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Section I: Diagnostic Testing

Does my patient need an electrophysiological study?

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 The decision to refer a patient for an electrophysiological study is based upon the type of conduction abnormality present.

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HPI: Episode of sudden cardiac arrest, palpitations, dyspnea, syncope, fatigue, lightheadedness.

PMH: Cardiac arrest, atrioventricular block, atrial fibrillation, atrial flutter, ventricular tachycardia.

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 P waves absent, biphasic "sawtooth" flutter waves present, narrow QRS complex, prolonged PR interval of fixed duration followed by a P wave that fails to conduct to the ventricles, dissociation between P wave and QRS.

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EP = Refer patient for ElectroPhysiological study.

RS = Patient with Recurrent Syncope that remains unexplained after an appropriate evaluation.

SND = Patient with Sinus Node Dysfunction.

S-AVB = Symptomatic (palpitations, dyspnea, syncope, lightheadedness) patients in whom AtrioVentricular Block is suspected.

IVCD = IntraVentricular Conduction Delay in symptomatic (palpitations, dyspnea, syncope, lightheadedness) patients.

NCT = Narrow Complex Tachycardia.

WCT = Wide Complex Tachycardia.

SRCA = SuRvivor of Cardiac Arrest without obvious reversible cause.

C-ABL = Patients with symptomatic supraventricular tachycardia due to AVNRT, symptomatic atrial tachyarrhythmias, or ventricular tachycardia amenable to Catheter ABLation.

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RS = EP

SND = EP

S-AVB = EP

IVCD = EP

NCT = EP

WCT = EP

SRCA = EP

C-ABL = EP

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 Electrophysiological studies provide valuable diagnostic information as they can determine the mechanisms of arrhythmia and help in the decision of whether drug, device, or ablation therapy is suitable.

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  • – The most common arrhythmia found by EPS studies is ventricular tachycardia, and the most powerful predictor is an ejection fraction of < 40%.

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  1. Tracy CM, et al. American College of Cardiology/American Heart Association Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion. Circulation. 2000;102:2309.

When do I need to order a stress test?

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 Stress testing is used in diagnosis and prognosis of coronary artery disease. It is done via exercise (treadmill, bicycle) or pharmacologic agents (adenosine, persantine, dobutamine).

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 Patients with symptoms of known/probable ischemic heart disease, stable angina controlled by medicine. The most important clinical finding is chest pain.

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 Determine if the patient has functional capacity to perform exercise or will need pharmacologic aid to achieve stress.

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 J point depression of 0.1 mV or more and/or ST segment slope of 1 mV/s in 3 consecutive beats (during stress).

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 Echocardiogram-check LVEF, wall motion abnormalities, hypertrophy.

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CAD = Coronary Artery Disease. Patients with intermediate pretest probability of CAD based on age, sex, and symptoms.

RA = Risk Assessment and prognosis of symptomatic patients of those with CAD. Initial evaluation for CAD, changes in clinical status, unstable angina free of symptoms.

POST-MI = Testing after Myocardial Infarction. Prognostic assessment ...

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