How to Prepare
Sometime prior to your procedure your doctor or the nurse coordinator will review your medical history. He or she will also explain the purpose of the Diagnostic Electrophysiology Study (EPS), its potential benefits and possible risks. Because an EPS is invasive, requiring the insertion of catheters into the body, it involves some risk. The risk is small, however, and the study is relatively safe. Most patients who undergo EPS do not experience complications.
You will need to have a blood test,
ECG, and
chest x-ray, before the procedure. If this has not been arranged before your procedure, call the Triage Office. If you have any questions, you can call your doctor's office or call the Triage Office at 416 340 4800 ext. 8436.
If there are any changes in the booking of your test, you will be called by the Triage Office.
If you cannot go to your test, call the Triage Office as soon as you know.
Take a shower the night before or the morning of your test.
Please bring with you all of your current medications in the original containers. This includes prescription medications, over-the-counter medications, vitamin or mineral supplements and herbal remedies.
If your procedure is in the morning you can have NOTHING to eat or drink from midnight the night before your procedure. You will be instructed by your doctor or the nurse coordinator as to which medications you are allowed to take on the morning of the procedure. Medications can be taken with sips of water unless you are instructed otherwise by your doctor or nurse coordinator. Your doctor or the nurse coordinator will give you instructions about your blood thinner or diabetic medications.
If your procedure is in the afternoon you can have a small breakfast (such as toast and juice) before 6:00 am. Do not have anything else to eat until after your test. You will be instructed by your doctor or the nurse coordinator as to which medications you are allowed to take on the morning of the procedure. Medications can be taken with sips of water unless you are instructed otherwise. Your doctor or the APN will give you instructions about your blood thinner or diabetes pills.
Blood Thinners such as Coumadin® (Warfarin), Pradaxa® (Dabigatran), Eliquis® Apixaban and Xarelto® (Rivaroxaban) are usually stopped 1 to 3 days before the procedure. You will be given specific instructions about what to do by your doctor or the nurse coordinator.
If you take any medication (pills or insulin) for your diabetes, call the Triage Office or the doctor who is arranging your procedure for instructions. Ask what you will need to do about your medication and breakfast on the day of the test.
If you need an interpreter, bring a friend or family member on the day of the procedure. You'll be sedated during this procedure. Your friend or family member will be instructed on how to care for you or assist with your care after the procedure on discharge and will be required to drive and/or accompany you home. They can also help you gather information, take notes and ask questions.
You can back a small bag with personal toiletries for your hospital admission. DO NOT bring large sums of money or valuables to the hospital.
If you are discharged the same day as your procedure, you'll need to arrange for someone to stay with you during the night, after you have had your procedure.
Checking In
Defibrillator implants, Pacemaker Implants and Implantable Loop Recorders are done in the Operating Room (OR) or the
Cardiovascular Investigations Unit (Cath Lab) on the 2nd floor Eaton Building.
You will initially check in at the
Cardiovascular Investigations Unit (Cath Lab) or the
Cardiac Short Stay Unit on the 5th floor Munk Building. Please check in at the nurses' station.
Please have the following ready:
- Health card (OHIP card). If you do not have an OHIP card, please bring another form of government-issued photo ID (such as a driver's license, passport, or other provincial health card). Please arrive 15 minutes before your appointment.
- Your name, address and birth date
Before your Diagnostic Electrophysiology Studies
When you check-in, the receptionist will give you a name band to wear. You will be assigned a room to wait until it's time for your procedure. You will be asked to change into a hospital gown. Your family should keep your valuables with them.
When you have finished changing, a nurse will prepare you for the test and the physician will explain the procedure and ask for your consent.
Diagnostic EP studies are usually done at UHN using the femoral veins at the right groin. In some cases, it may be necessary to use the left groin, the jugular or subclavian veins. Catheters are inserted through the femoral veins, which are veins near your groin. Prior to the procedure, it will be necessary to remove hair from the area.
During and After your Diagnostic Electrophysiology Studies
Diagnostic Electrophysiology Studies are done in a lab. The lab is kept cool to keep the machines working properly, so you may feel cool as well. During the procedure, the nurses will monitor your heart rhythm and blood pressure. Sterile sheets will be put on you to keep the insertion site clean.
We will give you medication to help you relax but you'll remain awake during the procedure.
The doctor will give you an injection to numb the area where the catheter will be inserted. Then a hollow plastic guide (sheath) will be inserted into the vein – you may feel some pressure and tingling, which is normal. Then your doctor will insert 2 to 4 catheters in the right groin which will enter your heart. If you feel any pain or discomfort during the procedure, tell the doctor right away.
With the help of fluoroscopy (x-rays on a television screen), all the catheters are guided to several specific locations in your heart to record specific electrical activity in order to pinpoint the type and location of the arrhythmia and decide how to treat it.
After the mapping of the abnormal electrical pathway is performed, the catheters will either be removed or a decision to treat the location of the abnormal pathway with an
ablation in the same session will be made. Either way, after the procedure, the sheath will be removed in the Cardiovascular Investigations Unit (Cath Lab) recovery room.
If your doctor has used the femoral vein near your groin, a clamp may be applied to the area where the catheter was put in. If your doctor has used your neck or jugular vein, another type of pressure will be used. This is to stop any bleeding and to help the area heal.
When you return from the lab, you'll be lying flat on your back with your leg straight.
You need to stay in this position for 4 hours before you're allowed to sit up. This allows more time for the area to heal. One hour after the procedure, you'll be allowed to have something to eat and drink. A nurse will check your blood pressure and the pulses in your feet and will also check the area where the catheters were inserted.
The Results of Your Diagnostic Electrophysiology Studies
The physician or the nurse coordinator will speak to you following the diagnostic EPS. Before discharge, you will be given specific instructions by your doctor or the nurse coordinator about when you can restart your medications.
How Long Will Your Procedure Be?
Diagnostic Electrophysiology Tests usually take about 1 hour, but you will be here all day. If an ablation is performed, the procedure can last up to 4 hours and you may need to stay overnight.
We do everything that we can to stay on time. Unfortunately, your appointment may be delayed by unforeseen circumstances. We recommend that you come prepared for delays.
Recovering at Home
You can resume your normal daily activities (such as walking, bathing, showering) upon discharge from the hospital unless, instructed differently. The only restriction is straining or lifting heavy objects more than 10 pounds, for 5 to 7 days, so that the incision site can heal. Avoid vigorous activity such as playing football, basketball, and exercise for one week.
You may experience some tenderness and bruising in your groin and upper leg. This is normal, but if the pain is excessive or continuous, please have your family doctor or closest emergency clinic examine it.
You can return to work in 3 to 4 days unless your job requires you to lift heavy objects.
Always follow your doctor's or nurse coordinator's instructions for mobility and activity levels.
