Dear Patients,

Due to your difficulties, there was an indication for electrophysiology study (EPS) with or without radiofrequency cardiac ablation (RFA).

Here you can read all about cardiac electrophysiology study.

Here you can read all about radiofrequency ablation.

Before the EPS procedure

Upon admission to the hospital, a series of tests will be performed: blood tests, ECG recording, heart and lung X-ray, echocardiography and similar examinations.

The day before the EPS procedure, you will receive informed consent that you are required to read and sign if you consent to the procedure.

Here you can download and complete consent forms for the cardiac electrophysiological study with or without radiofrequency ablation.

The evening before the procedure, it is recommended that you shower with an antiseptic shampoo which you can get at the hospital ward where you will be hospitalized.

Skin preparation. It is necessary to shave the skin above the intended point of puncture before the procedure. The most common puncture site is the area of the groin veins and arteries where you can feel the pulsations. In this case, it is necessary to completely shave both groin and genital area, from the navel to the middle of the thighs. In exceptional situations, veins are punctured in the neck area or under the collarbone, regarding this procedure, you will be notified in a timely manner.

Also, for the electrophysiology study, it is necessary to shave men’s chest. You can shave skin yourself at home, and if you are unable to do so, please ask a nurse at the ward for the help.

On the day of the procedure, you must be on an empty stomach! You can have a normal dinner the day before and drink fluids by midnight. After that you have to fast. If you are taking therapy, you will need to take the necessary medications in the morning as instructed by your doctor. In the morning before the procedure, the nurse will set you a vein line (a thin plastic tube for medication administration and infusion).

Electrophysiology study is performed at the EP laboratory. Before your nurse escorts you to the EP laboratory, you will have to remove all the jewellery you wear and dentures if you have them. Also, nail polish needs to be removed. If you are wearing a hearing aid, do not remove it in order to communicate normally with laboratory personnel.

In the operating room, you will be placed on the operating table, and electrodes will be attached to your skin to monitor your heart rate during the procedure. After the staff has disinfected the puncture field, you will be covered with blue/green sterile compresses. From that moment it is very important for you to remain stationary and to follow the instructions of the medical staff. It is also important that you immediately inform the medical staff of eventual symptoms, such as pain, nausea, vomiting, coughing, irritation, etc.

The doctor will anaesthetize the left and right groin area and you will not feel any pain during the procedure, but you will have the sense of touch. In rare cases, the procedure is performed under general anaesthesia. After the application of anaesthesia, the doctor in the same area punctures the large blood vessels and sets up introducers – thin plastic tubes through which catheter electrodes are introduced in the vessels. Catheters are carefully introduced through the blood vessels, and since the blood vessels are not susceptible to pain, no additional anaesthesia is required.

In general, patients describe anaesthesia injection and initial puncture as the most painful part of the procedure. The rest of the procedure is almost painless.

The entire procedure is performed under X-ray control. When the catheters are positioned at the desired location in the heart, signals (potentials) from different locations in the heart are recorded in the memory of a computer which is connected to the same catheters. While positioning the catheters in the heart, you may experience irregular heartbeat, which is a normal and harmless occurrence. It is also possible that during catheter placement and recording, your arrhythmia, for which you are undergoing this procedure, starts. Any arrhythmia caused in such controlled and safe EP laboratory conditions can be successfully interrupted, either by a computer or by the administration of drugs through a vein.

Electrophysiology study can take 30-60 minutes.

During the study, you may experience a fast and ir/regular heartbeat, very similar to your arrhythmia. During the EP study, if you find this feeling (symptom) too uncomfortable, the procedure can be paused briefly.

Depending on the results of the electrophysiology study, your doctor may suggest radiofrequency catheter ablation as a choice to treat your arrhythmia/tachycardia.

Radiofrequency ablation

Through the same area where the electrophysiology catheters electrode were introduced, a special catheter is introduced, which has the possibility of controlled heat release at the catheter’s tip. That kind of a catheter is called an ablation catheter, and the heat release through it is called the application of radiofrequency energy. After causing arrhythmia, the doctor tries to find the source of the arrhythmia using an ablation catheter and applies energy to disable it.

In most cases, radiofrequency ablation is completely painless. In a small number of cases, patients describe discomfort in the chest area (pressure, “like a weight on the chest”), with the same feeling spreading to the back and/or arms or jaw. If the patient considers the use of radiofrequency energy too uncomfortable or even painful, the procedure may be interrupted and the pain ceases immediately thereafter. In such cases, strong painkillers are administered or the patient can be admitted under general anaesthesia, thereafter ablation is then painless.

EP study with radiofrequency ablation can take 1-4 hours depending on the complexity of the arrhythmia and its origin.

After the EP procedure:

• Catheters are immediately removed from the blood vessels
• depending on the procedure’s result, duration and modality, introducers are usually pulled straight from the blood vessels and bleeding is stopped by applying pressure on the puncture site
• if high doses of anticoagulantion therapy were administered during the procedure, the introducers are removed after several hours (usually within 2-3 hours) when the anticoagulants are no longer in effect
• after the bleeding is stopped, sterile swabs are placed in the puncture area and, if necessary, sandbags are also placed over it, which additionally exert pressure to prevent bleeding after procedure and consequently prevent the occurrence of haematoma
• in most cases if only veins are punctured, it is necessary to rest for 6 hours in bed from the time the introducers were removed and bleeding has stopped – you should not bend the punctured groin, and the head of the bed should be slightly raised
• less frequently, if the groin artery is punctured, it is necessary to rest for 24 hours in bed
• during necessary bed rest, toilet, hygiene, and feeding will be provided in the bed range and at arm length
• after bed rest, it is recommended to go for a slow walk in the ward

After hospital discharge:

Hospitalization for electrophysiological interventions last normally 2-3 days.

• in the following week after hospitalization, it is recommended to avoid running, walking up the stairs or similar effort, in order not to form a haematoma at the puncture area
• in addition to above, patients have almost no restrictions, recovery time is fast
• it is necessary to take medication regularly as prescribed

Going to scheduled check-ups regularly. Go to the check-ups regularly as scheduled in your discharge letter (3-6 months) and make sure you schedule an appointment on time to avoid waiting. You can schedule your appointment in our cardiology clinic in person or by telephone (+385 1 37 87 951). Please leave your contact number on which you are always available and let us know if you have changed your place of residence. If the staff cannot admit you to scheduled appointment, you will be notified by telephone. Also, if you are not able to come to your appointment, please inform the nurses at the number listed above, in order for other patients to use the appointment time.

If you have general questions about cardiac electrophysiology study and radiofrequency catheter ablation, you can always contact your doctor or nurse.