Electrophysiology Studies Cardiac Conduction System. Mdmedicine.wordpress.com Patient Information Leaflet for: Electrophysiology Studies Available via Trust Docs Version: 6 Trust Docs ID: 10 Page 1 of 10
Contents Page Why do I need Electrophysiology Studies? 3 What are Electrophysiology Studies? 3 Risks of the procedure 3 How long will I need to stay in hospital? 4 What does the procedure involve? 5 Before admission 5 Before the procedure 5 During the procedure 6 After the procedure 7 Discharge 7 Wound Care 8 Medication 8 Resuming Normal Activities 8 Driving 9 Work 9 Follow up 9 Arrhythmia Specialist Nurses 9 Contact Numbers 10 Why do I need an Electrophysiology (EP) Study? The heart is a ball of muscle which delivers blood and oxygen around the body. It is divided into two upper chambers (atria) and two lower chambers (ventricles). The heart normally beats in a regular and organised way at 60 100 beats per minute. The heart is stimulated to beat by the sinus node. This causes electrical impulses to spread across through the top chambers of the heart, then into the bottom chambers of the heart via a connecting cable (the atrioventricular node). Sometimes the electrical conduction pathways of the heart can become damaged or blocked. Occasionally patients have an extra pathway; this is known as an accessory pathway. These changes can cause the heart to beat too slowly (Bradycardia) or too fast (Tachycardia). They can also cause the heart to beat in an irregular rhythm. Abnormal heart rhythms are known as arrhythmias. These abnormal rhythms can occur in the upper chambers or the lower chambers of the heart. Patient Information Leaflet for: Electrophysiology Studies Available via Trust Docs Version: 6 Trust Docs ID: 10 Page 2 of 10
Arrhythmias may affect the heart s ability to pump blood around the body which can lead to the symptoms you may be experiencing. To find out more about your arrhythmia and to decide on the best treatment plan for you, you have been advised that an EP study is needed. The EP study provides the doctor with information about your heart s electrical conduction system. It is carried out to try to find out why your heart is beating in an abnormal pattern i.e. too fast or in an irregular pattern, or due to an extra electrical conduction pathway. What are Electrophysiology Studies? An EP study is a relatively simple procedure. The doctor will insert several small tubes (catheter electrodes) through the vein in your groin. The catheters are fed up through the venous system and round into your heart. The electrodes will be placed in specific positions within your heart. They will then record the electrical signals from inside your heart. The EP study records how your heart reacts to extra electrical signals delivered to different areas within your heart. This will allow your doctor to collect detailed information about the cause of your arrhythmia and choose the most effective treatment for you. Risks of the procedure The majority of patients who undergo Electrophysiology studies do not experience complications. Complications associated with this procedure are very rare. However there are some risks associated with the procedure that may occur during or after the procedure. It is important to remember that the risks outlined below are rarely life threatening and can be treated. Patient Information Leaflet for: Electrophysiology Studies Available via Trust Docs Version: 6 Trust Docs ID: 10 Page 3 of 10
At the time of the procedure: Occasionally the catheter electrodes can accidentally damage the blood vessels when being moved into position within the heart. The risk of this happening to you is 3-5%. Serious injury to the blood vessels requiring surgical intervention to repair the damage is extremely rare and occurs in less than 1% of patients. If the area within your heart causing the problem is near the normal conduction pathway, there is a risk of damaging the normal system. This would mean you would need a pacemaker to correct the block down the normal conduction pathway. This is a rare complication. The risks of blood clots developing that travel to your lungs (Pulmonary Embolism), brain (Stroke) or lower leg (DVT) is less than 1%. It is common to experience palpitations during your procedure. Your heart beat will usually return to normal very quickly without needing further treatment. However, very occasionally additional treatment is needed to correct your arrhythmia. This may include medical or electrical cardioversion. If electrical cardioversion is required you will be given sedation prior to this. During placement the catheters may puncture your heart muscle causing blood to collect around the heart. This is called cardiac tamponade. If this happens you may need a further procedure to drain this off. The risk of this happening to you is less than 1%. After the procedure: Minor bruising and bleeding around the groin site is common following the procedure. This usually disappears within a week and does not cause any problems. You may experience some heavy heart beats or some very short runs of palpitations in the first few weeks after the procedure. These are usually nothing to be concerned about, but if you are worried please ring the Arrhythmia Nurses on 01603 288852. How long will I need to stay in hospital? Your procedure will usually be a day case procedure, so you are able to go home the same day. You will usually come into hospital on the morning of your procedure. You may need to stay in hospital overnight if you feel unwell after the procedure. Please bring a small overnight bag with your toiletries, night wear and any other personal belongings you may need. Please do not bring any thing valuable or large (over 20) amounts of money. You may want to bring a book, or a small music device (with ear phones), to help pass the time whilst you are on bed rest. Patient Information Leaflet for: Electrophysiology Studies Available via Trust Docs Version: 6 Trust Docs ID: 10 Page 4 of 10
What does the procedure involve? Electrophysiology Studies The procedure is carried out in a special EP lab, within the angiography suite, using x-ray screening (if you think you may be pregnant you must let us know prior to the procedure). This is a safe procedure. It is usually carried out under local anaesthetic, with sedation if needed. Before admission: You may be asked to stop some of your anti arrhythmic medication. The arrhythmia nurse will advise when to stop medications as needed at your pre assessment clinic appointment prior to your procedure. This allows the doctor to make a more accurate assessment of your heart rhythm. If you are taking warfarin or other blood thinning medication the arrhythmia nurse will advise you if you need to stop your warfarin or other blood thinning medication prior to the procedure, or if there is a specific target INR needed prior to the procedure. You may need weekly blood tests before and after the procedure, the nurse will tell you if this is needed. If you have any questions relating to your medication please contact the arrhythmia nurses. It is important to be aware that your symptoms may return when you stop taking your antiarrhythmic medication. If you are diabetic the arrhythmia nurse will advise you if you need to withhold any of your diabetes medications, at your pre assessment clinic appointment prior to your procedure. Before the procedure: You will be sent details of your admission date, time and admission ward. On arrival to the ward a nurse will admit you to the ward, or walk you to the recovery area of the angiography suite where you will be admitted. This involves talking to you and/or your family about the procedure, answering any questions you may have and preparing you for the procedure. You may need to have blood taken on admission if you are on warfarin or having an AF Ablation Procedure. - You will need a small plastic tube (cannula) inserted into your hand, this is used to give medications during the procedure if needed. - You will be given a hospital gown and paper pants to wear. You will go to the lab on your bed. - You cannot eat for 6 hours before your procedure; you can drink clear fluids until 2 hours before your procedure. If you are having an AV node ablation you can eat and drink normally until 2 hours before the procedure. The nurse at pre-assessment will advise you when to stop eating and drinking. - If you are diabetic the nurses will advise what to do about your insulin/tablets. Your blood sugar will be checked regularly as not eating may affect your sugar levels. - The procedure may take up to 4 hours. Patient Information Leaflet for: Electrophysiology Studies Available via Trust Docs Version: 6 Trust Docs ID: 10 Page 5 of 10
- If you have any allergies or have had any reactions to any medications please inform the nurse. - The doctor will also see you before the procedure to ask you to sign a consent form. This may not happen until you are in the angio suite prior to the procedure. Signing the consent form ensures that you understand the procedure you are about to have and the risks related to this. Your family may wait for you in the hospital public areas, but are not able to accompany you to the angio suite due to a lack of space. If you have any concerns or questions about your hospital stay or procedure, please ask the nurses. During the procedure: You may feel anxious. The nursing staff in the catheter lab are aware of your possible anxieties and will stay with you throughout the procedure. To help you relax the doctor may give you a short acting sedative which will make you feel relaxed and possibly sleepy. The doctor will inject local anaesthetic into your groin to numb the top of your leg. This may sting initially. The sheaths will then be inserted. Sometimes the doctor may also put a sheath into your neck or one of the veins below your collar bone. You may be able to feel some pressure as the sheaths are inserted into your groin (or neck), you should not feel pain. If you do feel any pain please let the doctor know as more local anaesthetic can be given. Through the sheaths the doctor will insert several flexible wires (catheter electrodes) and feed them into your heart. Once in place, these special wires will record the electrical signals from your heart. The wires are very small and are positioned under x-ray screening. You should not feel any pain during this procedure. Your doctor will then try to start your arrhythmia by giving your heart small electrical impulses to make it beat at different speeds. You may also need to be given drugs to help start your arrhythmia. During this time you may feel your heart speed up, slow down or miss a beat. This may feel uncomfortable for you. Please be reassured that we will be monitoring you closely and can stop the arrhythmia whenever we need to. This allows detailed information to be collected about the cause of your arrhythmia and pinpoint where the area of extra electrical activity responsible for your arrhythmia is within your heart. Once the doctors have collected enough information about your arrhythmia the test will be stopped. Patient Information Leaflet for: Electrophysiology Studies Available via Trust Docs Version: 6 Trust Docs ID: 10 Page 6 of 10
If you require ablation, this will usually then be carried out. This involves delivering a form of energy down the wire to the target area within the heart. The most common source of energy used is a heat source, called radio-frequency energy, but other types include, cryotherapy which freezes the area. This part of the procedure may be a bit uncomfortable, so more sedation may be given. Your arrhythmia should stop by itself once the procedure is completed. If it does not stop your doctor will need to stop it, using pacing, medication or electrical cardioversion (shocking the heart). If you need electrical cardioversion you will be given more sedation for this procedure to be carried out. If you have any discomfort during the procedure such as chest pain, dizziness or shortness of breath, please tell the doctor or nurse. It is important that the doctor is aware of how you are feeling. After the procedure is completed the catheters will be removed and the intravenous lines taken down. When the sheath is removed firm pressure will be applied to your groin to stop you from bleeding. This may be uncomfortable for you, for a few minutes. After the procedure: You will go into the recovery area of the angio suite where you will be observed for a short time before going to the ward (or you may stay in recovery until you are able to go home). On return to the ward you will be lying flat on bed rest for thirty minutes to 3 hours, following this you may be able to sit up and then get up after that. You may feel sleepy until your sedation has worn off. The nurses will be taking regular blood pressures and checking your groin site for any bleeding or swelling and checking foot pulses. The nurse will also record an ECG on your return to the ward. It is important that you do not get out of bed too early to help to prevent you from bleeding. You can rotate your ankle and flex your foot but try to lie still and avoid bending your leg. Once the sheaths are removed and you can sit up, you can eat and drink normally. The results of your EP test and/or procedure will be discussed with you after the test. Discharge You should be able to go home on the day of your procedure. If you live alone you will need to stay in hospital overnight. You will need someone with you for 24 hours after the procedure if you have had sedation. If you have sedation you are not able to operate machinery or sign legal documents for 24hours after the procedure. You must have someone to collect you as you are advised not to drive for one week. Patient Information Leaflet for: Electrophysiology Studies Available via Trust Docs Version: 6 Trust Docs ID: 10 Page 7 of 10
Wound Care Following your procedure please do not bathe for 24 hours. You may have a shower the day after your procedure. It is usual to experience some bruising of the groin. This may last a few days. In the unlikely event of any bleeding: 1. Lie down 2. Apply firm pressure to the puncture site for at least 10 minutes. 3. If the bleeding fails to stop, call 999 for an ambulance. 4. Continue to press for a further 10 minutes after the bleeding has stopped. 5. Inform the Arrhythmia Specialist Nurse if you have any bleeding (between 8am and 5pm Monday to Friday). 6. After 5pm, weekends and bank holidays, please contact the Coronary Care Unit on 01603 286364 for advice. Contact the Arrhythmia Specialist Nurse if you have a temperature or fever following the procedure, or if you notice any of the following: Persistent tenderness or swelling of the leg and/or foot Numbness or pain of the leg and/or foot Redness or warmth of the groin wound New oozing from the wound Increased shortness of breath Indigestion symptoms Medication You may be asked to take aspirin for one month. If you are on warfarin or other blood thinning medication you will be given specific instructions regarding your doses and blood tests following the procedure You should continue your other tablets unless instructed otherwise Some of your heart rhythm tablets may be stopped or changed by the Doctor. Resuming Normal Activities You can resume your normal activities (walking, bathing, sexual activity, etc.) upon discharge. The only restriction is straining or lifting heavy objects for one week, to allow the puncture site to fully heal. Patient Information Leaflet for: Electrophysiology Studies Available via Trust Docs Version: 6 Trust Docs ID: 10 Page 8 of 10
Driving The DVLA advises that you do not drive for at least 2 days following your procedure. Your consultant advises you do not drive for one week following the procedure. You do not need to inform the DVLA of your condition. If you have a group 2 licence the DVLA advice is not to drive for 6 weeks following successful ablation. For further advice regarding driving please speak to the Arrhythmia Specialist Nurse. Work You are advised to take one week off work following your procedure. Follow Up You will get a letter through the post, following discharge, with an appointment to come back to the hospital to see your consultant, usually in 4-6 months. If you have any queries or concerns in this time you can contact the Arrhythmia Specialist Nurse for advice. The Arrhythmia Specialist Nurse The Arrhythmia Specialist Nurse will ring you at home a few days after your procedure to check on your progress. This nurse will serve as a point of contact for any problems and queries you may have prior to and after your procedure. There is an answer phone service for non urgent queries and enquiries. The nurse will get back to you as soon as they can if you leave a message with your name and contact number. Patient Information Leaflet for: Electrophysiology Studies Available via Trust Docs Version: 6 Trust Docs ID: 10 Page 9 of 10
Hospital Contact Numbers Cardiac Arrhythmia Specialist Nurses: Available Monday to Friday between 9am and 5pm. Call the hospital switchboard on 01603 286286 and request bleep 0714 or DECT phone 2371. For non-urgent enquiries and queries, call 01603 288852 (answerphone). Useful Contacts NHS Direct (24 hours) 0845 4647 Arrhythmia Alliance website: www.heartrhythmcharity.org.uk British Heart Foundation website: www.bhf.org.uk DVLA Website: www.dvla.gov.uk Patient Information Leaflet for: Electrophysiology Studies Available via Trust Docs Version: 6 Trust Docs ID: 10 Page 10 of 10