EPS (Electrophysiological Study) – What Is Ablation? In Which Cases Is It Applied?
An electrophysiology (EP) study is a special procedure that allows the doctor to examine the electrical signals of the heart in detail and precisely identify the source of any abnormal heart rhythm (arrhythmia). If you are experiencing an abnormal heart rhythm, it may be helpful to investigate in more detail exactly what the abnormal heart rhythm is and, if possible, treat it. Standard ablation procedures are usually performed right after an EP study. There are necessary conditions for both procedures to be carried out. Before these procedures are performed, the doctor reviews the person's medical history. For more information about electrophysiological study and ablation, you can follow our article.
What Is an Electrophysiological Study (EPS)?
An electrophysiological study (EP study) is a test used to evaluate the electrical system of the heart and to control abnormal heart rhythms. During an EP study, the doctor inserts small, thin wire catheters into a vein in the groin (or, in some cases, in the neck). Once the catheters reach the heart, they measure the heart's electrical signals. An EP study can provoke and diagnose abnormal heart rhythms. The doctor sometimes continues to treat the problem by performing a catheter ablation. This treatment uses heat (radiofrequency ablation) or freezing to destroy the areas inside the heart that cause the abnormal rhythm. The possible risks of an EP study are bleeding and bruising at the site where the catheter is inserted into a vein. For some people, since it would be difficult to lie still throughout the study, these patients are sedated during the procedure.
In Which Cases Is It Performed?
Measurement of the heart's electrical activity with an ECG before the EPS may be requested. An ECG can detect the heart rhythm, but more tests are needed to find the source of the arrhythmia so that an intervention can be made, because the arrhythmia may originate from any area of the heart's electrical network. An EP study provides information on how electrical signals travel through the heart. Situations in which this information may be needed are:
Arrhythmia (rhythm disorder)
Atrial fibrillation (rapid beating of the upper chambers of the heart)
Ventricular fibrillation (rapid beating of the lower chambers of the heart)
Risk of sudden cardiac death
Tachycardia (fast heart rate)
Bradycardia (slow heart rate)
Dizziness
Fainting
Weakness
Palpitations
What Is Ablation?
Ablation is a procedure to treat atrial fibrillation, that is, heart rhythm disorders. It uses small burns and freezing inside the heart to help break the electrical signals that cause irregular heartbeats. Normally, a specific group of cells generates the signal that initiates the heartbeat. The atrium cannot contract normally to carry blood to the ventricles. In the burning process, a type of energy called radiofrequency energy uses heat to injure the tissue. Sometimes doctors use a surgical approach instead.
Cardiac ablation is a procedure that injures tissue in the heart to block irregular electrical signals. It is used to treat heart rhythm problems (arrhythmias). Long, flexible tubes (catheters) are passed through the blood vessels into the heart. Sensors at the tips of the catheters deliver hot or cold energy to destroy (cut) the tissue. Less commonly, ablation is performed during heart surgery. Cardiac ablation is a procedure used to correct heart rhythm problems. As the heart beats, the electrical signals that cause the heart to contract (squeeze) must follow a specific path through the heart. Depending on the type of heart rhythm problem, cardiac ablation may be one of the first treatments. At other times, it is performed when other medications and treatments have not worked.
Some people have distressing symptoms such as shortness of breath and palpitations due to atrial fibrillation. Atrial fibrillation also greatly increases the risk of stroke. Anticoagulant medications used to prevent stroke also carry their own risks, and people taking these medications need to consult a specialist before the procedure and should be monitored after the procedure. If there are symptoms arising from atrial fibrillation, ablation may be a good option.
Depending on the person's specific medical condition, other risks may also exist. All concerns that may cause worry should be discussed with a health professional before ablation. Although rare, there is a risk of death. Another risk is that the procedure may not permanently eliminate atrial fibrillation. If the person is elderly, has other heart problems, or has had atrial fibrillation for a longer period, this problem may be more likely to occur.
Catheter Ablation: If catheter ablation is being performed, an intravenous (IV) line is placed in the arm to administer anesthesia. Due to the length of the procedure, it is usually performed under general anesthesia. The cardiologist inserts a small tube through the skin into a vein, usually in the groin. Then, electrode catheters (thin tubes with wires) are inserted into the sheath and passed into the heart using X-rays as a guide. The catheter delivers hot or cold energy to eliminate irregular or abnormal rhythms.
Surgical Ablation: If surgical ablation is being performed, general anesthesia is administered. The cardiac surgeon may perform the ablation during open-heart surgery. Alternatively, the doctor may perform a less invasive hybrid operation and make small incisions in the chest to access the heart.
Is the Ablation Procedure Dangerous?
As with every procedure, there are various risks with ablation. However, risks may be greater if the treatment procedure is not performed. For this reason, the benefits of ablation for the person are evaluated by the doctor before the procedures, and ablation is recommended accordingly. The possible risks, which may occur in rare cases, are:
Arrhythmia
Blood clot
Vascular injury
Valve damage
Infection
Bleeding
How Is Ablation Performed?
First, before starting the procedure, it is checked whether the patient has an allergy to any drug, latex, or another substance. It is necessary to fast for a certain period before the test. A sedative agent is usually given before the test. An ablation usually does not work immediately, and some symptoms, such as palpitations, may continue after the procedure. In this case, the patient should be monitored for a while after the procedure. It becomes clear whether the procedure has worked after about 8–10 weeks. If it is successful, the doctor may consider stopping some of the medications. If the ablation does not work the first time and symptoms do not improve or return, another ablation may be needed or other treatments may be considered.
The physician who will perform the procedure may request several tests to obtain more information about the heart's condition before cardiac ablation. It is necessary to stop eating and drinking the night before the procedure. It is also important to decide how to continue any medications before cardiac ablation. Cardiac ablation is performed in the hospital. A specialist places an IV in a vein in the arm or hand and gives a sedative medication to help the person relax. The amount of sedation required for the procedure depends on the specific arrhythmia and other health conditions. The person may be fully awake or may have received general anesthesia.
During cardiac ablation, a long, flexible tube (catheter) is passed through a blood vessel to reach the heart. Sensors at the tip of the catheter send electrical impulses and record the heart's electrical activity. The health professional uses this information to identify the area causing the arrhythmia and to decide where the ablation should be applied. This part of the procedure is called an electrophysiology (EP) study. If there is severe pain or shortness of breath, the health professional should be informed.
How Long Does Ablation Take?
Completing cardiac ablation usually takes three to six hours, but it can vary greatly depending on the type of rhythm disorder. After the procedure, the doctor removes the catheter and sheath from your vein. The person is then taken to a recovery room, where they will be closely monitored for several hours. The length of stay depends on how invasive the surgery was. After the procedure, it is safer for someone else to take the person home. Some people feel a little pain after the procedure. The pain should not last more than a week. It is also important to avoid lifting heavy objects for about a week. The doctor may prescribe blood-thinning medications for several months.
Is There an Age Limit?
Apart from general health-related risks, there is little that prevents a young person from undergoing ablation. The benefit of an ablation becomes even more meaningful, as it can reduce the side effects of long-term medications, the risk of cardiovascular disease, and especially the risk of heart failure later in life. Doctors routinely treat young and healthy patients. At the same time, doctors also perform catheter ablation on elderly patients (up to 90 years of age), and it can yield results similar to those in younger patients. However, as age advances, patient selection becomes more critical. There is nothing inherent in the nature of the catheter ablation procedure that poses an excessive risk in an elderly person. Ideal patients are those who have not succeeded with one or more antiarrhythmic drugs, who have poor tolerance to the side effects of drug therapy, and who are at risk of or have heart failure.
People with arrhythmia problems who are considering the ablation option are strongly advised to seek support from a specialist. Since the procedures have surgical dimensions, they must definitely be performed by experts in their field. It should not be forgotten that otherwise, unwanted complications may occur. If you would like more information about electrophysiological study and ablation, please consult a healthcare institution.
