Electrophysiology

EP studies help determine where in your heart an abnormal rhythm starts. These tests take place in our electrophysiology lab. You may undergo testing as an outpatient or during a hospital stay.

An EP study is a special type of cardiac catheterization procedure. For the test, doctors insert a catheter with tiny electrodes on its tip into a blood vessel in your groin. They then thread it to your heart. Once there, the electrodes can measure electrical activity. They can also send out electrical signals.

You’re awake for your procedure, but you receive sedation. The study may take one to four hours to complete.

We will tell you how to prepare for your study. If you have the test as an outpatient, once it’s complete, we watch you for a while before sending you home. You go home with instructions for home care.

Knowing where an abnormal heartbeat begins guides decisions about treatment. Treatment may include medication, an implantable device or a procedure called cardiac ablation. We perform ablation procedures in the EP lab, much like EP studies. The treatments may be helpful for many arrhythmias.

Atrial Fibrillation Ablation

AFib ablation uses energy to destroy small areas of the heart where arrhythmias start. There are several types of ablation for AFib:

• Radiofrequency ablation: This form of ablation can be used on any area of the heart causing AFib. It applies radiofrequency energy to heat the tip of the catheter. We then deliver this heat to specific areas of the heart.
• Pulsed Field Ablation (PFA): This energy is non-thermal, meaning the tissue is neither burned or frozen. Rather, when PFA is delivered to electrodes in contact with the heart the abnormal cells are destroyed, resulting in effective treatment of the arrhythmia. Because neither heating or freezing are used PFA is safer by not damaging surrounding structures.

There has been a great deal of research and technology devoted to catheter ablation for AFib. Compared to the past, procedure times are shorter, hospital stays are reduced and there are fewer complications. There is also less chance that AFib will return with today’s treatments.

Supraventricular Tachycardia Ablation

Catheter ablation has a very high success rate for eliminating this arrhythmia. You may receive the treatment as an outpatient.

Premature Ventricular Contraction (PVC) Ablation

If medication doesn’t help this arrhythmia, or you don’t tolerate it well, we may recommend catheter ablation. It’s often very successful in treating PVCS.

Ventricular Tachycardia Ablation

If this type of arrhythmia continues to return, ablation may be helpful.

The Watchman is a device that blocks the left atrial appendage. This is an area of the heart where stroke-causing clots may form if you have AFib. The Watchman may be part of AFib treatment.

We insert the Watchman device into a vein in your groin and deliver it to your heart. It prevents clots from forming and reaching your brain.

Research shows this treatment reduces strokes at a rate equivalent to the blood thinning drug warfarin. But it comes with a lower risk of major bleeding that warfarin may cause. The FDA approved the Watchman device in March 2015 as alternative to warfarin for select patients. Lahey was the first center in Massachusetts to offer it to patients.

Newer blood thinners called DOACs have a lower rate of bleeding compared to warfarin, but in those patients unable to tolerate the newer blood thinners, Watchman remains as an alternative for reducing stroke risk.

You may qualify for the Watchman if you:

• Have AFib not linked to a heart valve problem and an increased risk of stroke.
• Aren’t a candidate for long-term blood thinners.

The procedure takes about 60 minutes. Most people go home the same day or after an overnight hospital stay.