life.

EPS can be used in the following situations:

• Fainting for unknown reasons
• Frequent palpitations
• Patients who have experienced cardiac arrest/sudden death
• Patients who have had cardiac disease at risk of arrhythmia
• Suspected Wolff-Parkinson-White (WPW) syndrome
• Assessment of the need for a pacemaker
• Patients who have had a stroke but the cause cannot be determined

Frequently Asked Questions About Electrophysiological Study (EPS)

What is the Difference Between EPS and Ablation?

EPS is a diagnostic method used to determine the location and type of rhythm disorders. Ablation, on the other hand, is a treatment procedure performed to destroy the area causing this rhythm disorder.

What is Electrophysiological Assessment?

Electrophysiological assessment is a detailed analysis of the heart's electrical activity.

Is Electrical Leakage in the Heart Dangerous?

The condition commonly known as "electrical leakage" is usually the presence of extra electrical pathways in the heart. The best-known example is Wolff-Parkinson-White (WPW) Syndrome. Whether it is dangerous or not can be clarified with an electrophysiological study.

What Do Electrophysiological Findings Mean?

The answers to questions such as the type of arrhythmia obtained after EPS, its location, whether there is a risk of sudden death, and whether electrical conduction is normal.

How Long Does Electrophysiology Take?

Electrophysiological study generally takes between 1 and 2 hours.