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Invasive electrophysiology studies (EPS) involve the recording of spontaneous and pacing-induced intracardiac electrical activation patterns (electrograms) that are analyzed with the assistance of computers.  The procedures are performed by placing electrode catheters inside the heart.  The catheters are introduced intravenously from veins in the groin and underneath the collarbone.  EP studies have broad applications including:

1. Prediction of risk for sudden death.  In selected cases of syncope or near syncope, the EP study can be useful in predicting future cardiac events by determining whether ventricular arrhythmias can be induced.  A powerful correlation has been demonstrated between inducible ventricular arrhythmias and sudden death in specific subgroups, such as patients with coronary artery disease and diminished left ventricular function.
2. Assisting in the diagnosis of the etiology of syncope secondary to abnormally fast or abnormally slow heart rates.  Electrophysiology studies enable definitive diagnoses and definition of appropriate therapy for patients with cardiogenic syncope.
3. Definitive treatment of selected types of fast heart rhythms with the use of radiofrequency ablation performed at the time of the EP study.  This is discussed in greater detail below.

Procedure

The EP study is performed in a specialized laboratory. The patient is typically awake during the procedure but lightly sedated to help him/her relax.  In some instances general anesthesia may be indicated.  Vital signs are constantly monitored.  The groin and, in many cases, the neck are cleaned with an antiseptic solution and sterile towels are placed over the body.  Local anesthetic is then injected into these areas to numb them for insertion of short intravenous sheaths into large veins.  These sheaths allow passage of long catheters into the heart that are used to measure electrogram intervals and allow electrical pacing inside the heart.  Depending on the type of study being done, as few as 1 to as many as 8 or 9 catheters may be placed in the heart at any given time.  The doctor then measures electrogram intervals to identify evidence of conduction disease and stimulates various areas in the heart to obtain the information necessary to identify specific types of conduction disorders and/or tachycardias.  Clinical decisions are made on the basis of the findings.