Electrophysiological examination (EPU) is also known colloquially as electrophysiology. The aim of EPU is to localize and treat the causes of cardiac arrhythmia. Heart palpitations (tachycardia), heart stumbling (extrasystole) and atrial fibrillation (AFib) are common cardiac arrhythmias.
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Article overview
- What is electrophysiology?
- Which patients receive an electrophysiological examination?
- What happens during an electrophysiological examination?
- The risks of electrophysiological examination
- What happens after an electrophysiological examination?
- What happens during radiofrequency ablation?
- The prognosis after radiofrequency ablation
- Specialists and clinics
Electrophysiology - Further information
What is electrophysiology?
Electrophysiology examination (EPU) is one of the cardiac catheter examinations. With the EPU, electrophysiology specialists can examine cardiac arrhythmias that have occurred in the electrocardiogram (ECG). For the diagnosis, doctors usually combine the electrophysiological examination and catheter ablation.
Which patients receive an electrophysiological examination?
Electrophysiological testing, or electrophysiology for short, is not an emergency diagnostic procedure. Rather, it is suitable for patients with pre-existing heartconditions.
In most cases, these pre-existing conditions are cardiac arrhythmias, such as
- A heart that beats too slowly (bradycardia)
- A heart that beats too fast(tachycardia)
- Atrial fibrillation (VHF)
- Seizure-like palpitations
- Cases of repeated unconsciousness(syncope)
- Survivors after sudden cardiac arrest
What happens during an electrophysiological examination?
The electrophysiological examination is carried out under X-ray control. Doctors take an ECG directly in the heart. Patients are usually given a sedative and a local anesthetic.
Access is gained via a vein in the groin, from where the cardiac catheter slowly penetrates into the heart. This special cardiac catheter measures the excitation conduction at various points in the heart.
The electrophysiology specialist can use the measurements to detect disturbances in the excitation conduction in the heart muscle that are the cause of the cardiac arrhythmia.
In addition, during the electrophysiological examination (EPU), the doctor can send electrical impulses to certain points in the heart.
Ideally, these trigger the cardiac arrhythmia previously described in the ECG. The aim is to localize the cause more precisely.
Electrophysiological examination (EPU) is a special cardiac catheter examination for patients with cardiac arrhythmia @ romaset /AdobeStock
The risks of electrophysiological examination
Electrophysiology is a safe procedure with few complications. Nevertheless, irritation of the excitation conduction system in the heart can occur.
This can result in atrial fibrillation.
In addition, as with any other invasive procedure, the following complications can occur:
- Bleeding
- inflammation
- Wound healing disorders
- haematomas
- Blood clots (thrombi) and
- Injuries to skin, vessels and nerves
What happens after an electrophysiological examination?
Normally, patients can return home a few hours after the electrophysiological examination. However, major physical exertion should be avoided for the first few days (no sport or heavy physical work).
The electrophysiological examination (EPU) is used to localize the cause(s) of cardiac arrhythmia. With this information, electrophysiology specialists then try to cure the arrhythmia.
This requires a further procedure called ablation (Latin for ablation, detachment).
What happens during radiofrequency ablation?
The most widely used ablation technique is radiofrequency ablation (radiofrequency ablation). The patient is also given a sedative during radiofrequency ablation.
In addition, the patient has a reduced perception of pain. Medicine refers to this form of sedation as analgosedation. In contrast to general anesthesia, the patient remains responsive and breathes independently during analgosedation.
Access via the inguinal vein is also possible here. From there, the doctor advances the appropriate cardiac catheter to the heart. There he applies a high-frequency current pulse to a specific point in the heart. This cauterizes the affected tissue through heat. This creates a scar in the heart tissue that is no longer able to conduct an impulse.
In comparison with certain heart medications, known as antiarrhythmic drugs, the ablation technique has a permanent and long-term effect on the heart .
Medication can only control cardiac arrhythmia if the patient takes it regularly.
Although radiofrequency ablation is a procedure with few complications, the following rare complications can occur:
- Complete AV block
- Heart valve damage
- Vascular injuries and
- Deep vein thrombosis
The prognosis after radiofrequency ablation
After about two days in hospital, the patient can usually go home again. Depending on the type of cardiac arrhythmia, radiofrequency ablation achieves recovery rates of 70 % to 90 %.
Specialists and clinics
Both electrophysiology (electrophysiological examination) and radiofrequency ablation are cardiology procedures. Electrophysiology specialists are therefore mainly found at university hospitals and in specialized cardiovascular centers.
We have compiled a list of selected electrophysiology specialists and heart centers near you above.
References
cardio-guide.com/therapie/radiofrequenzablation/
flexikon.doccheck.com/de/Analgosedierung
herzstiftung.de/infos-zu-herzerkrankungen/herzrhythmusstoerungen/vorhofflimmern/vorhofflimmern-behandlung-katheterablation
hgz-goettingen.de/epu_ablation
Hindricks G et al., 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal 2020; 42(5): 373–498, https://doi.org/10.1093/eurheartj/ehaa612
netdoktor.de/diagnostik/elektrophysiologische-untersuchung/
uke.de/kliniken-institute/kliniken/kardiologie/behandlungsangebot/interventionelle-elektrophysiologie/index.html