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Electrophysiology Study (EPS)

Electrophysiology Study: Symptoms, Causes and Risk Factors, Diagnosis, Treatments | National Heart Centre Singapore

Electrophysiology Study (EPS) - What it is

What is an electrophysiology study?

An electrophysiology study (EPS) is a minimally invasive procedure that tests the electrical activity and the conduction system of your heart. This test is used to find out the cause of any rhythm disturbance to the heart and determine the best treatment.

Examples of when an EPS is useful include:

  • Determining the cause of an abnormal heart rhythm
  • Locating the site of origin of an abnormal heart rhythm
  • Deciding the optimal treatment for an abnormal heart rhythm
  • Determining conduction system disease.

Once the electrical activity is recorded and the study is complete, your doctor may decide the optimal treatment for your rhythm disturbance is medication. If so, he will end the procedure and you will be taken back to the ward soon after. In other cases, he or she may decide that catheter ablation is best. If so, your doctor will most likely proceed directly to perform catheter ablation.

Note that you can have an electrophysiology study (EPS) without needing a catheter ablation, if your doctor determines that it is not needed.

Electrophysiology Study (EPS) - Symptoms

Electrophysiology Study (EPS) - How to prevent?

Electrophysiology Study (EPS) - Causes and Risk Factors

Risk Factors
As with any invasive procedure, there are risks. However, the risks associated with EPS are low, often 1% or less of a serious complication.

Your doctor will discuss the risks involved in your particular case with you before the procedure. If you have any questions, be sure to ask prior to the EPS. 

Electrophysiology Study (EPS) - Diagnosis

Electrophysiology Study (EPS) - Treatments

Electrophysiology Study (EPS) - Preparing for surgery

If I decide to have the EPS and/or the catheter ablation, when will I be admitted? How long can I expect to be admitted for?

Usually you are admitted on the day of the procedure; occasionally, you will be admitted the day before. 

The most common reason to be admitted the day before is to have a pre-procedure trans-oesophageal echocardiogram, which applies to patients who have atrial flutter or atrial fibrillation. This is to out rule the presence of a clot in the left atrial appendage. Your doctor will discuss with you if you would need to go for this procedure prior to the EPS/RFCA procedure.

Most patients can expect to be discharged the day after the procedure. In some cases, hospital stay may be longer, particularly if the patient was previously taking warfarin to thin blood. Therefore, the patient will often be asked to stay in hospital for a few days until their blood has sufficiently thinned out.


Do I continue to take my medications till the day of the procedure?

The doctor will instruct on what to do before the procedure. Please check before discontinuing any medications with your doctor. 

Can I eat before the procedure?

In most cases, you will be told to eat a normal meal the evening before your procedure. However, do not eat, drink or chew anything after 12 midnight before your procedure. This includes gum, mints, water, etc. If you must take medications, only take them with small sips of water. When brushing your teeth, do not swallow any water. 

What should I wear?

When getting ready, please do not wear makeup and remove nail polish. Wear comfortable clothes when you come to the hospital. You will change into a hospital gown for the procedure. Please leave all jewellery (including wedding rings), watches and valuables at home.

Is the procedure done under general anaesthetic?

A combination of local anaesthetic (to numb the groin) and sedation will be used so you do not experience pain or undue discomfort during the procedure. This procedure does not require general anaesthetic.

How long does the procedure take? What should I expect?

The time to perform the procedure varies greatly depending on the heart rhythm being treated, and your individual circumstances. Cases may be as short as an hour, or last many hours.

Patients with AVNRT or AVRT (including Wolff-Parkinson-White syndrome) can expect their case to take an hour or two. Patients with atrial fibrillation should expect their cases to take between two and six hours.

When it is time for your case, you will be taken to a special area called the Electrophysiology Laboratory. For both electrophysiology studies and radiofrequency ablation:

You will lie on a bed and the Electrophysiology Lab staff will connect monitoring equipment to your chest. They will also start an IV (intravenous) drop in a vein in your arm or hand. The IV is used to deliver any needed medication and fluids during the procedure. 

The doctor will then clean the groin using a special soap, and cover you using sterile drapes from your neck to your feet. He or she will then inject local anaesthetic to the skin and give you sedation before starting the EPS or RFCA procedure. You should feel a little sleepy at this point.

He or she will then place a number of catheters (small, thin, flexible tubes) from the groin to the heart under X-ray guidance. You may feel your heart beating fast at certain points, either because of intravenous medication or because your doctor is using the catheters to stimulate your heart.

If your doctor is performing radiofrequency ablation, you may feel a warm (but not painful) sensation inside your chest and/or your face. If you find it uncomfortable, be sure to inform your doctor by speaking out loud; he or she can increase your sedation if needed.

During both EPS and catheter ablation, it is important that you keep as still as possible. Let your doctor know by speaking out loud clearly if you need to move. At the end of the procedure, your doctor will remove all the catheters, and put a tight pressure bandage over the groin site. Once he or she is satisfied bleeding has stopped, you will then be escorted back to the ward on a bed.  

Electrophysiology Study (EPS) - Post-surgery care

What can I expect immediately after the EPS procedure?
You will return from the Electrophysiology Laboratory with a pressure dressing over your groin. 
If you have any pain, please inform your nurse so you can be given enough painkillers.

You will be asked to remain in bed and to rest for 4 to 6 hours after the procedure. Your nurse will take regular measurements of your pulse and blood pressure during this time.
After that, and once the staff are satisfied that the groin site will no longer bleed, the pressure dressing will be removed.

Discharge times varies, but is often the following day unless you need to take warfarin (a medication to thin your blood) - in that case, your hospital stay may be prolonged by a few days to ensure that your blood is sufficiently thinned out. (Measuring the INR level).

How will I feel after the procedure?
You may feel fatigue or chest discomfort during the first 48 hours after the procedure. Please tell your doctor or nurse if any of these symptoms are prolonged or severe. You may experience skipped heartbeats or short episodes of atrial fibrillation after the procedure. After your heart has healed, these abnormal heartbeats should subside. 

Are there any special precautions I must take after the procedure?
Generally, recovery after EPS is very fast. We normally advise avoidance of heavy lifting (>10 pounds) for the first 10 days while your the groin puncture site heals.

You should expect to resume normal activities by 2 weeks, unless your doctor advises you specifically otherwise.

What happens about medications?
Depending on the procedure and your circumstances, you may be asked to continue taking certain medications. Your doctor will advise you on the appropriate medications to take.

When will my doctor see me again after discharge?
Depending on the abnormal rhythm and the procedure performed, your next appointment with your doctor may range from one week to 3 months post-discharge. Your doctor will arrange follow-up prior to your discharge.

Electrophysiology Study (EPS) - Other Information

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