What does an EP actually do?

[chicky2001]

My first appointment with an EP is tomorrow and for some reason I'm scared.  I have been recommended to this EP by my cardio who discovered some Afibs on a monitor.  For two months I have been feeling really bad.  My heart slows down when I have skips which occur all the time.  My heart rate is slower than it's ever been in my life.  I'm tired of feeling sick.  I'm tired of walking around and feeling like I could faint and have to stop and lean against something until I feel better.   My cardio has refused to change my medication for two months.  She wants me to wait to see the EP.  Will the EP change my medication so I have some relief?  I can't wait for more tests.  I feel so bad.

I have always had benign PVCs all my life, just about, and taken meds, but this is different and the med I take now is not working.  I'm scared I will feel like this the rest of my life because no one wants to change my meds.

I have had many tests through my life and this is the first time I have had Afib.  

[chicky2001]

I will need you all to get through this and will keep you posted.  The EP is in the process of scheduling now.  It will be after the 15th.  My son is arriving here on the 14th to spend time with me.  If I have to stay in the hospital, he will be here to take care of my furbabies.  

What I don't understand is my heart does not speed up to fast.  It only goes up to a normal rhythm and I feel fine at that time.  It is the skipping that brings it down to far.  It is still within a normal range.  They usually don't put a pacemaker in until your heart pauses 3 seconds or more.  Mine is 1.9 seconds.  I think it could me the medication, but the EP simply does not want to try any other meds.  I think that's weird.  Norpace does extend the QT range.  

The EP is going right to the EP study.  No in between.  No tests of her own.  Not even her own monitor.  She is going off my cardio's monitor.  My cardio had said EPs have special monitors that cardios don't use.

It seems I'm being pushed to the EP study.  I just don't know.

[Brooke_38]

Hello...

Glad to hear that you had your appt. with the EP...Having the groin area anesthitized is very similar to that of having novacaine at the dentist. Stoping all medications prior to the procedure is standard protocol. I had to stop mine for a full 5 days prior.

Yes, it's done in a Cath Lab and because you are not going under general anesthesia which requires being intubated (breathing tube), an anesthesiologist isn't neccessary. You will most likely be given Versed (which has an amnesiac effect) and Fentanyl (narcatic pain reliever) this combo will put you into that "twilight" sleep.

From what you mention about your heart "speeding up and slowing down" leads me to suspect that you may be experiencing a Tachy-Brady type syndrome. A pacemaker is often recommended for this. It sounds as though the EP was merely pointing out the possible outcomes of the EP studay and didn't want there to be any surprises for you. I've been trying to avoid the pacemaker route for sometime now, unfortunately I think I may just have to accept that I've done everything else there is to do and this is my answer.

Have you been sceduled for the procedure yet? Please keep us posted and where all here to help you through this! :)

[chicky2001]

I saw the EP today.  She took my history, listened to my heart, and reviewed monitor results.  She didn't see Afib.  She doesn't know where it is coming from.  She said my heart pauses for 1.9 seconds.  She said my heart speeds up and slows down.  She discussed this with my regular cardio and they both feel I need an EP study.  They think I could need a pace maker.  I said OK.  Anyway she won't know for sure until she does the study which course to take.  

I told her my heart speeds up to my normal level of 75 to 80 beats when I am resting and not much more when I'm moving around.  When it skips or pauses (whatever) is when it slows down and I feel bad.  I think it is merely the medication I'm on.  

She is scheduling the procedure and I will have to stop the Norpace three days prior and since I will be on a monitor, she will see what happens.  

I'm freaked.  I will be seeing her before the procedure if I have any more questions.  I will have a stress test before.  No other tests though.

She told me it will hurt when they numb the groin and after that I will be in a twilight sleep.  

This will be done in a Cath Lab with no anesthesiologist present.  Just a nurse who works under her direction.  Does this sound right?

I mean a pacemaker?  Wow.  She will ablate anything that she can.  

I feel so bad I'm desperate enough to do whatever she says.  

[Brooke_38]

As Darlingorla mentions, the EP study does not hurt...I've been through it 5 times since 2006. I was given both a sedative and a pain reliever through the IV. Once they have pinpointed the location of the "hot spot" they usually sedate you to the point that you are completely asleep.

Yes, it is done in the hospital. Many people go in and come home on the same day. Whether or not you stay overnight depends on your Dr and the type of ablation you are having. If it is a left sided procedure, you will most likely have to stay overnight as you will be need to be Heprinized before coming home to start taking Coumadin. Are you currently taking Coumadin (anticoagulent)?

[Darlingorla]

Hi chicky - I had an EP study and ablation 2 weeks ago.  In all honesty it is quite a simple procedure in as much as they insert a catheter thru the femoral vein or femoral artery, depending on which side of the heart they are trying to access.  There is nothing to be scared of ...it's just the thought in our heads that create the issues.  These guys know what they are doing, they do it every day.  However be prudent in your choice of EP, one with lots of experience...

And it does not hurt - I had no sedation for the procedure, the only thing that I didn't like was the pacing of my heart, but that was totally bearable - I felt very safe throughout the procedure.

[chicky2001]

Does an EP study hurt?  Is it done in a hospital?  Is that where they run a wire up your groin?  Will I be out for that?  That really scares me.  

[chicky2001]

Thanks for your answers.  I am hoping to have the medication changed tomorrow to make me more comfortable until other tests are done if necessary.  Yes, I am well over 50 and this hit me like a ton of bricks two months ago.  Do you think the EP will change the meds before any other tests are done?  I really can't live like this.  My quality of life has taken a huge dive.  Will the EP just try different meds on me now???

[Jerry_NJ]

AFib is more prevalent with age, usually starting in the late 50s and later.

I would guess the EP will just "examine" you and your heart history.  That could lead to more test and if an ablation is considered, I'd guess an EP study to locate where the trouble paths are located.

I understand you to day you have bad side effects from the medication, more than from the AFib itself.  This is true for some people and that increases the possibility that an ablation is the best solution.  But, even that is not perfect...your visit with the EP should include such a discussion I believe.