Indication Of Clinical

EPS

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 Cardiac Electrophysiology

 Study of the electrical system of the heart and a broad spectrum

of abnormal heart rhythms (Arrhythmias) by –
 Recording
 Pacing
 Evaluating 0f the heart’s electrical signals

 Determining the characteristics of arrhythmias for potential

treatment

 Evaluating the efficacy of antiarrhythmic drugs or devices

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 Different Tachycardia

Different Tachy
https://youtu.be/Lc53tPyCzr8
 Arrhythmia Prevalence

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 Clinical Electrophysiology

A. Initial Assessment
1. Diagnostic workup

B. Clinical Evaluation of Arrhythmia

1. Response to drugs
2. Response to vagal maneuvers
3.Emergency management

C. Indications, Contraindications for EP Study

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 Indications for EPS
Class I
–General agreement that EPS useful & effective
Class II
–Divergent of opinion about usefulness and/or
efficacy
»Class II a – weight of evidence in favor of
EPS
»Class II b – usefulness/efficacy less well
established
Class III
–General agreement EPS not useful / effective
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 Class I
Syncope of otherwise unexplained origin and know HD
–Loop recorder may now be of more diagnostic benefit

Pt’s with palps with no ECG documentation

Documented SVT or VT for ablation

Symptomatic pt’s with suspected H-P block with no

documentation

Pt’s with WCT in whom correct diagnosis remains unclear

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 Class II

Pt’s with 2 or 3 HB to determine level of block

Asymptomatic WPW pt’s with FHx SCD

Pt’s with recurrent unexplained syncope without HD

+ -ve tilt test

Pt’s surviving cardiac arrest caused by

bradyarrhythmia

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 Class III

Symptomatic SND or AVND with ECG documentation

Symptomatic LQTS

Pt’s surviving cardiac arrest <48 hrs after MI

Pt’s with palps documented to be due to extracardiac

causes (eg, hyperthyroidism)

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 ACC/AHA Class I Guidelines

Sinus Node Dysfunction Suspected cause of symptoms

Acquired AV Block Suspected cause of symptom is His- Purkinjie
block
2nd or 3rdº block in pts who remain symptomatic
after PPM implant

Chronic Intraventricular Symptoms of unknown cause

conduction delay

Narrow complex tachy Frequent, poorly tolerated episodes in pts

Wide complex tachy Diagnosis remains unknown
WPW Pts who are being considered for abl
Survivors of cardiac arrest or with syncope
Symptomatic pts need further investigation

Unexplained syncope Structural heart disease of unknown cause

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 ACC/AHA Class I Guidelines

Survivors of cardiac arrest No evidence of Q wave MI

Cardiac arrest > 48 hrs after AMI

Unexplained palpitations Palpitations and documented rapid pulse without

ECG diagnosis
Palpitations preceding syncope

Guiding drug therapy Sustained VT or cardiac arrest, esp pts with prior
MI
Pts with AVNRT or AF associated with WPW

Pts with or candidates for Tachy b4 and during device implant and b4
an implantable device discharge
Pts in whom a clinical or drug change may affect
device efficacy
Assess interactions bt implanted devices

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 Indications for EP
Diagnostic
 Identification of conduction disturbances
 Mechanisms of arrhythmias

Prognostic
 Future therapy/ treatments

Therapeutic
 Drug
 Ablation
 Surgery
 Device

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 Diagnostic EP Procedures

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 VT Study

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 Non-invasive Evaluation of Arrhythmia

 Clinical History
 12 Lead ECG
 Holter Monitoring/Stress Testing
 Signal averaging
 Echocardiography
 Autonomic maneuvers
 Pharmacological provocation

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Cardiac Electrophysiology

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 Take Home Message

1. SV Arrhythmias & Ventricular Arrhythmias

2. Indications of EP

3. EP Study (Diagnostic evaluation followed by

determination of therapy)

4. Subjects for understanding of EP

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