Just a few decades ago, it was almost impossible to cure heart problems. Any problem was established only with the help of a conventional stethoscope, which could not accurately determine the causes of the violations. Although now not many people know how EFI of the heart is done correctly, doctors are increasingly beginning to use electrophysiological studies to establish heart rhythm disturbances. At the moment, this procedure can be called the most comprehensive and invasive method for assessing the condition of the heart.
Historical background
Despite the fact that the EPS procedure on the heart began to be used relatively recently, the experiments themselves on electrophysiological techniques began to be used at the end of the 18th century by the famous physician Luigi Galvani. He did not achieve any special results, however, over the next years, his students and followers continued to develop his experiments.
A new round begins in the 1970s, when a group of scientists rediscovered interest in this diagnostic method. Now more and moredoctors in their work use the EFI method of the heart.
The essence of the technique
Now the study of EFI of the heart is carried out to diagnose the conduction of the heart muscle and rhythm disturbances. Ultimately, the doctor can fully assess the state of the electrical heart system, and with the knowledge gained, optimally select the principle of treatment.
During the EPS of the heart, various parts of the heart are stimulated to detect existing heart rhythm disturbances. Widely used ECG and daily monitoring of electrocardiography do not allow to achieve the desired result in this situation.
In medicine, two types of EFI operations on the heart are used, each of which, in turn, is divided into subspecies.
Invasive research
Such a diagnosis is carried out exclusively in stationary conditions and is divided into 3 subspecies, depending on how EPS of the heart is done.
1. Endocardial EPS is performed by stimulating the inner lining of the heart itself - the endocardium. The procedure itself does not cause pain as there are no pain receptors, so no anesthesia or medication is required for the patient.
2. Epicardial EPS of the heart stimulates the epicardium during the procedure, therefore it is used only in cases of operations on the open heart muscle.
3. Combined research uses both methods together.
Invasive EFI method has a number of advantages over non-invasive - firstin turn, in a similar way, it is possible to stimulate any of the chambers of the heart, and there are four of them in the body.
Non-invasive method
This technique is better known as transesophageal EPS of the heart or transesophageal electrical stimulation. It is more widely distributed because it does not require hospital conditions. The procedure can be carried out under simple outpatient conditions, since only 2 parts of the heart are stimulated: the left ventricle and the left atrium. During the operation, it is necessary to use anesthesia, since the consequences of EPS of the heart will not only be unpleasant, but also very painful.
All the features of such a procedure must be pre-decided and discussed together with the patient before being sent directly. But at the same time, only one procedure performed can completely open the picture for an unclear diagnosis and set the tactics for treating arrhythmia in a patient.
Doctor's appointments
Because of the modern rhythm of life, more and more people are turning to doctors with the problem of arrhythmia, that is, a violation of the heart rhythm. Normally, in a he althy person, electrical signals pass through the heart uniformly and very clearly. But at the same time, high blood pressure, aging, heart attacks, and many other reasons can lead to the fact that gradually the heart begins to become covered with scars or calcium deposits. All this greatly hinders impulses. Which leads to heart rhythm disturbances - whether it will be regularity or consistency of the pulse. Similar violations and can reveal EPS of the heart.
Main indications forinvasive diagnostics
Depending on the examination technique, electrophysiological stimulation of the heart requires the following indications.
Invasive EPS is used to diagnose these heart conditions:
- atrial fibrillation and nodal tachycardia, as well as other supraventricular tachycardia;
- bradyarrhythmias with MAC attacks;
- any degree of anti-ventricular blockade;
- paroxysmal ventricular tachycardia with spontaneous fibrillation;
- Gis blockade followed by a blockade leading to heart death;
- before pacemaker surgery, RFA and cardioversion.
Main indications for non-invasive stimulation
TEE requires a number of the following indications:
- Frequent slow heart rate.
- Supraventricular tachycardia of a paroxysmal nature.
- Simultaneous bradycardia and tachycardia syndrome.
- Resolving the issue of subsequent pacemaker insertion in cases where drug treatment has not been successful.
- Assessing the effectiveness of the antiarrhythmic therapy the patient is undergoing.
Radiofrequency ablation
To solve problems with tachycardia, which manifests itself in an accelerated heartbeat, EFI RFA of the heart is used. Most often this is called cauterization, since in this case it is completelya small area of the heart is destroyed, in which the pathology of frequency excitation is formed. Those who are interested in how EFI RFA of the heart is done should be aware of the effect on tissue of radio frequency signals, which have the effect of damage. This prevents the appearance of other paths of the pulse. But it does not harm the normal heartbeat, so the heart continues to function in its natural state.
A number of contraindications
Despite the effectiveness of the procedure, there are a number of contraindications, in the presence of which EFI should not be performed in any case. Currently, they include problems with internal organs, mainly cardiovascular:
- prolonged angina for at least a month;
- acute myocardial infarction;
- aneurysm in the heart or aorta;
- heart defects with heart failure;
- thromboembolism;
- stroke - hemorrhagic or ischemic;
- high body temperature;
- circulatory disorders with cardiomyopathy;
- inflammation of the digestive system;
- tumors and strictures of the esophagus.
Pre-training
The appointment of the procedure begins with the obligatory study of the medical history. The entire procedure is discussed with the patient, since a signed consent is required. Depending on the type of procedure, it is performed in an inpatient or outpatient setting.
When conducting it on an outpatient basis, the patient must arrive at the clinicjust a few hours before the procedure itself, as a preliminary blood test is often required. The doctor is obligated to familiarize the patient with the nutrition plan, but it is best not to drink or eat anything for at least 8 hours before the procedure itself, although this period may be longer.
You may also need to take a number of medicines - they are prescribed exclusively by a doctor and are intended to narrow blood vessels and normalize heart rhythm. You may need to stop taking some medications a few days before the procedure, so you should tell your doctor about all the medications that the patient is taking to avoid complications.
After that, a dropper for sedation and anesthesia is necessarily placed before the procedure. Often it remains for the entire period of the operation and even after the study itself.
Features of the EFI
According to reviews, EPS of the heart is not a pleasant procedure, but it cannot be denied that it can effectively diagnose existing problems with heart rhythm disturbances.
To perform an invasive EFI procedure, a doctor inserts a thin tube called a catheter into a blood vessel, usually the femoral vein. This vessel must move towards the heart muscle. The electrode located on the catheter periodically allows you to send signals, but at the same time record your own electrical activity of the heart. The procedure is usually performed under sedation.(under light anesthesia), or when the patient is conscious.
The procedure requires hospital conditions, so the patient stays in the hospital for at least 2 days. The procedure itself usually does not take more than 45 minutes.
Non-invasive research is carried out by a different method, since access to the vessels is not required. The procedure itself is very unpleasant, so you should immediately notify the doctor about any inconvenience. To obtain the result, a normal electrocardiogram is pre-recorded, and then a probe with an electrode is inserted into the mouth or nose, which is gradually introduced into the esophagus. It is stopped near the heart, and then the results are compared.
Such EFI can last from an hour to four hours. It may be accompanied by chest pain or gag reflex, which greatly complicates the study.
Side effects
During the operation, although not dangerous, but unpleasant side effects are often manifested. These include:
- Cardiac arrhythmia, which often leads to severe dizziness and even fainting. This is considered a completely normal situation, so the doctor does not interrupt the EPS of the heart, but simply sends a small electrical shock to subsequently restore the heart rhythm.
- Blood clots at the end of the inserted catheter. At times, they can come off, and therefore block other blood vessels. To avoid such situations, heparin-based blood thinners are administered during EPS.
- In areas where directly injectedcatheter, bruising or bleeding may begin to appear. It is also possible to catch an infection, so you should carefully listen to the advice of doctors.
EFI Consequences
After the immediate end of the procedure, the patient should rest in a supine position for another hour to three hours. During this period of rest, the following recommendations should be observed: in no case do not move until the nurse allows. The limb used in the procedure should be kept relaxed.
Some time after the procedure, the patient's condition is monitored by a nurse to immediately identify any bleeding or swelling. After the patient recovers from anesthesia, the doctor explains the results of the study, and then lets go home or every other day.
Before discharge, the doctor also necessarily gives instructions for further treatment, which must be followed. Food and medications are usually allowed within 4 hours after diagnosis. A person can return to normal life after a day. Within a few days, the puncture site will hurt unpleasantly, bruising or bruising may appear - this is quite normal.
Possible Complications
In some situations, it is imperative to call an ambulance:
- strong and sudden increase in swelling at the puncture site;
- unable to stop bleeding despite all recommendations;
- numbness or tingling of the limb through whichthe doctor conducted the study;
- an arm or leg begins to change color or feel cold;
- a bruise or bruise starts to get bigger, spreading in different directions;
- the puncture site has discharge or swelling.
In fact, EPS is considered a low-risk procedure, so complications are extremely rare. A properly performed procedure with disinfection and all devices does not lead to complications, but it allows you to accurately establish the diagnosis. It is quite possible to endure the discomfort that occurs during the procedure, but it is still necessary to notify the doctor of all changes.
