Electrophysiology Tests and Catheterization in Cardiac Care

Electrophysiological study and cardiac catheterization?

Dear Director He: I apologize for bothering you again.
My attending physician has many patients and doesn't allow me to ask questions; they just keep checking and prescribing medications.
To find peace of mind, I keep asking you, and I truly appreciate your patience in answering my questions.
I am very grateful to you.

I would like to ask: During the electrophysiological study, several episodes of ventricular tachycardia (VT) were induced, but each lasted only about 2 seconds, which is shorter than the 4 seconds recorded during my 24-hour Holter monitor.
Why is this the case? If VT is induced but lasts for a short duration, does that mean it's not serious? What should I do? However, my doctor mentioned that this puts me in a high-risk group.
I am currently taking 40 mg of Esmolol twice a day; can this help prevent the occurrence of VT?
I also wonder if autonomic nervous system dysfunction could be causing my tachycardia.
Can autonomic dysfunction lead to transient VT? My attending physician said that vasospasm might have occurred during the cardiac catheterization (possibly due to the insertion of the catheter?).
I did not experience any discomfort in my chest prior to this; does that mean it's not typical vasospasm?
Currently, my blood pressure has dropped below 100 while taking Esmolol, sometimes even reaching around 80-90.
I am very concerned about developing hypotension.
Could this lead to irreversible hypotension? I am also seeing a traditional Chinese medicine practitioner for what I believe is autonomic dysfunction, and I am taking herbal medicine (once at noon and once before bed, ensuring there is at least a two-hour gap after taking Esmolol in the evening).
Is this acceptable?
Lastly, could you please explain what ventricular ectopy means? (I couldn't find this information while researching.) I previously had over 2000 episodes recorded during my 24-hour Holter monitor.
Thank you very much for your answers, Director He.
I am truly grateful and sincerely apologize for continually bothering you.

Jinzhang de ren, 40~49 year old female. Ask Date: 2023/10/23

Dr. He Dongjin reply Cardiology

Hello, ventricular ectopic beats should be referred to as premature ventricular contractions.
Taking Isoptin (verapamil) will not lead to irreversible hypotension.
The use of Isoptin is not only for arrhythmias but also to prevent vasospasm.
Due to autonomic nervous system dysregulation, traditional Chinese medicine is also being used.
I believe it is not harmful; in fact, the real issue is that even the doctors are unsure—spasm? Autonomic nervous system dysregulation? However, there is a concern about potential complications, which is why preventive medication is continuously taken.
Unless you are very confident that everything is fine, it is advisable to continue with this for safety.
Changhua Hospital cares about you.

Reply Date: 2023/10/23

More Info

Electrophysiology tests and catheterization are critical components in the management of cardiac conditions, particularly those related to arrhythmias and coronary artery disease (CAD). Understanding these procedures can help patients make informed decisions about their care and alleviate concerns regarding their heart health.

Electrophysiology Tests (EP Tests)
Electrophysiology tests are specialized procedures used to evaluate the electrical activity of the heart. They are particularly useful for diagnosing arrhythmias, which are abnormal heart rhythms that can lead to serious complications, including sudden cardiac arrest. During an EP study, catheters are inserted through the blood vessels into the heart to record electrical signals and induce arrhythmias in a controlled environment. This allows physicians to identify the origin of abnormal rhythms and determine the best treatment options.

In your case, the induction of ventricular tachycardia (VT) for a brief duration (2 seconds) during the EP study indicates that your heart has the potential to develop abnormal rhythms, but the short duration suggests that it may not be immediately life-threatening. However, your physician's classification of you as a "high-risk group" is likely based on the potential for these episodes to occur, even if they are brief. The concern is that these short episodes can sometimes precede more sustained and dangerous arrhythmias.

Catheterization
Cardiac catheterization is a procedure used to diagnose and treat various heart conditions, including CAD. During this procedure, a thin tube (catheter) is inserted into a blood vessel and guided to the heart. This allows for the measurement of pressures within the heart chambers, assessment of blood flow, and visualization of coronary arteries through angiography. If blockages are found, interventions such as angioplasty or stenting can be performed during the same procedure.

Your mention of potential coronary vasospasm during catheterization is relevant. Vasospasm can occur when the coronary arteries temporarily constrict, reducing blood flow to the heart muscle. This can happen during catheterization due to irritation or stimulation of the vessel walls. While it may not be typical, it can occur and is usually transient. If you did not experience significant discomfort or symptoms during the procedure, it may not be a cause for concern.

Management of Ventricular Tachycardia and Blood Pressure
Regarding your current medication regimen, including the use of Isoptin (verapamil), it is essential to follow your physician's instructions. Verapamil is a calcium channel blocker that can help manage heart rate and prevent episodes of tachycardia. However, monitoring your blood pressure is crucial, especially if you are experiencing readings below 100 mmHg. Low blood pressure can lead to symptoms such as dizziness, fatigue, and fainting. If you consistently experience low blood pressure, it is important to discuss this with your healthcare provider, as they may need to adjust your medication or explore other treatment options.

Your concerns about autonomic dysfunction are valid. Autonomic nervous system imbalances can lead to fluctuations in heart rate and blood pressure, potentially contributing to episodes of tachycardia. While autonomic dysfunction can cause transient VT, it is essential to have a thorough evaluation to rule out other underlying causes.

Understanding Ventricular Ectopy
Ventricular ectopy refers to premature contractions originating from the ventricles. These can manifest as isolated beats or runs of VT. The presence of over 2000 ectopic beats in a 24-hour Holter monitor study indicates that your heart is experiencing frequent abnormal beats, which can be benign or indicative of underlying heart disease. The interpretation of these findings should be done in conjunction with your symptoms and overall cardiac health.

In summary, it is crucial to maintain open communication with your healthcare provider regarding your symptoms, medication side effects, and any new developments in your condition. If you have concerns about your treatment plan or the need for further testing, do not hesitate to seek clarification or a second opinion. Your health and peace of mind are paramount, and understanding your condition is a vital part of managing your cardiac care.

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