What is an Electrophysiology (EP) Study?

An electrophysiology (EP) study, is a specialized procedure that evaluates the electrical system of the heart. The procedure takes few minutes and its goal is to pinpoint an irregular heart rhythm that may be leading to your symptoms. The EP study can show which area of the heart is causing the arrhythmia, which allows the physician to create a treatment plan. During the EP study, the patient is sedated, and small catheters are advanced into different areas of the heart. The catheters have the ability to read the electrical activity within different areas of the heart, and small amount of electricity can be delivered through these catheters in an effort to induce the arrhythmia. The internal recording of your heart’s electrical activity is often compared to the external recording (electrodes on the patient’s chest) in order to correctly diagnose the arrhythmia.

Why might you need an EP Study?

Your heart should beat in what is called Normal Sinus Rhythm, which is at a normal rate (60-100 beats per minute) with normal electrical conduction through the heart. Arrhythmias (abnormal heart rhythms) are sometimes found in patients – some are congenital, and some arise from different lifestyle factors. In these arrhythmias, the normal electrical conduction in the heart is disrupted and the heart does not function at its full potential. These abnormal rhythms can lead to many symptoms including: fatigue, dizziness, palpitations, sweating, light-headedness, shortness of breath, fainting, and chest pain. Identifying the root cause of the symptoms can be done with the EP study as your physician can ascertain which area of your heart is acting up.

What are the possible outcomes of an EP Study?

There are 4 possible outcomes:

The test was inconclusive: Though the rarest outcome, it is possible that the physician cannot reproduce the irregular rhythm that is leading to your symptoms. In the event this happens, your doctor may decide to send you home with some type of monitoring device. There are Holter monitors, which are portable monitors that externally observe your heart rhythm for 1-2 days. There are event recorders which are another external monitoring device that observe your heart rhythm for up to 1 month. Finally, there are implantable loop recorders that may be implanted for up to 2-3 years. This is a small device that is placed under the skin for a more reliable recording of your heart rhythm when you experience symptoms.

An arrhythmia was induced in the EP lab, but the physician decides that it is best if it is medically managed: In this case, the doctor will send you home with a prescription to control the arrhythmia and in turn help with your symptoms.

An arrhythmia was induced in the EP lab, but the physician decides that it is best if it is medically managed: In this case, the doctor will send you home with a prescription to control the arrhythmia and in turn help with your symptoms.

A radiofrequency ablation is necessary at this time: If the culprit area in the heart is easily fixed with cardiac ablation, the physician will advance another catheter into the heart. This catheter will heat up and cauterize the misfiring tissue, which will put you back into normal sinus rhythm. That tissue will then be unable to misfire anymore, and your symptoms will resolve.

Finally, the EP study may show that you need one of two implantable devices: If it shows that your natural pacemaker is showing signs of disease and sickness, then it is in your best interest to receive an implantable pacemaker. This device can automatically send electrical signals into the heart to ensure that your heart is beating at a normal rate, so it can function at the optimal level. If the EP study shows that your heart is susceptible to ventricular tachycardia or ventricular fibrillation, then it is in your best interest to receive an implantable cardiac defibrillator. In other words, the lower chambers of your heart may be susceptible to beat at very chaotic and high rates. When this occurs, blood is not properly ejected and supplied to the rest of your body. If this happens and you do not spontaneously convert back to normal rhythm, your implantable defibrillator can shock the heart back to its normal rhythm and rate.

How do I prepare for the procedure?

Prior to your procedure, check with our office to see what medications you are allowed to take. If you are taking them, we may ask you to discontinue your blood thinners few days before your scheduled procedure. Also, if you have diabetes, check with the office to see if these medications need to be adjusted.

• Do not eat or drink anything after midnight on the evening before your procedure. You are only allowed a sip of water with your medications – no other liquids or solids are permitted.
• You will be changed into a hospital gown prior to your procedure, so you may wear comfortable clothes into the hospital. Please leave any of your valuables, including jewelry at home.

What is the process of the procedure?

This test is done to study your heart’s electrical function. Your physician will be able to locate different areas in the heart that are causing abnormal rhythms that lead to your symptoms. Your procedure will take place in a specialized lab called the electrophysiology (EP) lab. You will be connected to several monitors for heart rhythm observation.

You will be placed under light sedation during this procedure to help you relax. Once relaxed, your physician will insert several catheters into the blood vessels in your groin, and these catheters will be advanced into the right atrium. A local anesthetic is used at this site to ensure you have minimal pain during the procedure. You will likely be lightly sedated during this study, but you should be comfortable and you will not feel these catheters moving through your vessel with the help of the sedatives and local anesthetics. A nurse or anesthesia provider will always be at the head of your bed to monitor your heart rate, blood pressure, and oxygen level. They will also ensure you are comfortable throughout. Once the catheters are placed in the appropriate regions of your heart, your physician will send electrical impulses from these catheters in order to induce the abnormal rhythm that is causing your symptoms. Different medications may also be used to help in this arrhythmia induction. You will likely feel your heart racing as well as chest pressure/pain during this study. Be sure to communicate with the nurse or anesthesia provider if your symptoms continue.

It is possible that the physician will be unable to reproduce the arrhythmia that is leading to your symptoms, but this is uncommon. If the arrhythmia is induced during the testing, your physician may decide to proceed with an ablation, or they may decide to implant a pacemaker or defibrillator. This decision all depends on what type of arrhythmia is induced.

What is the recovery process of the procedure?

Once the procedure is complete, the catheters will be removed from your groin and pressure will be held at the incision site for several minutes to prevent bleeding. You will then be sent to a recovery unit where you will remain on bed rest for 3-4 hours.

• You will be permitted to eat and drink at this time, but it is very important that your legs remain straight during this time in order to prevent bleeding from the groin.
• You will likely go home on the same day as your procedure depending on what the results are. The outcomes of the procedure will be discussed with you prior to your EP study so you are properly consented for the appropriate treatment before you begin the procedure.

Radiofrequency ablation

Radiofrequency ablation (RFA) uses heat to destroy tissue. For pain management, radio waves are sent through a precisely placed needle to heat an area of the nerve. This prevents pain signals from being sent back to your brain. RFA is considered for long-term pain conditions, especially of the neck, lower back or arthritic joints that haven’t been successfully treated with other methods.

What is radiofrequency ablation (RFA)?

Radiofrequency ablation (RFA), also called radiofrequency neurotomy, uses radio waves to create a current that heats a small area of nerve tissue. The heat destroys that area of the nerve, stopping it from sending pain signals to your brain. RFA can provide lasting relief for people with chronic pain, especially in the lower back, neck and arthritic joints.

Why is radiofrequency ablation (RFA) done?

The goals of radiofrequency ablation are to:

• Stop or reduce pain.
• Improve function.
• Reduce the number of pain medications taken.
• Avoid or delay surgery.

What conditions can be treated with radiofrequency ablation?

Radiofrequency ablation is used to treat:

• Chronic pain caused by conditions including arthritis of the spine (spondylosis) and sacroiliac (SI) joint pain.
• Pain in your neck, back and knee.
• Cancer pain.
• Facial pain caused by trigeminal neuralgia.
• Peripheral nerve pain.
• Heart rhythm problems.
• Tumors (to kill cells).

How does radiofrequency ablation work?

Radiofrequency ablation uses heat produced from radio waves to target diseased tissue. When radiofrequency is applied to nerve tissue, it damages nerves, which prevents or stops the pain signal from reaching the brain and results in pain relief. During a radiofrequency ablation procedure, a small hollow needle is inserted into the targeted nerve that is causing pain. An electrode is inserted into the top of the needle, which sends the radio waves through the needle to the targeted nerve. The heat causes a lesion that prevents the nerve from sending pain signals to your brain. Nearby healthy nerves are not damaged during the procedure.

Pain management within your spine

Radiofrequency ablation is often used to manage pain originating from joints (such as your knee) and oftentimes related to pain from your spine, especially your neck and lower back (lumbar area of your spine). Within your spine, nerves branch off from your spinal cord and travel to the facet joints and sacroiliac joints.

Facet joints are pairs of small joints between the vertebrae in your spine. These joints give your spine flexibility and allow movement of your back, such as twisting and bending. Two small nerves, called medial branch nerves, are connected to the facet joints and send a signal to your brain that there is pain coming from these joints. Sacroiliac joints are found near the bottom of your spine, right above your tailbone. Lateral branch nerves that are connected to these joints send pain signals from the spine to your brain. Using radiofrequency ablation to treat the targeted medial branch nerve in the facet joints or the lateral branch nerve in the sacroiliac joints decreases pain signals from reaching your brain.

Who is a candidate for radiofrequency ablation (RFA)?

Radiofrequency ablation (RFA) may be right for you if have:

• Pain relief following a nerve block injection. This tells your provider that that particular nerve is the source of your pain and is an appropriate target for RFA.
• Chronic pain that does not respond to other treatment, such as pain medication and physical therapy.

You may not be a candidate for radiofrequency ablation if you:

• Are pregnant.
• Have an infection.
• Have a bleeding problem.

What happens before a radiofrequency ablation (RFA) procedure?

We will review your medical and medication history and ask you questions about your pain. If you take aspirin or other blood-thinning medications, you may need to stop taking them for a few days before the procedure. We will examine you and order X-rays or other imaging tests that are typically ordered to see your anatomy, determine the level of arthritis or other spine injury and rule out any other causes. we will perform a test, called a diagnostic block, to confirm the source and level of your pain, which can then predict the potential level of your pain relief. The block consists of an injection of a local anesthetic near the area of pain. If the diagnostic block doesn’t provide significant relief, you may not benefit from RFA. If you have a favorable response to the diagnostic block, your provider may recommend RFA as a treatment to ease your pain

What happens during a radiofrequency ablation procedure?

First, you’ll lie on your stomach on a special X-ray table. Your healthcare provider will use monitors to watch your condition during the procedure. You’ll remain aware so you can answer your provider’s questions during the procedure. Medications can be given during the procedure to relax you but this is optional.

Your doctor will use a local anesthetic to numb the area of your skin where a needle will be inserted. Then:

• A thin needle is inserted into the area where you feel pain.
• Needle placement is guided by a special kind of real-time continuous X-ray called fluoroscopy.
• Once the needle has reached the intended site, your doctor will do a test to confirm it’s in the proper position. The test consists of inserting a microelectrode through the hollow needle. Your doctor will ask if you feel a tingling sensation (or discomfort or a muscle twitch). This means the right location has been found for treatment.
• A local anesthetic is injected through the needle to numb the target area.
• A radiofrequency current is sent through the needle to heat the identified portion of the nerve.
• The current destroys that area of the nerve, stopping it from sending pain signals to your brain.
• More than one nerve can be treated during the procedure (if needed).

How long is the radiofrequency ablation procedure?

Radiofrequency ablation takes from 15 minutes to two hours to complete, depending on the treatment location and number of treatments performed.

What happens after a radiofrequency ablation procedure?

After your radiofrequency ablation procedure:

• You’ll go home shortly after your procedure. Someone must drive you home
• Rest when you get home. Don’t drive or do anything strenuous for 24 hours after the procedure. After a day or two, you can return to your normal activities, including bathing or showering.
• You may still feel soreness, pain or muscle spasms at the treatment site for a few days. Your healthcare provider may have prescribed pain medication for the soreness and pain. You can also apply an ice pack to the injection site, off and on for 20 minutes a few times during the first day of your recovery at home.

Your provider may have also recommended physical therapy to regain strength and flexibility. You’ll also have a follow-up appointment to check on your progress and to have any questions you may have answered

What are the advantages of radiofrequency ablation?

Advantages of radiofrequency ablation include:

• Pain relief.
• No surgery.
• Little to no recovery time.
• Decreased need for pain medications.
• Improved function
• Return to regular activities after a day or two of rest.