Narendra Kumar Yadav is European Board Certified Cardiac electrophysiologist (ECES) with his doctorate thesis in cardiology on Atrial fibrillation ablation from Maastricht University Medical Centre, Netherlands(ranked among top 50 clinical university of world) . He is also a program chair for a cardiology program. His primary interest lies in atrial fibrillation, arrhythmia ablation and cardiovascular economics. He has extensive experience with >2500 ablation procedures and devices implantation (CRT, Micra and pacemakers) with >50 publications (and >250 citations) in reputed journals including JACC and Heart rhythm journal. His “ATSCA study” has been referenced in 2017 expert consensus atrial fibrillation ablation guidelines. He has also worked as a reviewer for journals such as The Lancet and global consultant for various studies as Discovery, painfree-sst and SCA . He is a Fellow of Royal College of physicians of Edinburgh (UK), American College of cardiology and European Society of Cardiology. He is also pursuing executive Master in Health economics and cardiovascular management from London School of economics. He moved to India in mid 2017 to start dept. of cardiac electrophysiology at Paras Hospitals ( Gurgaon and Patna).

We all love watching movies. I am sure, we all will remember Madhuri Dixit singing”Dhak Dhak Karne laga”. However, in real life if one can feel their heart beating at higher rate, it maybe secondary to a disease. Cardiac Electrophysiology studies (EPS) is the study of the heart’s electrical system to determines the mechanism of an arrhythmia. During the procedure, assessment of the function of each component of the cardiac conduction is conducted to determine the potential for a patient to have an arrhythmia. In simple words “We perform diagnostic EP in order to determine if the patient has some type of abnormal rhythm, what type of rhythm it is and what therapy can be implemented to provide the best possible outcome while exposing the patient to the least amount of risk.” During the past 25 years, cardiac electrophysiological studies has become widely used clinical tools, often indispensable in evaluating patients with specific cardiac arrhythmias. Because such studies carry a relatively small but finite risk of major as well as minor complications, routinely involve the purposeful induction of serious arrhythmias, and consume healthcare resources, it is important that their clinical usefulness for diagnosis and therapy of cardiac arrhythmias be carefully considered.

EPS is conducted by placement of several catheters at strategically important locations in heart as right atrium, right ventricle, coronary sinus etc. The pacing is done and responses are recorded and interpreted in a highly scientific method. Ablation procedures are done for the treatment of above mentioned arrhythmias including atrial fibrillation mostly using radiofrequency energy.

EPS must be done for
1] patients not tolerating or not responding to medications for narrow complex tachycardia in whom the study would alter their therapy
2] Narrow QRS tachycardia preferring ablative therapy
3] Sustained wide QRS complex tachycardia
4] An accessory pathway tachycardia that is symptomatic and may require ablative therapy
5] Unexplained syncope and known structural heart disease.
6] Palpitations and documented inappropriate rapid pulse rates without apparent cause.
7] Survival of cardiac arrest with NQWMI or surviving cardiac arrest occurring >48 hrs after AMI.
8] Candidates for implantation of an electrical device to treat their arrhythmias or those who have an implanted device and require therapy changes that may alter the safety or efficacy of their device.

The EP testing is needed for patients with following changes on ECG
1] sinus node dysfunction to exclude other arrhythmic causes or assess the severity or mechanism of dysfunction and drug response to direct therapy.
2] Second or third-degree AV block to determine the site or mechanism of the block in order to direct therapy.
3] Symptomatic patients with bundle branch block to assess the site and severity of the conduction delay in order to direct therapy and evaluate prognosis.
4] Patients with premature ventricular complexes and unexplained pre-syncope or syncope.

The indication of EPS has been increased to even include asymptomatic patients with ECG evidence of WPW syndrome to evaluate the accessory pathway in high-risk activities, a family history of premature sudden death, or unexplained syncope. EPS has a role in patients with clinically significant cardiac palpitations thought to be of cardiac origin but not documented by non-invasive testing in order to diagnose, treat, and assess prognosis and also for risk stratification of post MI patients with reduced LV function having frequent PVC’s, NSVT, or both, particularly if the signal averaged ECG shows late potentials.

If arrhythmias are not seen by a suitable specialist then heart failure may set in and is associated with higher morbidity and morbidity. So, when your heart does abnormal “Dhak Dhak”, It can be managed well with newer tools and techniques.

Figure 1: The international setting of an EP/Cath lab where EP study is carried out.

Author:

Prof. Dr. Narendra Kumar Yadav
Consultant electrophysiologist and cardiologist,
Heart Failure and Arrhythmia clinic,
Dept. of cardiology,
Paras HMRI Hospitals,
NH 30, Bailey Road,
Raja Bazar, Patna,
Bihar 800014 [India]
Mobile – (+91) 7903263691