Electrophysiological Study (EPS or EPS) is an interventional examination performed for the diagnosis of rhythm and conduction disorders in the heart. Therefore, before moving on to EPS (ElectroPhysiological Study), it would be useful to briefly talk about the rhythm and conduction functions of our heart. The main task of our heart is to pump the blood it contains. In order for this function to be performed regularly, a regular command must undoubtedly be received. Because our heart is an organ made up of muscle tissue and it needs to receive commands regularly in order to function regularly. The exit point of this command is in the right atrium and is called Sinus node. The sinus node works together with a complex nerve network and determines the pulse level the body needs, second by second. For this reason, our pulse rate constantly changes according to the needs of our body. Under normal conditions, our pulse rate is between 60-80 beats per minute. This figure may vary depending on the person's age, whether he does sports or not, the amount of consumption of beverages such as tea and coffee, and the person's psychological and stress conditions.
Another important issue is that the signals arising from the sinus node in the heart are distributed properly to the heart. There is a perfectly working electrical system or network for Thanks to this magnificent electrical network, the signals coming from the Sinus node spread harmoniously throughout the heart. There is a main center that functions like a fuse in the propagation of these impulses in the heart. This center is also the only point that electrically connects the atria and ventricles of the heart to each other. This point is called Atrioventricular node. Thanks to this magnificent electrical system, the electrical impulse generated from the sinus node, which is the main center, is transmitted to all heart muscle cells and the heart is contracted. It is an informative examination.
To whom is EPS performed?
EPS is performed on many patients with complaints of arrhythmia or palpitations. The cause of palpitations is the short circuit in the heart. are circuits. Some of these are congenital and some occur later, causing rapid heartbeats and palpitations, which we call tachycardia. Situations where EPS is required are summarized below.
1) Arrhythmias: Arrhythmias can be slow heartbeat (bradycardia), fast heartbeat (tachycardia) or irregular heartbeat:
Conditions where palpitations are prominent: Conditions that cause this type of arrhythmia can be summarized as follows:
a) AVNRT (Atrioventricular Nodal Reentrant Tachycardia):It is a type of palpitation involving the atrioventricular node.
b) Wolff Parkinson White Syndrome:It is a type of palpitation that occurs due to shortcuts connecting the atria and ventricles of the heart outside the atrioventricular node. Therefore, transmission sometimes or constantly takes these shortcuts instead of following its normal path. This may sometimes cause serious tachycardia attacks. With EPS, the location of these shortcuts is determined.
c) Atrial Tachycardia:It is a type of palpitation originating from a point in the atria of the heart.
d) Atrial Fibrillation:The heart's heart beats. It is a type of palpitation with an irregular rate that originates from more than one point in the atria.
e) Ventricular Tachycardia: It is a type of palpitation that originates from a single point in the ventricles of the heart.
2) Low heart rate Situations where speed operation is at the forefront:
a) Sinus node dysfunction (Sick Sinus Syndrome):In this syndrome, the sinus node cannot produce regular and sufficient stimulation. Tachycardia, bradycardia or various irregular rhythms may be observed.
b) Atrioventricular (AV) blocks: The atrioventricular node is in the middle of the structure that connects the atria and ventricles of the heart and is kept for a short time before the stimulus passes to the ventricle. is the place. Disruption of conduction in this node causes disruptions in the transmission of the stimulus to the ventricles and slowing down of the heart.
3) Fainting (syncope): If fainting is due to a heart-related cause, it can have serious consequences. The most important of heart-related faints are those caused by arrhythmias. Some of the arrhythmias we mentioned above It may also cause fainting. EPS is performed in order to understand what these arrhythmias are and to reveal the main cause of fainting.
How is the EPS procedure performed?
The procedure is performed by sedating or sedating the patient lightly. It is done while fully awake. The way EPS is performed is similar to coronary angiography, but it is a completely different application. After local anesthesia is administered to the right and sometimes left groin areas, 2 or 3 electrodes (2 mm thick cables) are advanced into the heart through the veins. The recordings obtained from these electrodes placed at various points of the heart are then transferred to the computer environment with the help of a special program. At the same time, electrical impulses are sent to various points of the heart through electrodes advanced to the heart and it is checked whether there is any disorder in the current rhythm and conduction system of the heart.
It is not a painful procedure. However, when anesthetizing the groin area, a slight pinprick pain may be felt at first. But if you have had a procedure such as a dental filling or tooth extraction, even that much pain is not felt most of the time. However, if the patient cannot tolerate the procedure psychologically, the procedure can be performed while the patient is completely asleep. The EPS process takes approximately 20-30 minutes. EPS usually requires a 1-day hospital stay. However, depending on the situation, the patient can also leave on the same day.
What is the risk of EPS?
EPS is basically a low-risk application. However, EPS is an invasive procedure. Are there alternatives to the electrophysiological diagnostic method?
The data obtained with the electrophysiological study cannot be provided by any other diagnostic method. It is often applied when other diagnostic methods are inadequate. These are ECG Holter and Stress ECG.
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