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What happens during an EP study?

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You will be transferred to the Electrophysiology Laboratory (EP lab) from your ward.  Usually before leaving your ward you will be given a light sedative and your groin will be shaved. 

The EP lab has a patient table, X-Ray tube, ECG monitors and various equipment. The staff in the lab will all be dressed in hospital theatre clothes and during the procedure will be wearing hats and masks.

Many ECG monitoring electrodes will be attached to your chest area and patches to your chest and back. These patches may momentarily feel cool on your skin.

A nurse or doctor will insert an intravenous line usually into the back of your hand.  This is needed as a reliable way to give you medications during the study without further injections.  You will also be given further sedation if and as required.  You will also have a blood-pressure cuff attached to your arm, which will automatically inflate at various times throughout the procedure.

The oxygen level of your blood will also be measured during the EP study and a small plastic device will be fitted on your finger for this purpose. Your groin area and possibly your neck or arm will be washed with an antiseptic cleansing liquid and you will be covered with sterile sheets leaving these areas exposed.

The doctor will inject local anaesthetic to the area where the catheters are to be placed.  After that, you may feel pressure as the doctor inserts the catheters but let the staff know if there is any discomfort so some more local can be given. Once the catheters are in place you may feel your heart being paced and possibly your abnormal heart rhythm will be induced.

 

What is radiofrequency ablation (RFA)?

Radiofrequency is a low power, high frequency energy that causes a tiny region of the heart near the tip of the catheter to increase in temperature, thus ablating a small area of tissue. 

Radiofrequency energy has been used for decades by surgeons to cut tissue or to stop bleeding. For the treatment of palpitations, a much lower power of radio-frequency is used.

 

Which patients are suitable for RFA?

Depending on the findings at your EP study it may be possible to ablate the mechanism for your abnormal heart rhythm. This is usually done at the same time as your EP study as the necessary electrodes within the heart are already in place.

 

Are there alternatives to radiofrequency ablation?

Before the advent of radio-frequency ablation patients had two options to control their palpitations.

One is life-long medication,which works well in some patients, but requires the patient to take daily medication.  There is also the possibility of side-effects from these drugs.

The other way of controlling the problem was by open-heart surgery to cut the accessory pathway.  This was a very successful technique and many patients were cured of their palpitations in this way.  Besides the small risk of open heart surgery and operation leaves a permanent scar on the chest.

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Melbourne Heart Rhythm is the arrhythmia service at the Department of Cardiology at the Royal Melbourne Hospital. We are comprised of a team of highly trained and dedicated health care professionals specializing in heart rhythm management. We have a strong focus on patient education and patient centered care. Our arrhythmia specialists have an international reputation of excellence in arrhythmia research and clinical arrhythmia management.