Role of Invasive Electrophysiologic Testing
Role of Invasive Electrophysiologic Testing
A comprehensive electrophysiologic study (EPS) is a useful diagnostic tool for the clinical cardiac electrophysiologist in the care of patients. It assists in diagnosing bradyarrhythmias and tachyarrhythmias; it also contributes immensely to the understanding of the mechanisms of arrhythmias. Moreover, because several intracardiac catheters are utilized during a standard EPS, the site of origin of the arrhythmia can often be ascertained. Knowledge about the mechanism and site of origin of a tachycardia are in turn useful in planning and directing ablation therapy.
In addition to its diagnostic utility, the EPS is also widely utilized for the assessment of risk for sudden cardiac death among patients with arrhythmias (e.g., non-sustained ventricular tachycardia), patients with a possible past cardiac arrhythmia event (e.g., syncope), patients with aborted sudden cardiac death or even patients without arrhythmias. The role of EPSin risk stratification of such patient groups is an important issue as the medical community selects methods to prevent sudden cardiac death in the most appropriate and cost-effective way. The sensitivity, specificity and predictive value of EPS are dependent on the clinical presentation, type of abnormality found at EPS and the underlying organic heart disease (Figure 1). In this article, we will review the data regarding the utility of EPS in risk stratification for arrhythmic occurrence and sudden cardiac death in various groups of patients.
(Enlarge Image)
Figure 1. Proportion of patients with various heart diseases who have ventricular arrhythmias induced with programmed ventricular stimulation at the time of the electrophysiologic study. CAD = coronary artery disease; SMVT = sustained monomorphic ventricular tachycardia; HCM = hypertrophic cardiomyopathy; DCM = nonsustained ventricular tachycardia.
A comprehensive electrophysiologic study (EPS) is a useful diagnostic tool for the clinical cardiac electrophysiologist in the care of patients. It assists in diagnosing bradyarrhythmias and tachyarrhythmias; it also contributes immensely to the understanding of the mechanisms of arrhythmias. Moreover, because several intracardiac catheters are utilized during a standard EPS, the site of origin of the arrhythmia can often be ascertained. Knowledge about the mechanism and site of origin of a tachycardia are in turn useful in planning and directing ablation therapy.
In addition to its diagnostic utility, the EPS is also widely utilized for the assessment of risk for sudden cardiac death among patients with arrhythmias (e.g., non-sustained ventricular tachycardia), patients with a possible past cardiac arrhythmia event (e.g., syncope), patients with aborted sudden cardiac death or even patients without arrhythmias. The role of EPSin risk stratification of such patient groups is an important issue as the medical community selects methods to prevent sudden cardiac death in the most appropriate and cost-effective way. The sensitivity, specificity and predictive value of EPS are dependent on the clinical presentation, type of abnormality found at EPS and the underlying organic heart disease (Figure 1). In this article, we will review the data regarding the utility of EPS in risk stratification for arrhythmic occurrence and sudden cardiac death in various groups of patients.
(Enlarge Image)
Figure 1. Proportion of patients with various heart diseases who have ventricular arrhythmias induced with programmed ventricular stimulation at the time of the electrophysiologic study. CAD = coronary artery disease; SMVT = sustained monomorphic ventricular tachycardia; HCM = hypertrophic cardiomyopathy; DCM = nonsustained ventricular tachycardia.
