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Electrophysiology Study of the Heart

Overview :

The rhythmic pumping action of the heart, which is essentially a muscle, is the result of electrical impulses traveling throughout the walls of the four heart chambers. These impulses originate in the sinoatrial (SA) node, which are specialized cells situated in the top right chamber of the heart: the right atrium. Normally, the SA node, acting like a spark plug, spontaneously generates the impulses, which travel through specific pathways throughout the atria to the atrioventricular (AV) node. The AV node is a relay station, sending the impulses to more specialized muscle fibers throughout the bottom chambers of the heart: the ventricles. If these pathways become damaged or blocked or if extra (abnormal) pathways exist, the heart's rhythm may be altered (perhaps too slow, too fast, or irregular), which can seriously affect the heart's pumping ability.

The patient is transported to the x-ray table in the EP lab and connected to various monitors. Sterile sheets are placed over him or her. A minimum of two catheters are inserted into the right femoral (thigh) vein in the groin area. Depending on the type of arrhythmia, the number of catheters used in an EP test and their route to the heart may vary. For certain tachycardias, two more catheters may be inserted in the left groin and one in the internal jugular (neck) vein or in the subclavian (below the clavicle) vein. The catheters are about 0.08 in (2 mm) in diameter, about the size of a spaghetti noodle. The catheters used in catheter ablation are slightly larger.

With the help of fluoroscopy (x rays on a television screen), all the catheters are guided to several specific locations in the heart. Typically, four to 10 electrodes are located on the end of the catheters, which have the ability to send electrical signals to stimulate the heart (called pacing) and to receive electrical signals from the heart-but not at the same time (just as a walkie-talkie cannot send and receive messages at the same time).

First, the electrodes are positioned to receive signals from inside the heart chambers. This allows the doctor to measure how fast the electrical impulses travel currently in the patient's heart. These measurements are called the patient's baseline measurements. Next, the electrodes are positioned to pace: The EP team actually tries to induce (sometimes in combination with various heart drugs) the arrhythmia that the patient has previously experienced so the team can observe it in a controlled environment, compare it to the patient's clinical or spontaneous arrhythmia, and decide how to treat it.

Once the arrhythmia is induced and the team determines it can be treated with catheter ablation, cardiac mapping is performed to locate precisely the origin and route of the abnormal pathway. When this is accomplished, the ablating electrode catheter is positioned directly against the abnormal pathway, and high radio-frequency energy is delivered through the electrode to destroy (burn) the tissue in this area.

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