Skip to main content

Electrophysiology Study: Indications and Interpretations

  • Chapter
  • First Online:
Management of Cardiac Arrhythmias

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

The electrophysiology study is central to the field of cardiac electrophysiology. This chapter begins by describing maneuvers performed in a basic electrophysiology study. Indications for an electrophysiology study are then discussed. They include (1) evaluation of syncope, (2) diagnosis of an arrhythmia, (3) evaluation of patients with Wolff–Parkinson–White, and (4) risk stratification of sudden cardiac death. The role of EP studies in non-ischemic cardiomyopathies is also addressed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Josephson ME (2002) Clinical cardiac electrophysiology: techniques and interpretations. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  2. Zimetbaum PJ, Josephson ME (2009) Practical clinical electrophysiology. Lippincott, Williams & Wilkins, Philadelphia

    Google Scholar 

  3. Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al (2006) ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American college of cardiology/American heart association task force and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death). J Am Coll Cardiol 48(5):e247–e346

    Article  PubMed  Google Scholar 

  4. Bachinsky WB, Linzer M, Weld L, Estes NA III (1992) Usefulness of clinical characteristics in predicting the outcome of electrophysiologic studies in unexplained syncope. Am J Cardiol 69(12):1044–1049

    Article  PubMed  CAS  Google Scholar 

  5. Engel TR, Luck JC, Leddy CL, Gonzalez AD (1979) Diagnostic implications of atrial vulnerability. Pacing Clin Electrophysiol 2(2):208–214

    Article  PubMed  CAS  Google Scholar 

  6. Gang ES, Reiffel JA, Livelli FD Jr, Bigger JT Jr (1983) Sinus node recovery times following the spontaneous termination of supraventricular tachycardia and following atrial overdrive pacing: a comparison. Am Heart J 105(2):210–215

    Article  PubMed  CAS  Google Scholar 

  7. Fujimura O, Yee R, Klein GJ, Sharma AD, Boahene KA (1989) The diagnostic sensitivity of electrophysiologic testing in patients with syncope caused by transient bradycardia. N Engl J Med 321(25):1703–1707

    Article  PubMed  CAS  Google Scholar 

  8. Scheinman MM, Peters RW, Suave MJ, Desai J, Abbott JA, Cogan J et al (1982) Value of the H-Q interval in patients with bundle branch block and the role of prophylactic permanent pacing. Am J Cardiol 50(6):1316–1322

    Article  PubMed  CAS  Google Scholar 

  9. Brembilla-Perrot B, Beurrier D, de la Chaise AT, Suty-Selton C, Jacquemin L, Thiel B et al (1996) Significance and prevalence of inducible atrial tachyarrhythmias in patients undergoing electrophysiologic study for presyncope or syncope. Int J Cardiol 53(1):61–69

    Article  PubMed  CAS  Google Scholar 

  10. Doherty JU, Pembrook-Rogers D, Grogan EW, Falcone RA, Buxton AE, Marchlinski FE et al (1985) Electrophysiologic evaluation and follow-up characteristics of patients with recurrent unexplained syncope and presyncope. Am J Cardiol 55(6):703–708

    Article  PubMed  CAS  Google Scholar 

  11. Hess DS, Morady F, Scheinman MM (1982) Electrophysiologic testing in the evaluation of patients with syncope of undetermined origin. Am J Cardiol 50(6):1309–1315

    Article  PubMed  CAS  Google Scholar 

  12. Denes P, Uretz E, Ezri MD, Borbola J (1988) Clinical predictors of electrophysiologic findings in patients with syncope of unknown origin. Arch Intern Med 148(9):1922–1928

    Article  PubMed  CAS  Google Scholar 

  13. Morady F, Scheinman MM (1983) The role and limitations of electrophysiologic testing in patients with unexplained syncope. Int J Cardiol 4(2):229–234

    Article  PubMed  CAS  Google Scholar 

  14. Daubert JP, Zareba W, Hall WJ, Schuger C, Corsello A, Leon AR et al (2006) Predictive value of ventricular arrhythmia inducibility for subsequent ventricular tachycardia or ventricular fibrillation in multicenter automatic defibrillator implantation trial (MADIT) II patients. J Am Coll Cardiol 47(1):98–107

    Article  PubMed  Google Scholar 

  15. Denniss AR, Ross DL, Richards DA, Uther JB (1992) Electrophysiologic studies in patients with unexplained syncope. Int J Cardiol 35(2):211–217

    Article  PubMed  CAS  Google Scholar 

  16. Campbell RW, Smith RA, Gallagher JJ, Pritchett EL, Wallace AG (1977) Atrial fibrillation in the preexcitation syndrome. Am J Cardiol 40(4):514–520

    Article  PubMed  CAS  Google Scholar 

  17. Wellens HJ, Durrer D (1974) Wolff-Parkinson-White syndrome and atrial fibrillation. Relation between refractory period of accessory pathway and ventricular rate during atrial fibrillation. Am J Cardiol 34(7):777–782

    Article  PubMed  CAS  Google Scholar 

  18. Wellens HJ (2005) Should catheter ablation be performed in asymptomatic patients with Wolff-Parkinson-White syndrome? When to perform catheter ablation in asymptomatic patients with a Wolff-Parkinson-White electrocardiogram. Circulation 112(14):2201–2207

    Article  PubMed  Google Scholar 

  19. Pappone C, Manguso F, Santinelli R, Vicedomini G, Sala S, Paglino G et al (2004) Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome. N Engl J Med 351(12):1197–1205

    Article  PubMed  CAS  Google Scholar 

  20. Klein GJ, Bashore TM, Sellers TD, Pritchett EL, Smith WM, Gallagher JJ (1979) Ventricular fibrillation in the Wolff-Parkinson-White syndrome. N Engl J Med 301(20):1080–1085

    Article  PubMed  CAS  Google Scholar 

  21. Montoya PT, Brugada P, Smeets J, Talajic M, Della BP, Lezaun R et al (1991) Ventricular fibrillation in the Wolff-Parkinson-White syndrome. Eur Heart J 12(2):144–150

    PubMed  CAS  Google Scholar 

  22. Timmermans C, Smeets JL, Rodriguez LM, Vrouchos G, van den DA, Wellens HJ (1995) Aborted sudden death in the Wolff-Parkinson-White syndrome. Am J Cardiol 76(7):492–494

    Article  PubMed  CAS  Google Scholar 

  23. Pappone C, Santinelli V, Rosanio S, Vicedomini G, Nardi S, Pappone A et al (2003) Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff-Parkinson-White pattern: results from a large prospective long-term follow-up study. J Am Coll Cardiol 41(2):239–244

    Article  PubMed  Google Scholar 

  24. Pappone C, Santinelli V, Manguso F, Augello G, Santinelli O, Vicedomini G et al (2003) A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome. N Engl J Med 349(19):1803–1811

    Article  PubMed  CAS  Google Scholar 

  25. Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ et al (2003) ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias–executive summary: a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias). Circulation 108(15):1871–1909

    Article  PubMed  Google Scholar 

  26. Richards DA, Byth K, Ross DL, Uther JB (1991) What is the best predictor of spontaneous ventricular tachycardia and sudden death after myocardial infarction? Circulation 83(3):756–763

    Article  PubMed  CAS  Google Scholar 

  27. Wilber DJ, Olshansky B, Moran JF, Scanlon PJ (1990) Electrophysiological testing and nonsustained ventricular tachycardia. Use and limitations in patients with coronary artery disease and impaired ventricular function. Circulation 82(2):350–358

    Article  PubMed  CAS  Google Scholar 

  28. Schmitt C, Barthel P, Ndrepepa G, Schreieck J, Plewan A, Schomig A et al (2001) Value of programmed ventricular stimulation for prophylactic internal cardioverter-defibrillator implantation in postinfarction patients preselected by noninvasive risk stratifiers. J Am Coll Cardiol 37(7):1901–1907

    Article  PubMed  CAS  Google Scholar 

  29. Buxton AE, Hafley GE, Lehmann MH, Gold M, O’Toole M, Tang A et al (1999) Prediction of sustained ventricular tachycardia inducible by programmed stimulation in patients with coronary artery disease. Utility of clinical variables. Circulation 99(14):1843–1850

    Article  PubMed  CAS  Google Scholar 

  30. Buxton AE, Lee KL, DiCarlo L, Gold MR, Greer GS, Prystowsky EN et al (2000) Electrophysiologic testing to identify patients with coronary artery disease who are at risk for sudden death. Multicenter unsustained tachycardia trial investigators. N Engl J Med 342(26):1937–1945

    Article  PubMed  CAS  Google Scholar 

  31. Turitto G, Ahuja RK, Caref EB, el Sherif N (1994) Risk stratification for arrhythmic events in patients with nonischemic dilated cardiomyopathy and nonsustained ventricular tachycardia: role of programmed ventricular stimulation and the signal-averaged electrocardiogram. J Am Coll Cardiol 24(6):1523–1528

    Article  PubMed  CAS  Google Scholar 

  32. Milner PG, Dimarco JP, Lerman BB (1988) Electrophysiological evaluation of sustained ventricular tachyarrhythmias in idiopathic dilated cardiomyopathy. Pacing Clin Electrophysiol 11(5):562–568

    Article  PubMed  CAS  Google Scholar 

  33. Brembilla-Perrot B, Donetti J, de la Chaise AT, Sadoul N, Aliot E, Juilliere Y (1991) Diagnostic value of ventricular stimulation in patients with idiopathic dilated cardiomyopathy. Am Heart J 121(4 Pt 1):1124–1131

    Article  PubMed  CAS  Google Scholar 

  34. Avella A, d’Amati G, Pappalardo A, Re F, Silenzi PF, Laurenzi F et al (2008) Diagnostic value of endomyocardial biopsy guided by electroanatomic voltage mapping in arrhythmogenic right ventricular cardiomyopathy/dysplasia. J Cardiovasc Electrophysiol 19(11):1127–1134

    Article  PubMed  Google Scholar 

  35. Waldo AL, Akhtar M, Brugada P, Henthorn RW, Scheinman MM, Ward DE et al (1985) The minimally appropriate electrophysiologic study for the initial assessment of patients with documented sustained monomorphic ventricular tachycardia. J Am Coll Cardiol 6(5):1174–1177

    Article  PubMed  CAS  Google Scholar 

  36. Vandepol CJ, Farshidi A, Spielman SR, Greenspan AM, Horowitz LN, Josephson ME (1980) Incidence and clinical significance of induced ventricular tachycardia. Am J Cardiol 45(4):725–731

    Article  PubMed  CAS  Google Scholar 

  37. Josephson ME, Almendral JM, Buxton AE, Marchlinski FE (1987) Mechanisms of ventricular tachycardia. Circulation 75(4 Pt 2):III41–III47

    PubMed  CAS  Google Scholar 

  38. Roy D, Marchand E, Theroux P, Waters DD, Pelletier GB, Cartier R et al (1986) Long-term reproducibility and significance of provokable ventricular arrhythmias after myocardial infarction. J Am Coll Cardiol 8(1):32–39

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Thomas, K.E., Zimetbaum, P.J. (2011). Electrophysiology Study: Indications and Interpretations. In: Yan, GX., Kowey, P. (eds) Management of Cardiac Arrhythmias. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-161-5_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-161-5_6

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60761-160-8

  • Online ISBN: 978-1-60761-161-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics