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Electrophysiology (EP) studies are used to locate and diagnose the cause of known arrhythmias, whether they occur in the upper chambers of the heart (atria) or lower chambers of the heart (ventricles). In general, EP studies are only recommended for patients whose conditions could not be adequately diagnosed with a standard electrocardiogram (ECG). Because the EP study is invasive, it is not considered a first-line diagnostic test for arrhythmias.
EP studies can diagnose bradycardia–related conditions such as:
- Sinus node dysfunction. The EP study can be used to assess patients with symptoms of sinus node problems that cannot be explained by other tests (e.g., an electrocardiogram, exercise stress test, stress test or tilt-table test.
- AV block. An EP study can be used to diagnose patients in whom an atrioventricular (AV) block is suspected but not confirmed, such as patients with chronic intraventricular conduction delay.
EP studies can also diagnose tachycardia-related conditions, such as:
- Complex tachycardias. An EP study is used to assess those patients with possible narrow or wide QRS complexes (the electrical waves used to measure heart rhythm) whose diagnosis remains unconfirmed after an EKG, who require an assessment of treatment alternatives or in whom drug therapy is unsuccessful.
- Wolff-Parkinson-White syndrome. The EP study may be performed prior to the elimination (ablation) of abnormal electrical conduction in the heart or to gauge the effectiveness of treatments already given.
- Syncope. The EP study can help the physician to diagnose patients whose syncope (fainting) remains unexplained after tilt-table testing and other medical tests.
Furthermore, an EP study may be performed before implantation of a pacemaker. Information from the EP study is used to assist in programming the pacemaker, or after implantation in special situations where performance data cannot be retrieved from the pacemaker itself.
The EP study is also used before implantation of an implantable cardioverter defibrillator (ICD), which is often used to treat abnormally fast heart rhythms. Information from the EP study can assist the physician in selecting the appropriate type of ICD, monitoring progress during the implantation surgery, programming the device and, after the procedure, measuring device effectiveness. EP studies can also assess the effectiveness of antiarrhythmic medications.
The EP study can also determine which patient with syncope or heart dysfunction would likely benefit from placing an ICD for prevention of sudden cardiac death. Patients are considered at higher risk of fatal arrhythmias if arrhythmias (ventricular tachycardia) can be induced by electrical stimulation during EP testing.
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