EP Study Risks

I am a 33 year old male, non smoker in good health and would like to know the risks that are commonly associated with an EP STUDY.  Can you tell me how safe is the EP Study and what are the risks?  I am familiar with an individual that suffered damage to their AV node during the ablation of an EP Study.  Is this an inherent risk of the procedure?  Does this happen often?  This individual now has a pacemaker because of the incident.  Is this common and will the pacemaker be permanent.  Thank you for taking the time to answer these questions. I will have to have the EP Study done and I am very concerned about the risks.

[Cleveland Clinic, MD]

In general an EP study by itself is very safe and has very low risks.  Ablation is an additional procedure and has some increased risks but is still in general safe.  Here is some more information about ablations.


Dear Kat,

Thank you for your question. Ablations are practically pain free (think going to the dentist).  A relaxing medication similar to valium is sometimes given and can have some amnestic properties but this is not the reason it is given.  Here are some other commonly asked questions concerning radiofrequency ablation.

What is radiofrequency ablation?

A radiofrequency ablation or RFA is a treatment for abnormal heart
rhythms. During RFA, your doctor will use a special machine to direct high
frequency electrical energy to remove areas of the heart muscle that cause
the abnormal rhythms. It can also be used to "disconnect" the electrical
pathway between the upper chambers (atria) and the lower chambers
(ventricles) of the heart. The type of RFA performed depends upon the
type of arrhythmia you have.

What to do before a RFA.
Should I take my medications?

Your doctor may ask you to stop certain medications (such as those that
control your heart rate or aspirin products) one to five days before your
procedure. Ask your doctors which medications you should stop.

Can I eat?

You must have an empty stomach. Do not eat or drink anything after
midnight the night before your procedure. If you must take medications,
drink only small sips of water to help you swallow your pills.

What should I wear?

When you come to the hospital, wear comfortable clothes. It is best not to
wear any jewelry or valuables.


What should I expect during the RFA?

Where does it take place?

Your test will take place in a special room called the EP
(electrophysiology) lab. Before the test begins, a nurse will help you get
ready. The nurse will start an IV (intravenous) line, This is so the doctors
and nurses may give you medications and fluids during the procedure if
necessary.

Will I be awake?

It is common to be nervous. A light sedative will be given to you through
your IV to relax you and make you drowsy. This medication will not put
you to sleep. You will be asked to report any symptoms, answer
questions or follow instructions given to you by your doctor. If you are
uncomfortable or need anything, please let your nurse know.

Will I be monitored?

The nurse will connect you to four monitors:

Defibrillator/Pacemaker:
Attached to one sticky patch placed on the center of your back and
one onto your chest. Allows the doctor and nurse to pace your
heart rate if it is too slow or deliver energy to your heart if the rate is
too fast.

Electrocardiogram or EKG:
Attached to several sticky electrode patches placed onto your
chest, as well as catheters placed inside your heart. Provides a
picture on graph paper of the electrical impulses traveling through
your heart.

Oximeter monitor:
Attached to a small clip on your finger. Checks the oxygen level of
your blood.

Blood pressure monitor:
Connected to a blood pressure cuff on your arm. Checks your
blood pressure intermittently throughout the study.

These monitors allow the doctor to check your heart rhythm and
the body's responses to arrhythmias.


What are catheters?

The catheters used by the electrophysiologist are special wires that can
pace the heart and precisely record its electrical activity.

How does the doctor insert the catheters into my heart?

Your groin area will be shaved and cleansed with an antiseptic solution.
Sterile drapes will be placed to cover you from your neck to your feet. A
light restraint will be placed across your waist and arms to prevent your
hands from coming in contact with the sterile field.

The doctor will numb your groin by injecting a medication. You may feel
an initial burning sensation, then it will become numb.

The doctor will then insert several catheters into the large blood vessel(s)
in your groin. The doctor will use the fluoroscopy machine to guide the
catheters into your heart. It is important that you remain still and resist the
temptation to raise your head to see what the doctor is doing while the
doctor places the catheters are being placed.

Sometimes, it may be necessary to use both an artery and a vein.

What will I feel?

After the catheters are in place, the doctor will look at the monitor to
assess your heart's conduction system. Then, the doctor will use an
external pacemaker to give the heart electrical impulses to increase your
heart rate. You may feel your heart beating faster or stronger when your
heart is paced. If an abnormal heart rhythm occurs, the nurse will ask you
how you are feeling. It is very Important to tell the doctor or nurse the
symptoms you feel.

The doctor will then move the catheters around your heart to see which
area(s) your arrhythmia is coming from. Once the doctor finds the area of
your heart that causes the arrhythmia, energy is applied through the
catheter. You may feel some discomfort or a burning sensation in your
chest. This is normal. During this time you must stay quiet, keep very still,
and avoid taking deep breaths. If you are extremely uncomfortable, tell
your nurse or doctor and more medication may be given.

How long does on RFA last?

About 2 to 6 hours.

Are there any risks to an RFA?

Radiofrequency ablation is generally very safe. However, as with any
invasive procedure, there are risks to having an RFA. Special precautions
are taken to decrease the risks. Your doctor will discuss these risks with
you. Any specific questions should be directed to your doctor.


What should I expect after the RFA?

When will I find out the results?

Results of the procedure will be given to you and your family after the test.
Your doctor will also discuss when you can resume activities.

If you have any other questions, please ask your doctor or nurse.

Will I have to stay in the hospital after RFA?

After RFA you will be admitted to the hospital. You will be taken to your
room and placed on a special monitors called telemetry. Telemetry
consists of a small box connected by wires to your chest with sticky
electrode patches, The box causes your heart rhythm to be displayed on
several monitors on the nursing unit. The nurses will be able to observe
your heart rate and rhythm.

You will be discharged the next day and given follow-up instructions.

Many individuals feel extra heartbeats on and off for a few weeks.
Sometimes you may also feel as if your tachycardia (fast heart rate) is
starting, but then it stops. These sensations are normal and you should not
be alarmed. If however, your tachycardia reoccurs, notify your doctor.

How do I care for the wound site?

After the RFA, the doctor will remove the catheters from your groin. To
prevent bleeding, the doctor will apply pressure to your groin area for
several minutes. Then, you will need to be at bedrest for one to six hours.
Keep your legs as still as possible during this time to prevent bleeding.

No stitches are needed. Your incision will have a small sterile dressing on
it which can be removed the next day. Keep the area clean and dry.
Report any redness, swelling, or drainage at the groin site to your doctor
or nurse.


I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.

If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

[Patrice]

Hi James,

i had an EP study done last year and I had a complication.  It is a low risk for complication but it does happen in any procedure.  I really don't like this test because the more I read about it the more I don't think its worth it.  First, it doesn't always give the doctors the answers they are looking for.  From what I have read its not an accurate test compared to otheres that are available depending on you condition.  For me for instance, they punctured my heart and I had to be rushed in for open heart surgery because my heart was drowning in blood.  All of that for nothing!! They found NOTHING!!  Well, I changed doctors and they did other test and now I am scheduled for open heart surgery to correct my mitral valve prolapse which was the problem all along.  I am not trying to scar you its just that I don't feel that an EP study gives the doctors the answers they are looking for (in alot of cases).  Good Luck!!

[Cleveland Clinic, MD]

Sorry to hear of your complication.  The risk for puncture of the heart is really quite low but it can happen and sometimes emergency surgery is then needed.  This is why the risks and benefits of any procedure should be discussed first with one's doctor.

[Greg]

i am a 36 yr old physically active male who enjoys trail running, hockey, tennis, etc. I have had several heart episode that only last about 5-10 seconds, but I get a right arm tingle, dizziness, and sluggishness after an episode. I have been diagnosed with atrial flutter that I captured on an event monitor. They say I am a good candidate for RFA. What do you think? ***@****

[ed]

Hi James,
I had an ep study and it took 7 hours. Please don't be as dumb as I was. I only had the initial local pain medication which wore off within 30 minutes. Noone told me to ask for more. 6 and a half hours of pushing and pulling 5 caths in my grion wasn't pleasant. By the time it was over my nose felt ice cold and my chin wouldn't stop quivering. They told me that was normal.

The next month I had an ablation.

Three monthes later I had to come back for another EP study and while they were checking electrical pathways my heart rate suddenly jumped so fast that it was panic time and many other med people came rushing in with carts and lots of yelling. I blacked out and woke up in my room about noon with circular burns on my back and chest. I requested at first then demanded to talk to a doctor. I just got the runaround as if noone wanted to be connected to what happened.

The next morning when a doctor was making rounds I tried to find out what was going on and he was so evasive I just pulled the tubes from my arms and got dressed and left.

I don't tell you this to scare you, but to advise you to have someone there to watch out for you and document what happens.

One question for the doc here: Since I still get rapid heart (270 to 280) how fast can a heart beat and still survive?

[RHONDA DUDLEY]

MY 13 YEAR OLD SON IS GOING IN FOR A EP STUDY IN 1 WEEK.
HIS DOCTOR FEELS AS THOUGH HE HAS VENTRICULAR TACHYCARDIA RATHER THAN SUPRAVENTRICULAR TACHYCARDIA. WHAT IS THE DIFFERENCE BETWEEN THE TWO AND WILL THE EP STUDY SHOW WICH ONE HE HAS FOR SURE? WHAT IS USUALLY DONE  TO TREAT EACH? MY SON IS VERY ATHLETIC WILL HE BE ABLE TO RESUME SPORTS IF HE HAS EITHER OF THESE AFTER HE IS TREATED FOR IT? RIGHT NOW HE IS RESTRICTED FROM SPORTS.

[neebie1000]

Rhonda, why does your doc. think your son has v-tach. instead of SVT? My son gets tachycardia, but we can't catch it on an ECG, so we don't know what kind he gets. We go to the Ped. Card. later this month