Electrophysiological examination

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The electrophysiological examination (EPU) is a special cardiac catheter examination for patients with cardiac arrhythmias .

The aim of the electrophysiological examination is to determine the type and mechanism of cardiac arrhythmias and, if possible, to carry out therapy . A simple examination takes about 1–2 hours, but also significantly longer in complex cases. Usually after only local anesthesia , at least two, but often also three or more thin electrode catheters are inserted into the right heart via the inguinal veins under fluoroscopy . This process is hardly noticeable. In cardiac arrhythmias that originate in the left half of the heart, you can either get into the heart via the inguinal artery and the main body artery or via a puncture in the atrial septum.

The electrical signals are registered at various points in the heart via the electrode catheter and the cardiac arrhythmia is triggered with the help of imperceptible pacemaker pulses. In most cases, these cardiac arrhythmias can be stopped again via the inserted catheter with pacemaker pulses or with fast-acting medication if symptoms occur. Ending the arrhythmia with an external electric shock under short anesthesia ( cardioversion ) is only rarely necessary.

In addition to the classic examination method, there is also the possibility of using special, computer-aided systems to generate a three-dimensional image of the heart cavity and the electrical excitation process. The advantage of this method is the reduced need for X-rays and the understanding of complex arrhythmias, especially in previously operated hearts or congenital heart defects . After diagnosis of cardiac arrhythmia of the examining physician further proposals can give the therapy and are carried out obliteration of the diseased part with high frequency current or cold (catheter ablation) in many cases in the same investigation.

A new method for the targeted control of the electrode catheter is magnetic field navigation. A very soft and flexible catheter with a small magnet on the tip is used, which is directed from the outside via computer-controlled permanent magnets. The attending physician controls the catheter via a joystick and can thus very accurately target the points on the inner wall of the heart that are intended for sclerotherapy. This method can also be used to reach regions of the heart that were previously inaccessible for catheter ablation. This is important for the treatment of atrial fibrillation , for example . The computer also helps to automatically reach previously treated areas again if the ablation did not work completely on the first attempt. The soft catheter also has the advantage that it can not injure the blood vessels like wire catheters that have been used up to now.