What is Cardiac Electrophysiology?

Heart Rhythm Abnormalities

Atrial Fibrillation Center

EP Diagnostic and Therapeutic Procedures

Clinical Research Studies

Educational Resources

Glossary of Terms

Who We Are

How to Contact Us

Where We Are Located

Electrophysiology Home

Diagnostic and Therapeutic Procedures
Performed in the Electrophysiology Lab

Diagnostic Tests:
Electrophysiology Study  Electrophysiology Study
Electrophysiology Study  Tilt Table Test

Therapeutic Procedures:
Pacemaker Implantation  Pacemaker Implantation
ICD (Implantable Cardioverter Defibrillator) Insertion  Implantable Cardioverter Defibrillator ( ICD) Insertion
Cardiac Ablation  Cardiac Ablation

Electrophysiology (EP) Study
During an electrophysiology study, electrode catheters are guided into the chambers of the heart and at strategic places along its conduction system. Once in place, these electrodes record the electrical impulses of the heart and define the exact location of abnormal electrical activity.

Patient Preparations for an Electrophysiology Study
  Fasting Requirements
You will be instructed not to eat or drink anything after midnight prior to your procedure.
  Medication Considerations
If you are taking prescription medications, you should discuss with your physician whether you should continue to take your medications on the day of your procedure. Patients who take blood thinners, such as Coumadin®, will be advised by their physicians to stop taking this medication for a period of time prior to their EP study. If you are diabetic, it is important for you to discuss with your physician how to adjust insulin and food intake prior to your procedure.
  Transportation upon Discharge
Since you will be sedated during your procedure, you must have someone with you to drive you home, unless you are staying overnight. You should pack a small bag of essentials in the event you do stay overnight. Patients whose EP study results are normal will be able to go home the same day after spending some time in the Cardiac Day Accommodation Room (CDAR). If your EP study detects a problem, you will be admitted to the medical center for treatment that usually lasts two days.

What to Expect During an EP Study
  You will be awake during the procedure; however, you will be given sedation to make you drowsy.
  Your heart rate, rhythm, and blood pressure will be continuously monitored.
  The area where the sheath will be inserted will be numbed with a local anesthetic medication. While the sheath is being inserted you may feel slight pressure.
  The catheter is inserted through the sheath and threaded to the heart. The Electrophysiology Lab is equipped with special imaging equipment that allows the physician to view the catheter as it is threaded towards the heart. While the catheter is moving through your body you should feel no pain.
  The catheter is connected to an EKG machine so the electrical activity of the heart can be monitored internally.
  The electrophysiologist will then pace the heart by sending impulses through the catheter to several areas of the heart.
  The catheter and sheath are removed when the study is completed. Pressure will be place on the sheath site, and once the bleeding has stopped, a dressing (bandage) will be applied
  The estimated time that it takes for an EP study is one hour.

What to Expect During Recovery from an EP Study
  A nurse will continue to monitor your heart rate, blood pressure, pulses, and insertion site.
  You will be instructed to lie flat with your head slightly elevated at a 30-degree angle. For a routine EP study, this time period will last for three hours.
  If the insertion site was in your groin, you will be asked not to move your leg, since limiting the movement of your leg will help prevent bleeding.
  Upon discharge, most patients require only minimal restrictions of their daily activities for a short period of time.

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Tilt Table Test
A tilt table test is performed to determine if the cause of fainting spells is due to neurocardiac syncope, a condition that can cause the loss of consciousness due to a drop in the heart rate or blood pressure. During this test, you are securely strapped onto a table that is moved from a reclining position to a heads-up, 60-degree angle. The purpose of these changing positions is to see if a loss of consciousness can be induced under a medically-supervised, controlled situation.

Patient Preparations for a Tilt Table Test
  Fasting Requirements
You will be instructed not to eat or drink anything after midnight prior to your procedure.
  Medication Considerations
If you are taking prescription medications, you should discuss with your physician whether you should continue to take your medications on the day of your procedure. If you are diabetic, it is important for you to discuss with your physician how to adjust insulin and food intake prior to your procedure.
  Transportation upon Discharge
Just in case you feel lightheaded after the test, you must have someone with you to drive you home.

What to Expect During a Tilt Table Test
  An intravenous (IV) tube will be placed into a vein in your arm for the injection of medications.
  Your heart rate, rhythm, and blood pressure will be continuously monitored.
  Several electrodes will be placed on your chest. To ensure good electrode contact with your skin, the area will be cleansed with alcohol and a special pad to remove skin oils and dry skin. These electrodes are connected to an electrocardiograph, the machine that records the heart’s electrical activity.
  You will be securely strapped to the table across your chest and legs.
  The table will be tilted upright to approximately an 60-degree angle for about 45 minutes, then returned to a flat position.
  You may be given medication that increases your heart rate, and then you will be tilted upright for another 15 minutes.
  The estimated time that it takes for a tilt table test is 60 to 90 minutes.

What to Expect During Recovery from a Tilt Table Test
  You can expect an immediate recovery from this test, although you should arrange for someone to drive you home, just in case you feel lightheaded.

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Pacemaker Implantation
A pacemaker is a small, electronic device that is implanted in the chest to regulate your heart rhythm. The pacemaker generator is generally implanted under the collarbone. Electrical wire leads are then threaded through the veins in the chest to the heart.

Patient Preparations for a Pacemaker Implantation
Fasting Requirements
You will be instructed not to eat or drink anything after midnight prior to your procedure.
Medication Considerations
If you are taking prescription medications, you should discuss with your physician whether you should continue to take your medications on the day of your procedure. Patients who take blood thinners, such as Coumadin®, will be advised by their physicians to stop taking this medication for a period of time prior to their Pacemaker implantation. If you are diabetic, it is important for you to discuss with your physician how to adjust insulin and food intake prior to your procedure.
Overnight Arrangements
You should pack a small bag of essentials since you will be admitted to the medical center and stay overnight.

What to Expect During a Pacemaker Insertion
  An intravenous (IV) tube will be placed into a vein in your arm. You will be given a sedative through the IV to help you relax.
  Your heart rate, rhythm, and blood pressure will be continuously monitored.
  The implantation site will be numbed with a local anesthetic medication.
  An incision is made to create a pocket just below the skin.
  The lead for the pacemaker is inserted into a vein through the chest incision, then it is threaded to and positioned inside the heart. The Electrophysiology Lab is equipped with special imaging equipment that allows the physician to view the lead as it is threaded towards the heart.
  Once the lead is tested, it is then connected to the pacemaker, which is then programmed to treat your specific type of arrhythmia.
  The incision is closed and covered with bandages.
  The estimated time that it takes for a pacemaker implantation is one to two hours.

What to Expect During Recovery from a Pacemaker Implantation
  A nurse will continue to monitor your heart rate, blood pressure, pulses, and insertion site.
  Your physician will change the dressing prior to your discharge the following day.
  You will be given a prescription for oral antibiotics that you will take for one week to prevent infection.
  Upon discharge, you will be instructed to limit arm movement for three weeks on whichever side that you had the pacemaker implanted.
  It is essential that you continue to see your physician regularly for follow-up care.
  You will be referred to the Hackensack University Medical Center Pacemaker Center, which provides specialized services to assure that your device works properly and is programmed appropriately to meet your specific needs. Working in conjunction with your physician, the center provides a friendly and comforting setting for this follow-up care and offers a technologically advanced system that assures precise programming of all devices.

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Implantable Cardioverter Defibrillator (ICD) Insertion
An implantable cardioverter defibrillator (ICD) is an electronic device that is implanted in the chest to monitor the heart rate and, if necessary, deliver electrical therapy to restore normal rhythm. An ICD is connected to leads positioned inside the heart. It is usually implanted under the collarbone.

Patient Preparations for an ICD Insertion
  Fasting Requirements
You will be instructed not to eat or drink anything after midnight prior to your procedure.
  Medication Considerations
If you are taking prescription medications, you should discuss with your physician whether you should continue to take your medications on the day of your procedure. Patients who take blood thinners, such as Coumadin®, will be advised by their physicians to stop taking this medication for a period of time prior to their ICD insertion. If you are diabetic, it is important for you to discuss with your physician how to adjust insulin and food intake prior to your procedure.
  Overnight Arrangements
You should pack a small bag of essentials since you will be admitted to the medical center and stay overnight.

What to Expect During an ICD Insertion
  An intravenous (IV) tube will be placed into a vein in your arm. You will be given a sedative through the IV to help you relax.
  Your heart rate, rhythm, and blood pressure will be continuously monitored.
  The implantation site will be numbed with a local anesthetic medication.
  An incision is made to create a pocket just below the skin.
  The lead for the ICD is inserted into a vein through the chest incision, then it is threaded to and positioned inside the heart. The Electrophysiology Lab is equipped with special imaging equipment that allows the physician to view the lead as it is threaded towards the heart.
  Once the lead is tested, it is then connected to the ICD unit, which is then programmed to treat your specific type of arrhythmia.
  The incision is closed and covered with bandages.
  The estimated time that it takes for an ICD insertion is one to two hours.
  Prior to discharge, you will be brought to the Electrophysiology Lab and your ICD will be tested. An anesthesiologist will give you medication through your IV to put you to sleep for each test session, and then the electrophysiologist will perform a detailed testing of your ICD.

What to Expect During Recovery from an ICD Insertion
  A nurse will continue to monitor your heart rate, blood pressure, pulses, and insertion site.
  Your physician will change the dressing prior to your discharge the following day.
  You will be given a prescription for oral antibiotics that you will take for one week to prevent infection.
  Upon discharge, most patients require only minimal restrictions of their daily activities for a short period of time, except for driving, which should be avoided until permission is given by your physician.
  It is essential that you see your physician every three months for follow-up visits following an ICD implantation.

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Cardiac Ablation
The goal of cardiac ablation is to eliminate areas of the heart that are generating the abnormal heart rhythms causing your arrhythmia. During this procedure, the electrophysiologist performs a detailed electrical map of the heart to determine the specific sites that are causing your abnormal heart rhythms. He or she then guides an ablating catheter to the sites and treats the defective tissue by rendering it electrically silent. This specialized catheter emits a painless electromagnetic energy to ablate (destroy) the defective areas.

Patient Preparations for a Cardiac Ablation
  Fasting Requirements
You will be instructed not to eat or drink anything after midnight prior to your procedure.
  Medication Considerations
If you are taking prescription medications, you should discuss with your physician whether you should continue to take your medications on the day of your procedure. Patients who take blood thinners, such as Coumadin®, will be advised by their physicians to stop taking this medication for a period of time prior to their cardiac ablation. If you are diabetic, it is important for you to discuss with your physician how to adjust insulin and food intake prior to your procedure.
  Transportation upon Discharge
Since you will be sedated during your procedure, you must have someone with you to drive you home. Following your procedure, you will spend three to six hours resting in the Cardiac Day Accommodation Room (CDAR) prior to discharge.

What to Expect During a Cardiac Ablation
  You will be awake during the procedure; however, you will be given sedation to make you drowsy.
  Your heart rate, rhythm, and blood pressure will be continuously monitored.
  The area where the sheath will be inserted will be numbed with a local anesthetic medication. While the sheath is being inserted you may feel slight pressure.
  Electrode catheters used for cardiac ablation are long, flexible wires that are inserted through the sheath and threaded to the heart. The Electrophysiology Lab is equipped with special imaging equipment that allows the physician to view the catheters as they are threaded towards the heart. While the catheters are moving through your body you should feel no pain.
  The electrophysiologist performs a detailed electrical mapping of the heart to determine the sites causing your abnormal heart rhythms.
  An ablating catheter is then guided to the abnormal areas. Electromagnetic energy is passed through this specialized catheter to treat the abnormal tissue and render it electrically silent.
  When the electromagnetic energy is applied you may feel a very warm sensation.
  The electrophysiologist may stimulate your heart with tiny electrical impulses at different times throughout the procedure.
  The catheters and sheath are removed when the study is completed. Pressure will be place on the sheath site, and once the bleeding has stopped, a dressing (bandage) will be applied.
  The estimated time for cardiac ablation is two to six hours, depending on how many areas need to be treated.

What to Expect During Recovery from a Cardiac Ablation
  A nurse will continue to monitor your heart rate, blood pressure, pulses, and insertion site.
  You will be instructed to lie flat with your head slightly elevated at a 30-degree angle. For a routine cardiac ablation, this time period will last for three to six hours.
  If the insertion site was in your groin, you will be asked not to move your leg, since limiting the movement of your leg will help prevent bleeding.
  Upon discharge, most patients require only minimal restrictions of their daily activities for a short period of time.


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