Electrophysiology Study

January 01, 2014

EP study and the treatment of cardiac arrhythmia
A new technique to trace cardiac arrhythmia is a great new tool in diagnosing and treating some heart problems.


EP study and the treatment of cardiac arrhythmia

A new technique to trace cardiac arrhythmia is a great new tool in diagnosing and treating some heart problems.

      Cardiac arrhythmia can be considered a silent killer, as the symptoms occur randomly and sometimes cannot be captured during diagnosis. This means that some patients can be left untreated. The condition is always challenging to diagnose, even for a cardiologist, requiring the latest advances in medical technology combined with the cardiologist’s personal expertise and experience.

      Cardiac arrhythmia is caused by a short circuit of the electrical system that controls the rhythm of the heart. Thanks to recent medical advancements, the electrophysiology study, or EP study, is now playing a vital role in diagnosing and treating cardiac arrhythmia all over the world. To help understand the advances in treatment that the EP study now offers, etter Health talked to Dr. Koonlawee Nademanee, Professor of Medicine and Cardiology, a world-renowned American-board certified cardiologist and electro-physiologist with over 30 years-experience in diagnosing and treating patients with cardiac arrhythmia both in Thailand and the U.S.
  “With the accurate electrical mapping, we can identify the exact location where the abnormal rhythm occurs and perform the treatment right at the spot, which allows us to get rid of the problem.”

Dr. Koonlawee Nademanee

      “Cardiac arrhythmia refers to heart rhythm disorders that could be too fast, too slow, or irregular,” explains Dr. Koonlawee. “There are many types of cardiac arrhythmia. Some arrhythmias are completely benign, while others are extremely dangerous and life threatening, such as ventricular tachycardia/ventricular fibrillation and atrial fibrillation. These are the most common types of cardiac arrhythmia requiring immediate medical intervention.”

      Atrial fibrillation is very common among seniors. Those over 75 years are 13 times more at risk than those of 50 or younger. “The causes of cardiac arrhythmia can vary from personto person,” says Dr. Koonlawee. “It could be congenital heart defects or an abnormal heart structure that affects the electrical system, such as a narrowed heart artery or a heart attack, which directly affects the heart muscles. High blood pressure, thyroid disorder or even electrolyte imbalance can also cause the heart’s electrical impulsesto go awry.”

The noticeable symptoms of cardiac arrhythmia may include racing heartbeat, palpitation, and lightheadedness. “Though it doesn’t always mean that you have cardiac arrhythmia when you have the stated symptoms, it would be wise to have a check up,” suggests Dr. Koonlawee. “To pinpoint if the condition is life threatening or not, other factors that contribute to heart disorders will have to be considered. If the patient has a weak heart or weak heart muscles to begin with, he or she won’t experience the same risks as those who have a normal heart. The treatment will be different for each patient.”


EP study and cardiac arrhythmia

      To diagnose the true cause of cardiac arrhythmia and help determine the best treatment options, an EP study is usually recommended for patients with indicative symptoms of cardiac arrhythmia and those at risk of a cardiac arrest. Advances in medical imaging technology and related software, along with better understanding of heart functions, have contributed to the advantages of the EP study.

    “The EP study is a discipline that helps diagnose and treat patients with cardiac arrhythmia,” says Dr. Koonlawee. “During an EP study, electrodes are placed on the patient’s chest to monitor heart rate and rhythm. Then a steerable catheter is inserted and advanced into the heart. When the catheter is positioned, electrical testing of the heart is performed to get more information on the heart’s conduction system.”

    The information taken from the EP study combined with cardiac imaging are synced by state-of-the-art software, which together with diagnostic experience allows the doctors to see the abnormality and then be able to treat it with radiofrequency energy from the tip of the catheter.

    “With accurate electrical mapping, we can identify the exact location where the abnormal rhythm occurs and perform the treatment right at the spot, allowing us to alleviate the problem,” says Dr. Koonlawee.

    “The virtual image of the heart generated by the EP study offers a real-time look at the pumping function of the heart. Doctors can have a 360-degree three-dimensional view of the virtual heart with electrical activity. When the abnormality is located, it will be marked with color codes. Then the radiofrequency energy is applied from the tip of the catheter to dissolve the abnormal tissues that cause arrhythmia, thus the heart rhythm is reset back to normal.”


Treating cardiac arrhythmia

    Diagnosing and treating cardiac arrhythmia with an EP study has offered hope for patients suffering from some types of arrhythmia. “It can offer a complete cure for some cardiac arrhythmia patients since the root cause of the problem is eliminated. However, for those with a previous history of heart attack, which results in scarring of the heart, an EP study won’t be able to change the scar or bring it back to normal. However, EP studies could identify the source of the arrhythmias that causes life-threatening heart rhythm disorder and guide the operator to fix it. However, if patients continue to have risk of future heart attack, such patients are still at risk of having cardiac arrhythmia sometime in the future,” says Dr. Koonlawee.

    “It is very important to note that the EP study only helps in fixing abnormal heart rhythm, and that it won’t help solve other problems contributing to heart disease. If the patient has high blood pressure, narrowing heart artery, or heart scar, the EP study will not change that. It should also be noted that although patients will experience much better quality of life after treatment, they still have to take pro-active steps to minimize other risks of heart disease.”

    Cardiac arrhythmia can occur any time at random and when left undiagnosed or untreated, can lead to permanent damage to an otherwise healthy heart. If you experience symptoms such as racing heart-beat, abnormal sweatiness, or feeling light-headed, then you should discuss this with your doctor right away. It might be that the EP study can play an important role in the diagnosis and then treatment of your heart.
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