Electrophysiological examination (EPU)

An EPU is performed in these cases, among others:

• For the diagnosis of cardiac arrhythmias: An EPU helps to identify the type, origin and cause of cardiac arrhythmias such as atrial fibrillation, ventricular tachycardia or other arrhythmias.
• To determine the treatment strategy: The examination can determine whether drug therapy, a pacemaker, a defibrillator or ablation is necessary. It also helps to better assess the risk of sudden cardiac death or other serious complications.
• Targeted ablation therapy: An EPU can lead directly to therapy by specifically obliterating the area causing the arrhythmia by means of an ablation procedure. This allows the normal heart rhythm to be restored. In this case, an EPU serves as preparation for ablation.
• For the evaluation of medication: The examination can be used to test the effectiveness of certain medications for the treatment of cardiac arrhythmias.

An electrophysiological examination is particularly helpful for patients who suffer from persistent or intermittent cardiac arrhythmias and helps with both diagnosis and targeted treatment to improve the patient's quality of life.

An electrophysiological examination (EPU) is carried out in several steps and is usually performed under local anaesthetic and sometimes under light sedation. The procedure is usually as follows:

Preparation:

• The patient is prepared for the procedure in a sterile examination area in a special cardiac catheterisation laboratory.
• In most cases, a mild sedative is administered and the relevant area (the right and/or left groin) is shaved and sterilised.
• The patient is connected to monitoring equipment to continuously check heart rhythm, blood pressure and oxygen levels.

Procedure site and access:

• The doctor anaesthetises the puncture site in the groin to create access for the electrode catheters.
• Flexible, thin electrode catheters are inserted via a vein or artery and carefully advanced into the heart under X-ray control.

Measurement and analysis:

• As soon as the electrodes are positioned in the heart, electrical impulses are emitted to specifically provoke cardiac arrhythmia and check the electrical conductivity in the heart.
• The heart's reaction is recorded and analysed to determine whether and where there is a disturbance, for example in the atria or ventricles.
• During this phase, the doctor can stimulate different areas of the heart to identify possible arrhythmias and better understand their triggers.

Diagnosis or treatment decision:

• Based on the results of the examination, the diagnosis and appropriate therapy are determined on an individual basis.
• EPU is often combined directly with catheter ablation to eliminate the cause of the arrhythmia. During an ablation, the tissue causing the cardiac arrhythmia is specifically sclerosed.

Completion of the examination:

• Once the examination is complete, the electrode catheters are carefully removed and the puncture site is treated.
• The patient must then remain in hospital for a few hours or up to a day for observation to rule out bleeding or other possible complications.

Aftercare:

• After the EPU, the patient should take it easy for a few days and avoid physical exertion.
• In the case of an ablation that often follows, a follow-up examination is often scheduled to ensure that the cardiac arrhythmia does not recur.

Duration:

A simple EPU takes about 30 minutes. However, depending on the complexity and origin of the cardiac arrhythmia, this duration may be extended accordingly.

Possible complications:

The examination is considered very safe, but complications can occur in rare cases. These include bleeding and haematomas at the puncture site, blood clots, injuries to the heart wall, infections, allergic reactions and cardiac arrhythmias.

The EPU provokes arrhythmias in order to identify their cause. However, sometimes these can also occur briefly after the procedure. However, they usually normalise on their own or can be treated with medication.