Each heartbeat usually begins with an electrical signal from the heart's natural pacemaker. The signal spreads through the upper chambers and then passes to the lower chambers, so the chambers squeeze in sequence. A rhythm problem can occur when a signal starts somewhere else or travels around an abnormal electrical circuit and repeatedly triggers fast heartbeats.
An electrophysiology study, often shortened to EPS or EP study, examines these signals from inside the heart. Thin, flexible tubes called catheters carry small electrodes that record electrical activity and deliver controlled pulses. The recordings show how signals travel through the heart, while the pulses test its response. This can reveal the source and type of an abnormal rhythm, called an arrhythmia.
The test is performed by an electrophysiologist, a cardiologist who specialises in heart rhythm problems.
Call triple zero (000) for severe, worsening or persistent chest pain, or chest discomfort with breathlessness, sweating, nausea or pain spreading to your arm, jaw or back.
Do not wait for a routine appointment or drive yourself to hospital.
The hospital provides instructions about fasting and medicines before the test. Check these with the treating team, particularly if you take blood thinners, diabetes medicines or heart rhythm medicines. Don't stop or change a medicine yourself.
You'll lie on a procedure table with ECG electrodes on your chest and a small cannula in your arm or hand for medicines. Sedation helps you relax and feel drowsy, although you may remain aware of what's happening. Some studies use a general anaesthetic, so you're asleep.
Local anaesthetic numbs the entry site, usually at the groin. The doctor passes the catheters through a vein into the heart and checks their position with X-rays and sometimes a three-dimensional mapping system. You may feel pressure at the entry site; tell the staff if it hurts.
The electrodes record activity at different points inside the heart. The doctor sends small pulses through them to make your heart beat at different speeds. This is called pacing, and it may reproduce the rhythm that caused your symptoms.
By comparing how the signals spread and respond to pacing, the doctor maps their route through the heart. The pattern helps tell a rhythm that starts in one small area apart from one that travels around a loop. It also helps locate tissue that might be treated with ablation.
If you're awake, you may feel your heart racing or fluttering. Staff monitor your rhythm and blood pressure throughout. Pacing, medicines or an electrical shock can stop the abnormal rhythm if needed. When the study and any agreed ablation are finished, the catheters are removed and pressure is applied to the entry site to stop bleeding.
An EP study may follow an ECG or heart monitor that has found an abnormal rhythm needing closer investigation. It can also help investigate fainting when a heart rhythm problem is suspected, or assess the risk of a serious arrhythmia.
A wearable monitor records episodes during daily life, while an EP study tests the heart's electrical pathways under controlled conditions. That extra information is useful when it could change treatment, for example by finding a pathway that ablation could target. Your symptoms and earlier results guide whether the study is needed.
For some fast rhythms, signals keep travelling around a loop. If the study identifies a part of that loop that can be treated safely, catheter ablation may be an option. It delivers energy through a catheter to make a small scar that blocks the unwanted signal. Locating the loop is one reason an EP study may be part of SVT or flutter ablation.
Ablation can sometimes be performed during the same session. It must be discussed beforehand and included in your consent, as agreeing to the study doesn't automatically mean agreeing to ablation.
The findings may instead support medicines to slow a fast heartbeat or reduce rhythm episodes, or continued monitoring without a procedure.
An EP study can also help decide whether you need an implanted device. A pacemaker supplies electrical pulses when the heart's own signals are too slow or fail to reach the lower chambers. An implantable defibrillator (ICD) detects certain dangerous fast rhythms and treats them with electrical pulses or a shock. Neither device is implanted as a routine part of the study.
The catheter entry site can be bruised, tender or swollen. Less common complications include significant bleeding, a blood clot, or damage to a blood vessel or the heart. A rhythm triggered during testing may need urgent treatment to restore the normal heartbeat.
Ablation adds risks that depend on the tissue being treated. For example, injury near the heart's normal electrical pathway can cause heart block, where signals no longer pass properly to the lower chambers. This can mean a pacemaker is needed.
You'll rest in bed while staff check your heart rhythm and the entry site. This gives the vein time to seal. Some people leave the same day; others stay overnight. Someone will need to take you home after sedation.
Follow the hospital's instructions about wound care, driving, lifting and returning to work or exercise. Report increasing pain, swelling, redness or discharge at the entry site to the hospital or your doctor. The discharge plan should also cover any medicine changes and your follow-up appointment to review the findings.
Your GP or specialist can refer you to a Heartscope cardiologist to discuss a heart rhythm problem. The cardiologist reviews your symptoms and results and can refer you to a hospital heart rhythm specialist if an EP study may help. The clinic can answer questions about the consultation.
Consultations are privately billed. If you're eligible, Medicare pays part of the consultation fee when you have a valid referral from your GP or specialist. The clinic will confirm the amount left to pay before the visit.
Hospital and procedure fees are separate from the Heartscope consultation. The hospital and treating providers confirm those costs before the procedure.
Heartscope cardiologists see patients at clinics in Melbourne and Queensland. If you have a referral, our team can confirm the location and appointment details.
View clinic locationsNo. Heartscope cardiologists may be able to see patients with a valid referral from their GP or specialist, and can refer them to hospital for the study.
No. An ECG records electrical activity through electrodes on your skin. An EP study places electrodes inside the heart to make detailed recordings and test its response to electrical pulses.
The study catheters are removed afterwards. A pacemaker or defibrillator needs a separate implantation procedure and consent.
Sometimes the doctor can't reproduce it, and that doesn't rule out every rhythm problem. Your doctor looks at the findings alongside your symptoms and earlier recordings, and you may still need further monitoring.
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