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Since the 1980s, there have been dramatic advances in clinical electrophysiology procedures to diagnose and treat cardiac arrhythmias with catheter ablation. Electrophysiologic studies (EPS) generally refer to the catheterization procedure that provides diagnostic information. An EPS is often combined with catheter ablation to treat the identified arrhythmia.

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Diagnostic EPS are performed to diagnose an arrhythmia when the diagnosis has not been obtained with noninvasive techniques or as part of an ablation procedure to treat the arrhythmia. EPS can be performed when an arrhythmia is suspected, but symptoms are intermittent and electrocardiographic (ECG) monitoring has not captured the symptomatic rhythm or there is concern that the arrhythmia may be life threatening, as in a patient with structural heart disease and syncope. Diagnostic EPS provides information about cardiac automaticity and conduction (sinus node, atrioventricular [AV] node, and His-Purkinje function) as well as inducible arrhythmias. Programmed electrical stimulation is performed to attempt to induce suspected or documented arrhythmias. EPS can help to detect arrhythmia causes of syncope and distinguish ventricular tachycardia (VT) from supraventricular tachycardia (SVC) with aberrancy (see Fig. 44–2C) and has a role in assessing the risk of ventricular arrhythmias in patients with known or suspected diseases associated with a risk of sudden death. Common uses of EPS are summarized in Table 44–1.

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Table 44–1. Diagnostic Electrophysiologic Studies

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