Testing for and diagnosis of atrial fibrillation
Many issues can contribute to heart rhythm disorders, from physical issues to genetic factors. We offer a full suite of diagnostic services to learn more about your arrhythmia and ultimately create the treatment plan. Some of these include include:
EP Study
An EP study, also known as an electrophysiology study, is an interventional diagnostic test to understand the electrical pathways of the heart, and what, if anything, is causing an irregular heartbeat, or arrhythmia. Further, the EP study is effective in understanding exactly where any errant electrical signals originate, allowing for a better understanding of the heart’s function.
Typically, we perform an EP study only after trying to find the root cause of the arrhythmia, using less-invasive diagnostic tools such as an EKG,Holter monitor, loop recorder, event recorder and more.
The study is performed in a specially created operating room known as an EP lab, located in the hospital. This room is equipped with the latest imaging and modeling technology to get an accurate three-dimensional picture of the heart using only a catheter.
To perform an EP study, your electrophysiologist will make a small incision in the groin and thread a catheter, with an electrode tip, up to the heart. This electrode accurately models the heart in three dimensions and allows your electrophysiologist to see both the structures of the heart as well as its electrical pathways.
The EP study is very safe and effectively determines the type and location of the arrhythmia. Most importantly, once the arrhythmia has been found and a treatment plan decided upon, your electrophysiologist can continue to perform a curative treatment like an Afib ablation during the same procedure. This reduces the amount of time you will spend recovering and allows you to leave their EP study potentially cured.
Event Monitor
An event monitor is very similar to a holter monitor in that it is a portable EKG that can record data beyond when patients are at their physician’s office. However, unlike a Holter monitor, the event monitor is triggered by the patient themselves and does not offer continuous recording. The event monitor can be worn for up to 30 days, during which time the patient can trigger the recording activity every time they have an arrhythmic episode.
Event monitors may be needed when there is any kind of abnormal heartbeat. This may be a fast heartbeat, known as tachycardia; a slow heartbeat, known as bradycardia; or when patients experience unexplained lightheadedness, palpitations, chest pain or fainting, known as syncope. The electrophysiologist will determine whether a Holter or event monitor is more suitable for the patient’s particular situation. For longer-term data, an implantable loop recorder may be appropriate. This will be determined after a full analysis of the patient’s condition.
Periodically, the data from the event recorder will be sent to our office for analysis. This data will be very useful in understanding the type of arrhythmia. However, patients should also keep a journal of their activities immediately before, during, and after the arhythmic episode. This will assist the electrophysiologist in understanding more about the circumstances during which an episode occurs.
An event monitor is completely safe, as it is entirely non-invasive.
Holter Monitor
A Holter monitor is, in essence, a portable EKG that monitors the electrical activity of the heart when the patient is not at their doctor’s office. A standard EKG offers the physician a snapshot of the heart’s electrical activity at any given point in time, but it only records this activity for about 5 minutes at a time. Therefore, occasional or paroxysmal arrhythmias are often undetected.
The Holter monitor can be used for 24 hours at a time, or even longer if needed, and the data it collects can be used by our office to detect or understand more about the arrhythmia.
The Holter monitor does not require any intervention, cutting or surgery. Small electrodes are placed on the chest and connected to an external EKG that is carried around, much like a portable music device. Patients do not have to perform any special activities but will be asked to keep a journal of their activities while wearing the monitor. This helps our electrophysiologists understand the circumstances during which an arrhythmia may occur.
The Holter monitor has no serious risks whatsoever, as it is completely noninvasive. The data that a Holter monitor can provide is far more detailed than a standard EKG and can be the catalyst for diagnosing an arrhythmia. Holter monitors can also be used to determine whether a procedure or a device is working as intended. Unexplained fainting, known as syncope, or unexplained chest pain can also be better understood with a Holter monitor.
Implantable Loop Recorder
An implantable loop recorder is an excellent diagnostic tool for patients with paroxysmal or occasional arrhythmias, including Afib. Occasional arrhythmias may not show up on traditional EKGs (which typically last for about five minutes and only show a single point in time), and often require longer-term monitoring. Arrhythmias, in particular, may only happen once in a very long while. Further, patients may suffer from syncope, or unexplained fainting, and traditional diagnostic devices such as the EKG, or even Holter monitors, may not capture these events due to their limited length of use.
As such, the implantable loop recorder is a longer-term solution to understanding the type of arrhythmia and creating an appropriate treatment plan .
As the name suggests, the implantable loop recorder is placed under the skin of the chest and is a semi-permanent fixture for as long as the diagnostic process takes, which can be up to three years. The recorder catalogs the heart rhythm for a specified period of time but has a loop feature that overwrites old data to allow it to collect data for longer periods of time. Periodically, the patient will use a specialized transmitter to send data back to our office so it can be analyzed for irregularities.
Eventually, when the loop recorder has served its purpose, it can be switched off and left in the body or can be removed. Implantation of a loop recorder is rapid and performed under local anesthetic.