Diagnostic EP study

An electrophysiology (EP) study may be required to diagnose arrhythmias. It is minimally invasive and provides valuable data in selected patients with suspected arrhythmias such as SVT or syncope. In some cases, it can be used to risk stratify patients who are at risk of developing abnormal rhythms such as ventricular tachycardia. It is often used together with a loop recorder implant to diagnose difficult to document arrhythmias.

Generally, it is important to have documentation of rhythm by non-invasive means prior to embarking on invasive investigations or treatments.

 What are the risks of having a diagnostic EP study?

They include but are not limited to the following.

Common risks and complications (< 5%)  include:
• Bruising bleeding at the puncture site. Bruising can extend beyond the puncture site and can take a few weeks to improve in some cases.

Uncommon risks and complications (<0.5%) include:

• A hole is made in the heart needing drainage
• Major bleeding related to the groin puncture site or injury to an artery in the groin. This (rarely) may need surgery and or blood transfusion.
• Blood clot in the leg (DVT) causing pain and swelling. In rare cases part of the clot may break off and go to the lungs called pulmonary embolus.

What are the costs involved with an ablation?

If you are having this procedure in a public hospital as a public patient, the cost is covered by Medicare.  If you are having this procedure in a private hospital, there is no additional out of pocket cost for our specialists. The usual hospital excess applies. Some anaesthetists have an out-of-pocket cost that we encourage you to discuss prior to your planned procedure.

How do I prepare for a diagnostic EP study?

You will receive a letter with instructions and steps required prior to your procedure including, date of admission, fasting instructions, medications to stop and items to bring with you.

In General, do not eat or drink for 6 hours before your procedure. Ask your doctor about taking your usual medications. Blood thinners are usually continued for AF ablation procedure. If you take SGLT2 medicine for heart failure or diabetes, you will need to stop taking them at least 3 days before your surgery. Read the SGLT2 inhibitor information sheet. Leave any personal items of value such as jewellery at home.

What happens when you arrive at the hospital?

Once you arrive at the hospital for your procedure, you will usually be directed to the cardiac catheter laboratory admission area where you will be formally admitted as a hospital patient. You will be asked to change into hospital gown and put away all your valuable belongings. You will have some basic tests such as ECG, have your vitals recorded, groin shaved and have a cannula inserted into your arm to assist with the procedure. The technologists will place special wires and stickers on your chest and back.

What happens during the procedure?

Local anaesthetic is administered at the groin which numbs the area. Small tubes called sheaths are passed into the vein in the right groin through which catheters are inserted and gently passed up until they reach your heart. An X-ray machine guides the catheters to your heart. The wires are used to transmit electrical signals to the heart to evaluate the electrical system and to induce abnormal rhythms if applicable. The diagnostic EP study procedure can take about 30mins or more hours in some cases.

If an abnormal rhythm is found, your doctor may proceed to a therapeutic intervention called ablation based on the clinical circumstances of your case.

What happens after an ablation?

At the end of your procedure, your doctor will remove the catheters and apply pressure, followed by a dressing. You may have a little device applying pressure at the puncture site for a few hours. You’ll be watched closely in a recovery area, and depending on how you feel, you might need to rest in bed for a while. People are usually discharged the same day.

What happens after discharge?

Follow up:

• An appointment will be made for you to be seen in clinic about 2 months after the procedure
• If you do not receive a date for an appointment within 8 weeks, please call the clinic and ask to speak to the secretary

Medications:

• Continue your medications as instructed. If you are uncertain about your medications, please ring the rooms for clarification

Postoperative care:

• Avoid strenuous exercise for 2-3 days

Symptoms to monitor:

• It is not uncommon to have a bruise at the groin that extends / spreads after the ablation. This usually resolves over time without any other problems.
• Bleeding: It is rare to have severe bleeding from the puncture site once you are at home. If bleeding does occur you must: lie flat, apply pressure to the site for 10 minutes. If it continues, call an ambulance for assistance.

Please contact the rooms if you have any questions or concerns at any time.

In recommending this procedure your doctor has balanced the benefits and risks of the procedure against the benefits and risks of not proceeding. Your doctor believes there is a net benefit to you going ahead. This is a very complicated assessment.

Download the EP study patient information sheet {link to EP study patient information sheet