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1. www.inahrs.or.id

2. STUDI ELEKTROFISIOLOGI (SEF)
Sunu Budhi Raharjo

3. Electrophysiology (EP) Study

5. Preparations for an EP Study
EP Lab
Lab Equipment
Patient Preparation
Infection Control
Radiation Safety

6. Indikasi
• 1. Indikasi diagnostik
a. evaluasi fungsi nodus sinus
b. blok AV didapat
c. perlambatan (delay) konduksi intraventrikular
d. sinkop dengan kausa tidak jelas
e. pasca henti jantung
f. palpitasi dengan kausa tidak jelas
• 2. Indikasi terapeutik
a. panduan untuk terapi obat
b. pasien yang merupakan kandidat atau sudah dipasang alat pacu/ICD
c. pasien takiaritmia supraventrikular simtomatik
d. pasien dengan takikardia ventrikular simtomatik
(Braunwald)

7. Lab Equipment

8. A Typical Control Room
Generator
Flouroscopy
EP computer
Stimulator
• Fluoroscopy equipment
• EP Computer
• RF Generator
• Stimulator

9. Catheter Positioning – Superior Approach
 Superior Approach
Internal jugular
Subclavian
Brachial
Internal Jugular
External Jugular
Left Brachiocephalic
Left Subclavian

10. Catheter Positioning – Inferior Approach
 Inferior Approach
 Femoral vein
 Femoral artery
Femoral artery
Femoral
vein

11. His
CS
HRA
RVA
Catheter Positioning – Catheter Positions

12. RAO
RV
HIS
CS
HRA
Catheter Positioning – Fluoroscopic Imaging

14. Performing an
Electrophysiological Study

15. What is an EP Study?
• Electrical stress test
• An invasive study to assess the heart’s electrical
conduction system
• Patient under conscious sedation
• Often classified outpatient
• Done in EP lab, part of cardiac cath labs

16. Why Conduct an EP Study?
• To evaluate conduction system function
• To confirm supraventricular tachycardia
• To evaluate ventricular tachyarrhythmias
• To classify the extent of bradycardia
• To test efficacy of antiarrhythmic drugs
• To test efficacy of implanted devices

17. Electrophysiology Study
• Measurement of baseline conduction intervals
• Atrial Pacing
- Assessment of SA nodal automaticity and conductivity
- Assessment of AV nodal conductivity and refractoriness
- Assessment His-Purkinjie system conductivity and
refractoriness
- Assessment of atrial refractoriness

18. Electrophysiology Study cont
• Ventricular pacing
• Access retrograde conduction
• Access ventricular refractoriness
• Arrhythmia Induction
• Atrial extrastimulus testing
• Atrial burst pacing
• Ventricular extrastimulus testing
• Ventricular burst pacing

19. Catheters used in a Conduction System Study
• Quadripolar for HRA
• Quadripolar for HBE
• Quadripolar for RVA
Evaluate sinus node function
Evaluate antegrade AV node
conduction
Evaluate retrograde AV node
conduction

20. Intracardiac Electrogram Terminology
II
Between dashed lines (-----) = A wave
Between solid lines ( ) = V wave
Between dashed & solid lines = H potential

21. Normal Activation Sequence
Earlies
t A
wave
Earlies
t v
wave

22. BASELINE

23. Intracardiac recordings can reveal
more than the Surface ECG

24. Intracardiac recordings can reveal
more than the Surface ECG

25. Intracardiac recordings can reveal
more than the Surface ECG

26. Intracardiac recordings can reveal
more than the Surface ECG

28. Basic EP Principles
EP Study
Programmed Electrical Stimulation
Baseline EGM Recordings
Refractory Periods
Sinus Node Recovery Time (SNRT)
Sinoatrial Conduction Time (SACT)
Basic EP Tasks

29. Which Type of EP Study?
Clinical Presentation
• Documented SVT or
atrial flutter
• Suspected SVT
• Syncope
• Nonsustained VT
• Suspected brady
Recommended Study
• Comprehensive EPS
with ablation
• Comprehensive EPS
• Tilt, Baseline EPS, or
loop recorder
• Baseline EPS
• Baseline EPS only if VT
suspected

30. EP Study Outcomes
Therapy
Device
Therapy
Surgical
Therapy
Pharmacologic
Therapy
Device
Implant
Catheter
Ablation
No
Therapy
EP Study

31. EP Lab Staff
• Electrophysiologist (MD)
• Scrub nurse or tech (RN or RCVT)
• Nurse anesthetist (RN)
• EP technician (RCVT)
• Radiology technician (RT)
• Other: physician assistant, EP fellow physician,
anesthesiologist (for cardioversions)

32. Thank you for listening…