Electrophysiology and pacing (EP) involves the diagnosis and treatment of arrhythmias (abnormal heart rhythms), including atrial fibrillation.
When someone’s heart doesn’t beat normally, doctors use electrophysiology studies to find out why. Heart attacks, aging, high blood pressure, congenital (present from birth) defects, and other factors may cause your heart to beat abnormally fast or slow.
EP studies assess the electrical conduction system of the heart. A physician specially trained in electrophysiology places small catheters through blood vessels into the heart to identify rhythm problems. The results help physicians determine the best treatment options.
Treatments for Arrhythmia
Depending on your arrhythmia type, treatment options could include medicine (or a change in medication), a pacemaker, an implantable cardioverter defibrillator (ICD), or cardiac ablation.
EP procedures take place in the state-of-the-art electrophysiology lab on the second floor of Lancaster General Hospital.
- Pacemaker: A permanent pacemaker is a small device that sends electrical impulses to start or regulate a slow heartbeat. This device is usually implanted in the chest area, just under the collarbone. A pacemaker may be used if the heart’s normal electrical conduction system is not working properly, or if the conduction system is blocked.
- Defibrillator: An implantable cardioverter defibrillator (ICD) looks similar to a pacemaker, though slightly larger. It works very much like a pacemaker, sending out a low-energy shock impulse that resets an abnormal heartbeat back to normal. It is also able to send out a high-energy shock impulse if the heart develops a severe arrhythmia.
- Biventricular (BIV) Therapy: Another specialized pacemaker, a biventricular pacemaker, is used to help resynchronize the ventricles (the two large chambers of the heart). A third lead is placed on the surface of the left ventricle which enables the heart to contract more effectively. This type of treatment is called resynchronized therapy (CRT).
- Lead Extraction: Over time, it may be necessary to remove pacemaker and defibrillation leads due to scarring that occurs around the leads. Lancaster General Health experts trained in transvenous lead extraction perform this minimally invasive procedure.
What to Expect
EP procedures take place in the state-of-the-art electrophysiology lab on the second floor of Lancaster General Hospital. EP procedures take place in the state-of-the-art electrophysiology lab on the second floor of Lancaster General Hospital. Prior to the study, we will carefully explain potential risks, review any preparation you may need, and answer your questions. Afterwards, we will make sure you understand how to care for any incision site, and provide other follow-up information.
Preparation: You will be asked to not eat or drink anything other than water starting at midnight before the day of your procedure. Your physician will give you specific instructions regarding medications prior to the procedure. If you are not given any instructions, please continue taking your medications as you normally would. On the day of the procedure, an IV (intravenous line) will be started for any medications needed during the procedure. Your groin area will also be shaved to allow the physician to place catheters in your heart. Family members will be asked to stay in the Sky Light waiting area. A pager will be given to them and the nurse will keep them updated throughout the procedure.
During Your Procedure: You will be lifted on to a special X-ray table. Electrode patches will be placed on your back and chest. You will also receive arm pads, leg pads, and a warming blanket. At this time you will be sedated or placed under general anesthesia. You will then be prepped with a cleaning solution, and a sterile drape will be placed over you. Your electrophysiologist will then insert catheters (small flexible tubes) into your veins or arteries which will then be advanced into your heart using an X-ray system. The catheters will allow recording and testing of your heart’s electrical system.
After Your Procedure: When the procedure is complete, catheters will be removed, and pressure placed over your blood vessels to stop any bleeding. You will need to be in bed with your leg straight for about three hours. Your nurse will observe the catheter site and measure your blood pressure throughout your stay. You will be able to eat and drink following your procedure. Your IV will be discontinued when ordered by your physician. Your electrophysiologist will talk to your family following the procedure and to you when you are fully awake. At this time, the results of the procedure and your care plan will be explained.