Electrophysiology Testing

Nancy McDaniel M.D.

Procedure Explanation

Your child has been diagnosed with a heart rhythm problem. In order to learn more details about the heart rhythm problem, your child's cardiologist has recommended that your child have a test called an electrophysiology test. This test or procedure will give the cardiologist information about the heart rhythm problem that cannot be learned from listening to the heart, looking at the electrocardiogram (EKG) or be seen on the ultrasound (echocardiogram). Often the electrophysiology information is used to plan for medications or pacemaker placement to treat the rhythm problem.

Your child will need to have an empty stomach before the electrophysiology test. The nurse or doctor will tell you when the child may eat or drink the night before or morning of the catheterization. Medications are usually not given the morning of the test.

A mild sedative is usually given before the procedure (newborn infants usually don't receive this). A numbing cream is often put on the upper thigh (groin area) of both legs and under the left collar bone one hour before the test. Some doctors will have you do this at home and then come to the hospital.

Numbing medicine is either put on the skin or under the skin at the top of the legs (one side or both may be used) and collar bone area. After the area is numb, a needle is placed the vein at the top of the leg and in the vein under the collar bone. The needle is then replaced with a plastic tube, like an IV and called a sheath. The sheath lets the doctor put the catheters in safely and prevents the child from bleeding from the needle puncture.

An electrophysiology catheter is a special piece of wire about the size of a piece of thin spaghetti. It shows up on the special xray camera that is used in the electrophysiology lab. The doctor then guides the catheter through the big blood vessels to the heart and uses the catheter to record the electrical activity in the heart. Sometimes the abnormal heart rhythm can be treated in the electrophysiology laboratory (ablation or cardioversion).

You will be informed as to the reason for the procedure and be told of the risks to your child. Ask again if you are not sure why the test is being done. Let the cardiologist know of any concerns or questions that you have.

What are the risks?

The risks of the electrophysiology catheterization depend on the type of heart rhythm problem your child has and the age of the child. In general, problems with the procedure are infrequent and minor. Problems might include bleeding, infection or injury to the blood vessel. More serious risks might be arrhythmia, injury to the heart, or allergic reaction to the dye used to check catheter placement. The most serious risk would be that your child could have a stroke or die as a result of the electrophysiology procedure and catheterization. You must discuss the procedure in detail with the cardiologist who will be doing the procedure, and you are required to give consent. This information does not replace informed consent for the actual procedure.

Common questions asked about heart catheterization

Q:Will my child be in pain during the test?

A: No. In general the children who are put to sleep for the test feel no pain. If they are uncomfortable more medication is given during the test. Mild soreness of the site may occur and usually needs nothing more than acetaminophen.

Q:What if my child is awake?

A: Often, the children are awake and talk with the nurses and doctors during the routine part of the test. Reassurance and comfort is always given and the child's needs are attended to.

Q:Can I watch the electrophysiology test?

A: No. There is no place for the family to watch and care is taken to prevent infection much like an operating room, so only doctors, nurses and technicians are in the room with the child.

Q:How long will the test take?

A: Generally the test takes several hours and the child may be gone from the observation area (recovery area) for three to four hours. A member of the team will keep you informed of the progress.

Q:When will I know what the test showed?

A: The cardiologist who performed the test will tell you whatever information is available. Often final recommendations about the need for further surgery or further testing will not be made until all the cardiologists and heart surgeons who care for your child have reviewed the test results. Sometimes that might take a week. Ask your child's doctor when to expect to hear from them with the final results.

Q:Will the x-rays harm my child?

A: No. The smallest amount possible is used and no harm should come to your child.

Q:Will my child need a blood transfusion?

A: No. The blood loss is usually less than one tablespoon and does not need to be replaced.