Electrophysiology
Our electrophysiology program offers comprehensive care for diagnosing and treating heart rhythm problems.
Call 911 if you are seriously injured or feel you need emergency care. Emergency responders will help you decide the best course of action.
Restoring Your Heart Rhythm
At TMC, we have a comprehensive electrophysiology program that diagnoses and treats a wide range of heart rhythm problems. While much of the care of the heart is focused on keeping veins and arteries open so blood can flow, electrophysiology concerns the electrical signals that keep the heart pumping in its regular rhythm. For those with an irregular heartbeat, or arrhythmia, cardiac electrophysiology can help. Our team uses the latest technologies to provide personalized care for each patient. We offer a variety of treatment options, including medications, ablation techniques, defibrillators and pacemakers. Our goal is to help you restore your heart rhythm and improve your quality of life.
Conditions and symptoms we treat
- Atrial fibrillation
- Atrial flutter
- Barostim for heart failure
- Bradycardia
- Complex epicardial VT
- Heart block
- Lead extractions
- Palpitations
- Premature ventricular contractions
- Remedy for sleep apnea
- Supraventricular tachycardia (SVT)
- Ventricular tachycardia
Patient resources
How are heart rhythm problems diagnosed?
- Electrocardiogram (ECG)
- Holter monitor
- Event recorder
- Electrophysiology study (EPS)
- Medications
- Ablation techniques
- Pacemakers
- Implantable cardioverter-defibrillators (ICDs)
Our Cardiac Catheterization Suite, commonly called the Cath Lab, is a highly complex, technical area where most cardiac diagnostics and interventional cardiac procedures are performed.Our Cath Lab Suite at TMC consists of seven catheterization rooms, a state-of-the-art Stereotaxis electrophysiology suite and two hybrid cath-lab suites. The Cath Lab is equipped to perform assessment of total heart function including electrophysiology/ablation procedures. Find out more about the Cath Lab here.
- If you were instructed to have your blood drawn prior to the procedure, please don’t forget to do this.
- Inform your doctor if you are unable to lay flat on your back for several hours.
- If you feel sick prior to the procedure, please contact your electrophysiologist immediately as we may need to postpone your procedure.
- Take a shower either the night before or the morning of your procedure.
- Do not eat or drink anything starting eight hours prior to procedure. It’s OK to have a small sip of water with your medications.
- You must have a responsible adult drive you home if you are having any type of sedation or anesthesia.
Please note: Follow your electrophysiologist's office for medication instructions given to you prior to your procedure. Recreational drug use including cocaine, amphetamines, and methamphetamines will result in an immediate cancellation of your procedure.
- Do not stop anticoagulants (e.g. Eliquis, Xarelto, Pradaxa, Savatsa or Coumadin) prior to your procedure unless specifically instructed to do so by your doctor.
- Do not take Diltiazem or Metoprolol for 2 to 5 days prior to a SVT ablation. Continue these uninterrupted for atrial fibrillation or atrial flutter ablations.
- If your procedure is being done under general anesthesia (e.g. atrial fibrillation ablations) do not take ACE inhibitors, Angiotensin Receptor Blockers or ARBs the morning of the procedure. These medications include Lisinopril, Benazepril, Captopril, Enalapril, Fosinopril, Moexipril, Perindopril, Quinapril, Ramipril, Trandolapril, Azilsartan, Candesartan, Eposartan, Telmisartan, Valsartan, Losartan, Olmesartan, Byvalson and Entresto.
- Diabetic medications for patients: Do not take the following medications for at least 48 hours prior to your procedure: Riomet, Fortamet, Glumetza, Obimet, Dianhen, Diabex, Diaformin, Glucovance, Janumet, Avandomet, ACTOS plus Met. Do not take Metformin the day of the procedure. If you take insulin, take ½ of your usual morning dose (regular insulin only on the day of your procedure). EXCEPTION: If your procedure is scheduled to start after 12 noon, do not take your insulin on the day of your procedure.
- If you take water pills, DO NOT take them on the day of your procedure. These medications may include furosemide (Lasix) or hydrochlorothiazide, Spironolactone, Edecrin, ethacrynic acid, HydroDiuril, Maxzide, metolazone, Zaroxolyn and eplerenone.
- If you take antidepressant or antipsychotic medication, take your normal dose on the day of your procedure.
- If you are taking a monoamine oxidase inhibitor antidepressant (MAOI) (such as Marplan, Isocarboxadzid, Nardil, Phenelzine and Tranylcypromine), contact your physician. The nurse should notify Anesthesia if the patient is taking any of these medications.
- If you use asthma medication (inhalers), please bring these with you on the day of your procedure.
- For the following medications, take your usual morning dose on the day of your procedure:
- Glaucoma medication – High blood pressure (hypertension) medications (other than ACEI, and ARBs) – Heart (cardiac) medications – Asthma or COPD medications – Thyroid medication – Myasthenia gravis – Seizure (anticonvulsant) medication – Prescription pain medication – Steroid medications (such as Prednisone or hydrocortisone)
- Government-issued photo identification.
- Insurance card(s).
- Current medication list with medication name and dosage. Please include the date and time everything was taken last. It is not necessary to bring the bottles with you.
- Some patients may stay overnight while others may be discharged the same day of the procedure. Since this is a medical decision that is sometimes made after the procedure, please be prepared for both circumstances.
- Bring a small overnight bag with toiletries. This is OK to leave in your car during the procedure.
- Bring the name and phone number of your emergency contact and/or the person available to take you home. Books and magazines are OK to bring. If you bring an iPad, your family will need to be responsible for the device during the procedure.
- Please wear comfortable, loose-fitting clothing, and slip-on shoes if possible. • If you wear glasses, contacts, hearing aids or dentures, you will be allowed to keep them with you.
- Please bring a copy of your advance directives (living will/health care proxy) if available.
- PLEASE LEAVE ALL VALUABLES AT HOME (e.g., jewelry, watches, credit cards, money). Tucson Medical Center cannot be held responsible for items lost during your stay. You may leave your wedding ring on.
- Do not bring any weapons to the hospital, including guns, pocket knives, mace and/or pepper spray.
- Please check in two hours prior to procedure time to allow sufficient time for hospital registration and check-in, pre-operative blood work and procedure preparation. Your procedure may be rescheduled if you are late for your pre-appointed time at the hospital’s discretion. Please call if you are running late.
- Enter off North Craycroft Road and park at the Northeast Entrance. Valet parking is available. It is a free service provided as a courtesy to our patients and their families. Or, you can self-park in the northeast parking garage.
- Check in with the Admitting Office first. This is located inside the Pre-Catheterization area to prepare for your procedure.
- After checking in, you will be instructed to wait in the lobby until you are called. Visitors will be allowed to wait in the waiting room that is located inside the Pre-Catheterization area. We ask for only one visitor at a time in this area since it is so small. Children under the age of 13 are not allowed in the recovery unit. There is an additional waiting room where remaining family and friends can wait in the Rosenstiel Lobby. Please note that while ablations are typically relatively short procedures, if they are complex they can take several hours.
- Service animals are not allowed in restricted areas such as the pre-op or post-op areas.
- Before your procedure, you will meet your nurse who will start an IV, draw blood for laboratory testing if not already done prior to admission, obtain a detailed health history, perform an EKG if necessary and have you sign consents.
- For your cardiac electrophysiology procedure, the area where the catheters and patches will be placed will be cleaned and the surface hair will be clipped.
- Note: we are preparing several patients for different procedures, doctors and scheduled times. Patients do not necessarily go to EP Lab in the order they arrived to the Pre-Cath area.
- Patients are taken up to the Electrophysiology Lab 15-30 minutes prior to procedural start time, or earlier, depending on the schedule. Visitors can wait in the Rosenstiel Lobby during the procedure.
- Visitors are not allowed in the electrophysiology area unless directed by Cath Lab charge personnel. Visitors can check in with the volunteers in the Rosenstiel Lobby and provide them with their name, their contact number and the patient’s name. Visitors, please make sure your cell phone is on and the ringer is turned up.
- You will be asked to empty your bladder before the procedure begins. If you are chilly when you are brought into the air-conditioned Electrophysiology Lab, do not hesitate to ask for a warm blanket.
- You will meet with the anesthesiologist prior to the procedure either in the pre-catheterization area or in the Electrophysiology Lab.
- You will discuss the type of anesthesia, from sedation to completely asleep, and, if appropriate, discuss procedures to help manage your pain after the procedure.
- Once in the room, you will move or be moved with help to the procedure table.
- Monitors will then be placed on you to look over your vital signs for the procedure
- A mask will be placed over your face for you to breathe in 100% oxygen before going off to sleep with medications through your IV.
- Once asleep, your eyes will be taped to protect them from scratches. A plastic breathing device will be placed into your mouth or through your vocal cords to protect and maintain your airway. This will go in after you are asleep and come out as you wake up, more than likely you will not remember.
- You may also undergo a transesophageal echocardiogram by the electrophysiologist physician or another trained physician while you are under anesthesia.
- A temperature probe may be placed in your esophagus to monitor your temperature during ablation.
- While you are asleep, you will be given medicines through your IV for pain and nausea so that you wake up comfortable and not nauseous.
- After the procedure is completed, you will be taken to the recovery room until you wake up from anesthesia.
Although anesthesia is generally considered safe, it is not without risk to you and has side effects. Most side effects of general anesthesia occur immediately after your procedure and do not last long. Once the procedure is completed and anesthesia medications stopped, you will slowly wake up in the procedure room or recovery room. You will probably feel groggy and a bit confused.
- NAUSEA AND VOMITING. This common side effect usually occurs immediately after the procedure, but some people may continue to feel sick for a day or two. Anti-nausea medicines can help.
- DRY MOUTH. You may feel parched when you wake up. As long as you are not too nauseated, sipping water can help take care of your dry mouth.
- SORE THROAT OR HOARSENESS. The tube put in your throat to help you breathe during surgery can leave you with a sore throat after it’s removed.
- CHILLS AND SHIVERING. It is common for your body temperature to drop during general anesthesia. Your doctors and nurses will make sure your temperature doesn’t fall too much during the procedure, but you may wake up shivering and feeling cold. Your chills may last for a few minutes to hours.
- CONFUSION AND FUZZY THINKING. When first waking from anesthesia, you may feel confused, drowsy and foggy. This usually lasts for just a few hours, but confusion can last for days or weeks for some people — especially older adults.
- MUSCLE ACHES. The drugs used to relax your muscles during surgery can cause soreness afterward.
- ITCHING. If narcotic (opioid) medications are used during or after your operation, you may be itchy. This is a common side effect of this class of drugs.
- BLADDER PROBLEMS. You may have difficulty passing urine for a short time after general anesthesia.
- DIZZINESS. You may feel dizzy when you first stand up. Drinking plenty of fluids should help you feel better.
- Electrophysiology procedures may be performed under general anesthesia with an anesthesiologist or under moderate or deep sedation administered by your electrophysiologist.
- Note: If you are having a PVC ablation, you will receive local anesthesia but little or no sedation since sedation may suppress your PVCs and make finding them impossible. This can be somewhat uncomfortable but unfortunately is necessary. • The Electrophysiology Lab staff will clean the insertion site with an antibacterial soap. This is to further reduce the risk of infection. After cleaning the site, the area is draped in a sterile manner. It is important to remain still so the site does not become contaminated.
- When the physician arrives, the nurse may give you a sedative medication through your IV. This may continue through the procedure as directed by the physician.
- You will feel very calm and will be able to respond to questions, follow commands and breathe on your own. Some people become very sleepy during sedation.
- Local anesthesia will be injected at the site. This will numb just that area.
- The femoral vein may be used on both sides of the groin to place multiple sheaths. Flexible wires are used to guide one or more catheters, inserted into this large vein in your groin. The catheters will be guided to your heart. The positioning of catheters inside your heart will be monitored on a screen. You may feel pressure when the catheters are inserted. The incision site is less than a quarter of an inch.
- Try to remain calm and relaxed.
- Do not move your arms or legs in the sterile working area.
- If you are uncomfortable, let your doctors or nurses know so they can help you get comfortable.
- In the controlled environment of the EP Lab, induced arrhythmias are handled by well trained personnel with state-of-the art equipment. This is an important tool that allows your electrophysiologist physician to gain information about your arrhythmia that will help prevent future occurrences.
- Some ablations are performed with Stereotaxis, a system that moves the ablation catheter robotically. This is typically the case for PVCs and VT ablations
- You will be taken to a recovery room called the Specialized Cardiac Outpatient Recovery, or SCOR. Your sheaths will be removed and you will be monitored while you wake up from sedation.
- Visitors may come in, but we ask that they come in one at a time and stay for only a few minutes.
- If the nurses are removing sheaths or need to perform other personal tasks, visitors will be asked to step out to the waiting area. This is to allow each patient’s privacy and to ensure that nurses can focus on their care.
- Figure 8 suture or manual pressure requires four to six hours of bed rest. You will be allowed to sit up in bed after two hours.
- Note: Recovery time varies from patient to patient, so it may be an hour or more before you are transferred out of the recovery area.
- Note: If you live out of town be prepared to get a local hotel in Tucson as we want to make sure you are safe and don’t have any bleeding issues. In the unlikely event of complications, you may stay overnight in the hospital for observation
- As soon as you can sit up, you will be provided a small boxed lunch (please let us know if you have special dietary considerations). Visitors are welcome to sit with you while you recover, but only one visitor at a time.
- Your nurse will explain your discharge instructions and answer any questions you may have. You will receive a written copy of these instructions to take home with you.
During the first days after an ablation, some patients experience:
- Mild sharp chest discomfort due to post-procedure inflammation. The pain will often worsen with a deep breath or when leaning forward. It should resolve within a week.
- Mild shortness of breath with activity.
- Soreness and bruising in the groin area. This bruising may extend below the knee and will go away slowly over several weeks.
- Palpitations, fast heart rates, episodes of atrial fibrillation or flutter. As inflammation resolves after the procedure some patients require medications or cardioversion (shocks) to maintain a normal rhythm. Recurrence of the arrhythmia during this time is not an indicator of the failure of the ablation.
- Should you have a recurrence of atrial fibrillation but are otherwise doing well this is not an emergency. Please call your electrophysiologist during regular business hours.
The following are general recommendations:
- You may shower after you return home the day after your procedure.
- Make sure to limit heavy lifting (more than 10 pounds) or active exertion for 4-5 days following your study.
- You may remove any bandages placed at the catheter site once you are home.
- You may return to work in 1-2 days, as long as it does not involve heavy lifting or strenuous labor.
- Call your electrophysiologist physician’s office if your incision site (typically in the groin) appears to swell larger than the size of a quarter or becomes increasingly painful.
- Bruising at the catheter site is normal. However, it should not become more painful or produce increased swelling in the days following the procedure.
- Talk with your nurse or physician about your medication regimen before discharge.
- Plan to have a follow-up visit with your electrophysiologist physician approximately one to two weeks after the procedure
- Your bandage at the catheter site has become saturated with blood. Apply pressure to the site.
- There is any pus from the access site.
- The swelling has increased and has become substantially more painful since leaving the hospital.
- Your body temperature is higher than 100 degrees.
- You have leg numbness, tingling, change in skin color or weakness.
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This health information is provided by the
Mayo Foundation for Medical Education & Research.
