Electrophysiology (EP) Study and Catheter Ablation are very similar procedures. While an EP study is a diagnostic test to identify the presence and mechanism of arrhythmia, catheter ablation is a non-surgical technique that ablates (destroys) parts of the abnormal electrical pathway or circuit that is causing the arrhythmia. During the study, electrode catheters (long, flexible wires) are inserted into blood vessels and positioned inside the heart. Your doctor may decide to perform both the EP study and the ablation procedures, one after the other, while you are in the EP lab. This possibility will be discussed between you and your doctor prior to your procedure. When the exact area to be ablated is found, the ablation can be done. A special electrode catheter is placed near the problem pathway or circuit. Energy waves sent through the catheter destroy (ablate) the problem cells. The rest of your heart muscle is unharmed. Depending on the particular arrhythmia, a comprehensive EP study and ablation procedure can last from two to six hours.

Well in advance of your procedure:

• Make sure your primary care provider is aware of any bleeding problems you may have, or if you are taking coumadin or other blood thinning medication.
  
  
• A change may be required in the diabetic patient’s insulin or pill regimen on the morning of the procedure. Prior to the day of the procedure, diabetics should discuss any possible changes with their physicians.
  
  
• Patients with a history of kidney problems will occasionally require special preparation. Your physician will determine your preparation needs based on the nature and severity of your kidney problem.
  
  
• Your primary doctor may request some standard tests, such as an electrocardiogram, chest x-ray or routine blood tests, that should be completed at your community clinic or hospital prior to your procedure. The results of these tests are sent to the Minneapolis Heart Institute prior to your EP study.

On the day of your procedure:

• You will be asked not to eat or drink anything after midnight prior to your procedure.
  
  
• Routine medications should be taken the morning of your procedure with small sips of water, unless otherwise instructed by your physician. (Parents of infants and young children undergoing an EP study should inquire about any necessary diet restrictions.)
  
  
• When you arrive at Abbott Northwestern Hospital, you should report to the second floor of the Heart Hospital and check in at the appointment desk; Choose from the following links to view maps and directions or a campus guide.) You will then be taken to the Cardiovascular Outpatient Care Unit to prepare for the procedure.
  
  
• In preparation for your procedure, your catheter insertion site(s) will be shaved and cleansed. In most cases the major blood vessel in your groin is used for catheterization, but less commonly the arm, chest, or neck area may be used. Shaving and cleansing makes it easier to insert the catheters and helps to avoid infection. (Pediatric patients will be shaved and cleansed after sedation has been given.)
  
  
• An anesthesiologist will review your medical history and discuss sedation options with you. You will be anesthetized (“put to sleep”) during the procedure.
  
  
• If necessary, routine lab tests may be performed.
  
  
• Typically, an intravenous line (IV) is begun in the hand, and fluids are administered. This should be the only slightly painful part of your procedure.
  
  
• If you had not seen a Minneapolis Heart Institute cardiologist prior to your procedure, one will see you to fully explain the procedure and he or she will follow you through your hospital stay. *Please note: the physician overseeing your care may not be the physician actually performing the procedure.
  
  
• During the procedure, your family may wait comfortably in a special area in the Day Angiogram unit. After the preparation phase, your family may come back and stay with you until you are taken for your procedure. When the procedure room is ready, you will be transported to the lower level of Abbott-Northwestern Hospital where the EP lab is located. Your family may take a break (i.e. breakfast, lunch) and return to the same family room as before.

• During the procedure, you will receive fluids and medication (to help you relax) through an intravenous (IV) line.
  
  
• Most patients receive sedation during the procedure, and are usually asleep, but can be awakened.
  
  
• A local anesthetic will be injected to numb the site(s) where the catheter(s) will be inserted, so you should feel little to no pain.
  
  
• A short tube known as a sheath will be placed into the blood vessel at the insertion site, through which a longer catheter will be placed into the blood vessel. (The catheters are placed into your blood vessels through needle holes, and you will not have stitches in your skin.)
  
  
• Your electrophysiologist will carefully maneuver the catheter through the blood vessel to your heart. You will not be able to feel the catheter as it moves through the blood vessels and heart, but your doctor will be able to monitor the catheter’s progress on a digital screen next to your bed.
  
  
• When the exact area to be ablated is found, the ablation can be done. A special electrode catheter is placed near the problem pathway or circuit. Energy waves sent through the catheter destroy (ablate) the problem cells. The rest of your heart muscle is unharmed. Depending on your heart rhythm problem, areas to ablate may include:
  • An extra pathway or circuit
  • Part of your AV node (to slow down the signals passing through this node)
  • All of your AV node (to stop signals from passing through this node)

• After your ablation procedure is completed and the catheters are removed, a staff member will apply firm pressure over the groin area for about 10 to 20 minutes. This is done to prevent bleeding.
  
  
• You’ll be transported to your room or the recovery area. Whether you are allowed to eat or drink soon after the study depends on your condition.
  
  
• Back in your room, you’ll lie flat in bed for up to four hours (occasionally longer), to allow a seal to form over the puncture in the blood vessel. During that time, do not bend or lift the leg where the catheters were inserted. To relieve stiffness, you may move your foot or wiggle your toes.
  
  
• Your nurse will check your pulse, blood pressure, and catheter puncture site(s) frequently. If you feel sudden pain at the site or if you notice bleeding, notify the nurse immediately.
  
  
• The doctor who performed your ablation will discuss the outcome with you as soon as possible after the procedure. One ablation is usually enough to treat a heart rhythm problem. Occasionally the heart rhythm problem returns or another one is found, which may require another ablation procedure.
  
  
• In most cases, your heart rhythm will be monitored overnight, to help assess the effectiveness of the ablation. Generally, your doctor will visit you that evening or the next morning, to discuss the results of the procedure. When it’s time to go home, have a friend or family member drive you.

Other procedures for this sub-specialty

• Cardioversion 
• Implantable Cardioverter Defibrillator 
• Pacemaker & ICD Follow-up/Evaluation 
• Pacemaker Implantation 
• Stereotaxis 
• Tilt Table Testing