Electrophysiology Services

  • Electrophysiology Studies
  • Cardioversion
  • Pacemaker and Defibrillator Implantation
  • Pacemaker and defibrillator lead extraction
  • Radiofrequency Ablation
  • Cryo Ablation
  • Cardiac Resynchronization Therapy
  • Device follow-up clinic and remote monitoring
  • Tilt Table Testing

Electrophysiology Studies

Electrophysiology Study

An electrophysiology (EP) study is a test that records the electrical activity and electrical pathways of your heart. This test is used to help determine the cause of your heart rhythm disturbance and the best treatment for you. During the EP study, your doctor will safely reproduce your abnormal heart rhythm and then may give you different medications to see which controls it best or to determine the best procedure or device to treat your heart rhythm.

Why Do I Need an EP Study?
You may need an EP study:

  • To determine the cause of an abnormal heart rhythm ( or arrhythmia)
  • To locate the site of origin of an abnormal heart rhythm
  • To decide the best treatment for an abnormal heart rhythm
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Sometimes, an EP study is conducted before implantable cardioverter/defibrillator (ICD) placement to determine which device is best, and then afterward to monitor treatment success.

How Should I Prepare for the EP Study?

  • Ask your doctor what medications you are allowed to take during the EP study. Your doctor may ask you to stop certain medications 1 to 5 days beforehand. If you have diabetes, ask your doctor how you should adjust your diabetes medications.
  • Do not eat or drink anything after midnight the evening before the EP study. If you must take medications, take them only with a small sip of water.
  • When you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry or valuables at home.
  • Your doctor will tell you if you can go home or must stay in the hospital after the procedure. You may be instructed to bring an overnight bag with you to the hospital. If you are able to go home, bring a companion to drive you home.

What Can I Expect During the EP Study?

  • At the start of an EP study, you will lie on a bed and the nurse will start an intravenous (IV) line into your arm or hand. This is so you can receive drugs and fluids during the procedure. You will be given a drug through your IV to relax you and make you drowsy, but it may not put you in a total sleep.
  • The nurse will connect you to several monitors.
  • Your groin will be shaved and cleansed with an antiseptic solution. Sterile drapes are used to cover you, from your neck to your feet. A soft strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile field.

An electrophysiologist (a doctor who specializes in the diagnosis and treatment of abnormal heart rhythms) will numb the skin in your groin (a few inches to the side of your genitalia) with medication and then insert several catheters, or tubes, into the vein beneath the skin. Guided by the fluoroscopy machine, the catheters are threaded to your heart. The catheters sense the electrical activity in your heart and are used to evaluate your heart’s conduction system. The doctor will use a catheter stimulate your heart in an attempt to produce an arrhythmia.You may feel your heart beating faster or stronger. Your nurses and doctor will want to know about any symptoms you are feeling. If your arrhythmia — or irregular heart rhythm — occurs, your doctor may give you medications through your IV to test their effectiveness in controlling it. If necessary, a small amount of energy may be delivered by the patches on your chest to bring back a normal heart rhythm. Based on the information collected during the study, the doctor may continue with an ablation procedure or device implant (pacemaker or ICD).

The EP study takes about 1 to 2 hours to perform. However, it can take longer if additional treatments such as catheter ablation are performed at the same time.

What Happens After the EP Study?

After the EP study, the doctor will remove the catheters from your groin and apply pressure to the site to prevent bleeding. You will be on bed rest for about one to two hours.

Cardioversion

If you have an irregular heartbeat (called an arrhythmia), your doctor might suggest a treatment called cardioversion to help get your heart back into a normal rhythm.

If your heart beats too fast or unevenly, it can be dangerous. Your heart may not be pumping enough blood to meet your body’s needs. An irregular heartbeat also can lead to a stroke or a heart attack.

Types of Cardioversion

There are two kinds of cardioversion: chemical and electrical. Your doctor will talk to you about which one is right for you. Both types are most often done in a hospital or outpatient center.

Chemical cardioversion: If your arrhythmia isn’t an emergency, a doctor will usually use medication to make your heart beat normally. This is called chemical or pharmacologic cardioversion. You typically get the medicine through an IV while doctors check your heart. But sometimes, people can take the medicine as a pill.

Electrical cardioversion: Drugs alone may not work to correct your heartbeat. Electrical cardioversion uses electric shocks delivered through patches on your chest to regulate your heartbeat:

  • First, you will receive IV medication to make you fall asleep.
  • Then, doctors put special patches on your chest, and sometimes your back, to deliver a mild electrical shock to restore your heart’s rhythm.

Most people only need one shock. Because you are sedated, you likely won’t remember being shocked. You can usually go home the same day you have the procedure.
Your skin may be irritated where the paddles touched it. Your doctor can suggest a lotion to ease any pain or itching.

Electrical Cardioversion Is Not the Same as Defibrillation

Defibrillation also uses electric shocks, but it is not the same as electric cardioversion.

In defibrillation, doctors use high-voltage shocks to treat life-threatening arrhythmias or a heart that has stopped.

Cardioversion Risks and Complications

When you have either kind of cardioversion, there’s a chance the treatment could knock loose blood clots that were created as a result of your abnormal heartbeat. If the clot travels to the brain, it can cause a stroke. Before the cardioversion, your doctor may do a special type of ultrasound to look for blood clots in your heart. You will probably also be given medicine to help prevent blood clots to take for several weeks before and after cardioversion.

It’s unlikely, but there is a small possibility that cardioversion could damage the heart or lead to further arrhythmias.

After Cardioversion

Once your heart is back in a normal rhythm, your doctor will give you medicine to make sure it stays that way.

You’ll return to your doctor in a few weeks for an electrocardiogram (EKG) to make sure your heart rhythm is still regular. Keep up with your doctor visits and follow your treatment plan. Let your doctor know if you have any questions or notice any changes in your health.

Pacemaker and Defibrillator Implantation

A pacemaker system consists of a battery, a computerized generator, and wires with sensors called electrodes on one end. The battery powers the generator, and both are surrounded by a thin metal box. The wires connect the generator to the heart.

A pacemaker monitors and helps control your heartbeat. The electrodes detect your heart’s electrical activity and send data through the wires to the computer in the generator.

If your heart rhythm is abnormal, the computer will direct the generator to send electrical pulses to your heart. The pulses then travel through the wires to reach your heart.

Newer pacemakers also can monitor your blood temperature, breathing, and other factors and adjust your heart rate to changes in your activity.

The pacemaker’s computer also records your heart’s electrical activity and heart rhythm. Your doctor will use these recordings to adjust your pacemaker so it works better for you.

Your doctor can program the pacemaker’s computer with an external device. He or she doesn’t have to use needles or have direct contact with the pacemaker.

Pacemakers have one to three wires that are each placed in different chambers of the heart.

The wires in a single-chamber pacemaker usually carry pulses between the right ventricle (the lower right chamber of your heart) and the generator.
The wires in a dual-chamber pacemaker carry pulses between the right atrium (the upper right chamber of your heart) and the right ventricle and the generator. The pulses help coordinate the timing of these two chambers’ contractions.
The wires in a biventricular pacemaker carry pulses between an atrium and both ventricles and the generator. The pulses help coordinate electrical signaling between the two ventricles. This type of pacemaker also is called a cardiac resynchronization therapy (CRT) device.

Types of Pacemaker Programming

The two main types of programming for pacemakers are demand pacing and rate-responsive pacing.

A demand pacemaker monitors your heart rhythm. It only sends electrical pulses to your heart if your heart is beating too slowly or if it misses a beat.

A rate-responsive pacemaker will speed up or slow down your heart rate depending on how active you are. To do this, the rate-responsive pacemaker monitors your sinus node rate, breathing, blood temperature, and other factors to determine your activity level.

Most people who need pacemakers to continually set the pace of their heartbeats have rate-responsive pacemakers.

What Is an Implantable Cardioverter Defibrillator?

An implantable cardioverter defibrillator (ICD) is a small device that’s placed in your chest or abdomen. The device uses electrical pulses or shocks to help control life-threatening, irregular heartbeats, especially those that could cause sudden cardiac arrest (SCA).

SCA is a condition in which the heart suddenly and unexpectedly stops beating. If the heart stops beating, blood stops flowing to the brain and other vital organs. This usually causes death if it’s not treated in minutes.

ICDs use electrical pulses or shocks to treat life-threatening arrhythmias that occur in the ventricles (the heart’s lower chambers).

When ventricular arrhythmias occur, the heart can’t effectively pump blood. You can pass out within seconds and die within minutes if not treated. To prevent death, the condition must be treated right away with an electric shock to the heart. This treatment is called defibrillation.

An ICD has wires with electrodes on the ends that connect to your heart chambers. The ICD will continually monitor your heart rhythm. If the device detects an irregular rhythm in your ventricles, it will use low-energy electrical pulses to restore a normal rhythm.

If the low-energy pulses don’t restore your normal heart rhythm, or if your ventricles start to quiver rather than contract strongly, the ICD will switch to high-energy electrical pulses for defibrillation. These pulses last only a fraction of a second, but they can be painful.

An ICD is similar to a pacemaker, but there are some differences. Pacemakers can only give off low-energy electrical pulses. They’re often used to treat less dangerous heart rhythms, such as those that occur in the upper chambers of your heart. Most new ICDs can act as both pacemakers and defibrillators.

Patients who have heart failure may need a special device called a cardiac resynchronization therapy (CRT) device. The CRT device is able to pace both ventricles at the same time. This allows them to work together and do a better job pumping blood out of the heart. CRT devices that have a defibrillator are called CRT-D.

How Does an Implantable Cardioverter Defibrillator Work?

An implantable cardioverter defibrillator (ICD) has wires with electrodes on the ends that connect to one or more of your heart’s chambers. These wires carry the electrical signals from your heart to a computer in the ICD. The computer monitors your heart rhythm.

If the ICD detects an irregular rhythm, it sends low-energy electrical pulses to prompt your heart to beat at a normal rate. If the low-energy pulses restore your heart’s normal rhythm, you may avoid the high-energy pulses or shocks of the defibrillator (which can be painful).

Single-chamber ICDs have a wire that connects to either the right atrium or right ventricle. The wire senses electrical activity and corrects faulty electrical signaling within that chamber.

Dual-chamber ICDs have wires that connect to both an atrium and a ventricle. These ICDs provide low-energy pulses to either or both chambers. Some dual-chamber ICDs have three wires. They connect to an atrium and both ventricles.

The wires on an ICD connect to a small metal box implanted in your chest or abdomen. The box contains a battery, pulse generator, and computer. When the computer detects irregular heartbeats, it triggers the ICD’s pulse generator to send electrical pulses. Wires carry these pulses to the heart.

The ICD also can record the heart’s electrical activity and heart rhythms. The recordings can help your doctor fine-tune the programming of your ICD so it works better to correct irregular heartbeats.

The type of ICD you get is based on your heart’s pumping abilities, structural defects, and the type of irregular heartbeats you’ve had. Whichever type of ICD you get, it will be programmed to respond to the type of irregular heartbeat you’re most likely to have.

Implantation of Pacemaker or Defibrillator

Pacemaker/ICD insertion is done in the cardiac catheterization laboratory, or the electrophysiology laboratory. The patient is awake during the procedure, although local anesthesia is given over the incision site, and generally moderate sedation is given to help the patient relax during the procedure and produce “twilight sleep.” A night or two of hospitalization may be recommended so that the functioning of the implanted device may be observed.

A small incision is made just under the collarbone. The pacemaker/ICD lead(s) is inserted into the heart through a blood vessel which runs under the collarbone. Once the lead is in place, it is tested to make sure it is in the right place and is functional. The lead is then attached to the generator, which is placed just under the skin through the incision made earlier. Once the procedure has been completed, the patient goes through a recovery period of several hours.

If you are on blood thinners (Aspirin, Plavix Warfarin/Coumadin) please speak with your doctor prior to the procedure.

On the day of your procedure, take your medications with a sip of water.

During the Procedure

Generally, a pacemaker/ICD insertion follows this process:

  • You will be asked to remove any jewelry or other objects that may interfere with the procedure.
  • You will be asked to remove your clothing and will be given a gown to wear.
  • You will be asked to empty your bladder prior to the procedure.
  • If there is excessive hair at the incision site, it may be clipped off or shaved and disinfected.
  • An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.
  • You will be placed on your back on the procedure table.
  • You will be connected to an electrocardiogram (ECG or EKG) monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure.
  • Large electrode pads will be placed on the front and back of the chest.
  • The pacemaker insertion site will be cleansed with antiseptic soap.
  • A local anesthetic will be injected into the skin at the insertion site.
  • Once the anesthetic has taken effect, the physician will make a small incision at the insertion site.
  • A sheath, or introducer, is inserted into a blood vessel, usually under the collarbone. The sheath is a plastic tube through which the pacer lead wire will be inserted into the blood vessel and advanced into the heart.
  • It will be very important for you to remain still during the procedure so that the catheter does not move out of place and to prevent damage to the insertion site.
  • The lead wire will be inserted through the introducer into the blood vessel. The doctor will advance the lead wire through the blood vessel into the heart.
  • Once the lead wire is inside the heart, it will be tested to verify proper location and that it works. There may be one, two, or three lead wires inserted, depending on the type of device your doctor has chosen for your condition. Fluoroscopy, (a special type of X-ray that will be displayed on a TV monitor), may be used to assist in testing the location of the leads.
  • The pacemaker/ICD generator will be slipped under the skin through the incision (just below the collarbone) after the lead wire is attached to the generator. Generally, the generator will be placed on the nondominant side. (If you are right-handed, the device will be placed in your upper left chest. If you are left-handed, the device will be placed in your upper right chest).
  • The ECG will be observed to ensure that the pacer/ICD is working correctly.
  • The skin incision will be closed with sutures, adhesive strips, or a special glue.
  • A sterile bandage or dressing will be applied.

Pacemaker/ICD wires have a lifespan of approximately 10 years.  If leads should need to be replaced, your electrophysiologist will discuss the need for lead extraction and replacement.

Pacemaker and defibrillator lead extraction

Lead Extraction via Laser

At CGHC, our cardiologists remove pacemaker or defibrillator leads using special catheter-guided lasers. A lead is the wire that connects your device to your heart. The lead delivers energy from the battery directly to the heart muscle. These devices are used to help patients maintain a normal heart rhythm. If a cardiac lead or pacemaker is infected, not working properly, or builds too much scar tissue, it may need to be extracted.
Prior to the development of this laser procedure, leads were removed surgically and often resulted in damage to the heart tissue. This new technique uses cold, controlled laser energy to free the lead from surrounding scar tissue. This lets the doctor safely remove the lead with little risk.

Procedure

The laser lead extraction procedure takes two to four hours. You will be asleep during the procedure. The doctor first makes a 5-centimeter incision on the left side of the chest, usually in the same place where your original device incision was made.

Through this incision, the doctor removes the battery from your device and disconnects it from the lead.

Then a sheath, or tube, is inserted inside the vein and over the lead that needs to be removed. Your doctor guides this sheath down to the tip of the lead, where it attaches to the heart. The sheath helps stabilize the heart muscle while the lead is removed.

The doctor may then implant a new lead and/or a new device right away, or this may be done at a later date. This depends on the reasons for having the lead extracted in the first place. If there was an infection at the lead site, it is preferable to wait until the infection heals before placing new leads. Your doctor will recommend the appropriate course of treatment for your specific situation.
After the procedure is complete, the doctor then closes the incision and applies bandages to the incision site.

What to expect after

After the procedure, you will be moved to a recovery room for several hours, and then to a regular hospital room for the night. Most patients are able to go home one or two days after laser lead extraction. If you need to be treated for an infection at the lead site, you may need to stay in the hospital a little longer.

Radiofrequency Ablation

What is Radiofrequency Catheter Ablation?
Radiofrequency ablation is a procedure that can cure many types of arrhythmias. Using special wires or catheters that are threaded into the heart, radiofrequency energy (low-voltage, high-frequency electricity) is targeted toward the area(s) causing the abnormal heart rhythm, permanently damaging small areas of tissue with heat. In some cases, cryoablation, which damages tissue by freezing rather than heating, may be used rather than radiofrequency energy.

The damaged tissue is no longer capable of generating or conducting electrical impulses. If the procedure is successful, this prevents the arrhythmia from being generated, curing the patient.

Which Rhythm Problems Can Be Treated?

Radiofrequency ablation can be used to treat many arrhythmias that cause a fast heartbeat.

Radiofrequency ablation may be recommended for:

  • Paroxysmal supraventricular tachycardia, which includes:
    • Wolff-Parkinson-White syndrome
    • AV nodal reentrant tachycardia
    • Atrial tachycardia
  • Atrial flutter
  • Inappropriate sinus tachycardia
  • Ventricular tachycardia and premature ventricular contractions
  • Atrial fibrillation

What to Expect

Preparation — Patients may be asked to discontinue certain medications in the days before the procedure. Most patients are advised to stop eating and drinking at midnight the night before the procedure. A pregnancy test is usually done immediately before the procedure in women of childbearing capacity because of the radiation exposure.

Procedure — Before the procedure begins, you may be given a sedative medication through an intravenous line; many patients are not aware of what is happening during the procedure.

Small catheters (special wires) will be threaded into the heart. The catheters are usually inserted into the vein or artery in the right and left groin (inner thigh) and are then positioned within the chambers of the heart using fluoroscopy (low energy x-rays). Occasionally, catheters are inserted via veins into the side of the neck, upper chest, or arm. The doctor will test various parts of the heart and usually will try to provoke the arrhythmia.

The sections of the heart that are causing your arrhythmia can be identified. The doctor will then use the radiofrequency energy (heat or electrocautery) or cryoablation (freezing) to treat the problem area. During the procedure, your heart rate and rhythm, oxygen level, and blood pressure will be monitored.

When the procedure is completed, the doctor will again try to provoke the arrhythmia. If it cannot be initiated, the procedure is considered to be a success. However, if the arrhythmia can still be initiated, additional radiofrequency energy is delivered.

The length of the procedure varies from patient to patient, depending upon the type of arrhythmia being treated and other factors. Typically, the procedure lasts two hours or more.

Post-ablation care — you will be taken to a recovery area while the effects of the sedative medication wear off. The catheter site will be monitored for bleeding and the heart rhythm is observed closely during this period. You must stay in bed for several hours to reduce the risk of bleeding from the catheter site. You usually feel tired but well. Pain medication is usually needed for only a short time, if at all.

Some patients are admitted to the hospital after the procedure while others go home later the same day. Certain activities are not recommended for a brief period to avoid straining the catheter site.  A certain amount of chest discomfort is normal after the procedure and your doctor will discuss with you what is considered normal.

You may be asked to take aspirin every day for several weeks after the procedure to prevent blood clots. After some ablations, a more powerful blood thinning medication is required (anticoagulant). The doctor will give more detailed information about medications needed after the procedure.

Radiofrequency Ablation Complications

Like any invasive procedure, radiofrequency ablation carries some risk. However, the risk of these complications is small in most cases.

Possible complications include:

  • Problems related to threading the catheters through the blood vessels such as bleeding, infection, blood clots, bruising, and injury to the vessel(s).
  • Injury to the heart as a result of the catheters; this includes a perforation through the muscle or damage to one of the valves within the heart.
  • Blood clots that travel to the lungs (pulmonary embolism) or brain (stroke).
  • Heart block or failure of any electrical impulse to travel from the top parts of the heart to the bottom. This complication, if permanent, requires implantation of a pacemaker.
  • New arrhythmias.
  • Exposure to radiation during the procedure, which can take several hours. This can produce a very small increase in the risk of cancer or genetic defects.
  • Death (occurs in approximately 0.1 percent of cases).

Cryo Ablation

Cardiac Cryoablation

Cardiac cryoablation is used to restore normal electrical conduction by freezing tissue or heart pathways that interfere with the normal distribution of the heart’s electrical impulses. Cryoablation is used in two types of intervention for the treatment of arrhythmias: (1) catheter-based procedures and (2) surgical operations.

A catheter is a very thin tube that is inserted into a vein in the patient’s leg and threaded to the heart where it delivers energy to treat the patient’s arrhythmia. In surgical procedures, a flexible probe is used directly on an exposed heart to apply the energy that interrupts the arrhythmia. By cooling the tip of a cryoablation catheter (cardiology) or probe (heart surgery) to sub-zero temperatures, the cells in the heart responsible for conducting the arrhythmia are altered so that they no longer conduct electrical impulses.

Cardiac Resynchronization Therapy

If you have heart failure and have developed arrhythmia, you may be a candidate for cardiac resynchronization therapy (CRT).

What is CRT and how can it help your heart?

Arrhythmias are irregular heart rhythms and can be caused by a variety of reasons, including age, heart damage, medications and genetics. In heart failure patients CRT, or biventricular pacing, is used to help improve the heart’s rhythm and the symptoms associated with the arrhythmia.

The procedure involves implanting a half-dollar sized pacemaker, usually just below the collarbone. Three wires (leads) connected to the device monitor the heart rate to detect heart rate irregularities and emit tiny pulses of electricity to correct them. In effect, it is “resynchronizing” the heart.

Benefits of CRT

Because CRT improves the heart’s efficiency and increases blood flow, patients have reported alleviations of some heart failure symptoms – such as shortness of breath. Clinical studies also suggest decreases in hospitalization and morbidity as well as improvements in quality of life.

Who is a Candidate for CRT?

In general, CRT is for heart failure patients with moderate to severe symptoms and whose left and right heart chambers do not beat in unison. However, CRT is not effective for everyone and is not for those with mild heart failure symptoms, diastolic heart failure or who do not have issues with the chambers not beating together. It is also not suitable for patients who have not fully explored correcting the condition through medication therapies. To date, studies show CRT to be equally effective for both men and women.

To Learn More

Talk with your doctor about your own suitability for CRT. They can take into account your unique medical history as well as age and desired level of intervention. CRT is also often combined with other treatments to achieve the best results.

Device follow-up clinic and remote monitoring

Pacemaker Follow-up Clinic

For our patients with a pacemaker or an implantable cardioverter-defibrillator (ICD), ongoing
monitoring is an essential part of care. Our cardiologists are able to carefully follow your progress through a combination of office visits and telephonic transmissions from the comfort of your own home.

The devices we use are equipped to wirelessly, and non-invasively, communicate vital information. Via your home telephone, your device can transmit data to our office. This information will allow your doctor to do the following:

Ensure proper overall functioning of your device:

  • Verify integrity of pulse generator and lead(s)
  • Assess battery life
  • Determine possible replacement time

Your doctor will evaluate your results and alert you of any reasons why you should come in for an office visit.

These same tests can be performed in our office using a wireless wand which interrogates your device and provides your doctor with all necessary information.

Tilt Table Testing

The Tilt Table Test is used to determine a cause of fainting (syncope or loss of consciousness). There can be different reasons people experience syncope. For some people it is related to an abnormal nervous system reflex causing the heart to slow and the blood vessels to dilate (open up) lowering the blood pressure. When this happens there is a reduced amount of blood to the brain causing one to faint. This type of syncope is called vasovagal, neurocardiogenic or abnormal vasoregulatory syncope and is considered benign (not dangerous or life-threatening), except for the injuries that can happen when one faints unexpectedly.

The Tilt Table Test is performed to reproduce (bring on) symptoms of syncope while the person is being closely monitored. The patient is positioned on a table that is tilted to a preset angle. Blood pressure and heart rate are constantly monitored.

Is it Safe?

As a general rule, this medical test is very safe for the patient, although it can be scary. Patients are closely monitored to make sure that the medical team can step in if patient needs assistance, and even if the patient loses consciousness, he or she is firmly strapped in place, and not at risk of falling. Because the tilt table test is performed in a hospital, the medical staff has access to drugs and other supportive measures in the event that they are required.

Tilt Table Test help to evaluate:

This is used when a patient has frequent fainting spells to evaluate what may be causing it, such as a drop in blood pressure that happens when a part of the nervous system that controls blood pressure is disturbed, or there is significant increase or decrease in heart rate.  Of course any disturbance in blood pressure presents a potential risk of heart disease. This test is used to determine the cause of syncope, or fainting.

A trained nurse or technician and a physician may do the test. You will be asked to lie down on a special examining table with safety belts and a footrest. An intravenous line (IV) is inserted into one of your arms and a blood pressure cuff (or similar device) is attached to your other arm to monitor your blood pressure during the test. You are attached with electrodes (adhesive stickers) to an electrocardiograph recorder to monitor your heart rate. For your safety, you are belted onto the tilt table. It is then tilted upright to a 60-80 degree vertical angle for approximately 45 minutes. You are instructed to limit the movement of your legs and not to shift your weight during the test. You will also be asked to describe any symptoms you may be experiencing during the test.

Preparation

  • Generally, there is no eating or drinking 4-6 hours prior to the test to limit symptoms of nausea/vomiting
  • Ask your physician if you need to discontinue any of your routine medications prior to the test
  • When you come to the hospital, wear comfortable clothes. It is best not to wear any jewelry or bring valuables.
  • Plan to have someone drive you home after the test.

What Happens During the Test

You will change into a hospital gown and be taken to the procedure room. You will be asked to lie flat on a table and is secured to it with straps. A nurse inserts an intravenous (IV) line to deliver medication and other fluids, as well as connects the patient to machines to monitor vital signs.

Because talking can alter blood pressure and electrocardiograph (ECG) measurements, the patient will be asked to lie still and remain quiet for the entire test. Baseline ECG and blood pressure readings are taken. After 15 minutes, the end of the table closest to the patient’s head is raised about 30 degrees for about 5 minutes while more ECG and blood pressure readings are taken. The table is then raised to between 60 and 80 degrees. This simulates standing up from a lying position. The person being tested may then remain in the upright position for 30 to 45 minutes. If after 45 minutes you have not experienced syncope, a medication, usually Isoproterenol/Isuprel that is similar to adrenaline that the body naturally releases, is administered while you are tilted again, for up to another 45 minutes while your heart rate and blood pressure continue to be monitored.

If you faint during the test, the table will be returned to a flat (horizontal) position and you will be continued to be monitored closely while you recover. Recovery is usually immediate.

Typical symptoms of vasovagal or neurocardiogenic syncope includes:

  • Nausea
  • Sweatiness
  • Pallor
  • Lightheadedness
  • Sensation of palpitations
  • Near-fainting
  • Fainting

A tilt table test that induces an episode of syncope is considered positive. When syncope is not induced, the test is negative.

Length of Test

The test takes about 90 minutes to 2 hours. The test results are generally available directly following the test.

After the Test

Patients can resume normal activities immediately after a tilt table test.  If it is positive, treatment is usually with medication.

What the risks are:

The Tilt Table Test is generally a safe test. You are closely monitored and belted safely onto the table. You may faint during the test. Most people recover once the table is lowered to a horizontal (flat) position. In rare cases a medication has to be administered to help increase the heart rate and blood pressure.