Electrophysiologic testing (EPS) refers to a catheterization
procedure during which attempts are made to provoke potential
rhythm disturbances. In theory, if a given type of rhythm
problem cannot be produced by provocation, then it would be
considered unlikely that the suspected arrhythmia could occur
spontaneously. On the other hand, if a given rhythm disturbance
can be reproducibly induced in the EP lab, it is felt that the
patient is likely to be at risk for developing this same arrhythmia
spontaneously at any time in the future. Thus, the test is intended
to uncover an occult rhythm disturbance. Depending upon the type
of arrhythmia to be evaluated, the complexity and number of
catheters may vary. Most commonly, tachyarrhythmias either in
the upper or lower chambers are being sought.
The patient is usually brought to the EP lab in the fasting, non-
sedated state after obtaining appropriate informed consent.
Under moderate sedation, between 2-4 catheters are placed
into the heart via the veins of the lower and sometimes upper
extremities. After suitable catheter tip positioning and standard
locations, the process of heart stimulation is begun. If a specific
arrhythmia is induced, stimulation is usually repeated to ensure
reproducibility.
EPS is generally a low risk procedure and may last for only 15-45
minutes. A brief period of bed rest is usually necessary to avoid
bleeding from the puncture sites. The risk of the procedure is
quite low, comparably less than that associated with cardiac
catheterization.
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