The heart is fundamentally an electrical organ. Every beat, every rhythm, every coordinated contraction of its chambers depends on a precisely timed sequence of electrical impulses travelling through specialised tissue. When that electrical system malfunctions — producing abnormal rhythms that are too fast, too slow, irregular, or outright dangerous — the field of electrophysiology provides the tools to diagnose and treat it.
Electrophysiology (EP) is the subspecialty of cardiology dedicated to understanding, diagnosing, and treating disorders of the heart’s electrical system. At Vikram Heart Care Centre, Dr Kushaal Vikram provides specialist electrophysiology services, offering patients in Patna and Bihar access to advanced cardiac rhythm diagnosis and management without the need to travel to larger metropolitan centres.
What Is an Electrophysiology Study?
An electrophysiology study (EPS) is an invasive cardiac procedure performed in a catheterisation laboratory. Thin, flexible electrode catheters are passed through blood vessels — typically the femoral veins in the groin — and guided under X-ray imaging to precise positions inside the heart. These catheters can both record the heart’s electrical activity from within and deliver precisely controlled electrical stimuli to test the behaviour of the conduction system.
An EPS allows the cardiologist to:
- Map the electrical pathways of the heart in detail
- Identify the exact origin and mechanism of an arrhythmia
- Reproduce the arrhythmia in a controlled environment to study it
- Test the response of the heart to various stimulation protocols
- Locate abnormal tissue or accessory pathways responsible for the arrhythmia
- Guide and confirm the success of ablation treatment at the same sitting
An EPS is typically performed when non-invasive tests — ECG, Holter monitor, echocardiogram — have been unable to fully characterise an arrhythmia, or when a decision needs to be made about ablation or device therapy.
Conditions Diagnosed and Treated
Supraventricular Tachycardias (SVT) A group of arrhythmias originating above the ventricles, in the atria or AV node. They typically cause episodes of sudden-onset rapid heart rate — often 150 to 250 beats per minute — with abrupt onset and termination.
- AV Nodal Re-entrant Tachycardia (AVNRT) — the most common cause of SVT; caused by a re-entry circuit within or around the AV node
- AV Re-entrant Tachycardia (AVRT) — involves an accessory pathway connecting the atria and ventricles outside the normal conduction system; Wolff-Parkinson-White (WPW) syndrome is the most recognised example
- Atrial Tachycardia — rapid firing from an ectopic focus within the atria
Atrial Fibrillation (AF) The most common sustained cardiac arrhythmia worldwide. The atria fire chaotically at 300 to 600 impulses per minute, with irregular conduction to the ventricles producing an irregularly irregular heart rate. AF significantly increases the risk of stroke due to blood clot formation in the left atrial appendage, and can cause or worsen heart failure over time.
Types include:
- Paroxysmal AF — episodes that start and stop spontaneously
- Persistent AF — episodes that do not self-terminate and require cardioversion
- Long-standing Persistent AF — continuous AF lasting more than 12 months
- Permanent AF — AF accepted as the long-term rhythm when cardioversion is no longer pursued
Atrial Flutter A rapid, organised atrial rhythm typically at 250 to 350 beats per minute driven by a large re-entry circuit, most commonly in the right atrium. Often produces a ventricular rate of 150 beats per minute due to 2:1 block at the AV node. Highly amenable to catheter ablation.
Ventricular Tachycardia (VT) A potentially life-threatening fast rhythm originating in the ventricles. Can cause haemodynamic compromise, syncope, or degenerate into ventricular fibrillation and cardiac arrest. Occurs most commonly in the context of structural heart disease — particularly previous heart attack with scar tissue — but can also occur in structurally normal hearts.
Ventricular Fibrillation (VF) Chaotic, disorganised ventricular electrical activity resulting in the ventricles quivering rather than contracting. Causes immediate loss of cardiac output and is fatal within minutes without defibrillation. Survivors of VF require comprehensive electrophysiological evaluation and usually ICD implantation.
Wolff-Parkinson-White Syndrome (WPW) An accessory electrical pathway connects the atria and ventricles outside the normal AV node, allowing electrical impulses to bypass normal conduction. This can cause episodes of rapid heart rate and, in a subset of patients, carries a risk of sudden cardiac death if atrial fibrillation conducts rapidly through the accessory pathway. Catheter ablation of the accessory pathway is curative.
Brugada Syndrome An inherited channelopathy — a disorder of cardiac ion channels — that produces a characteristic ECG pattern and predisposes affected individuals to ventricular fibrillation and sudden cardiac death, often during rest or sleep. Electrophysiological evaluation helps risk-stratify patients.
Long QT Syndrome Prolongation of the QT interval on ECG — representing delayed ventricular repolarisation — predisposes to a specific life-threatening arrhythmia called Torsades de Pointes. Can be inherited or acquired (from medications or electrolyte abnormalities).
Syncope of Unknown Origin When fainting episodes remain unexplained after non-invasive investigation, an EPS may be performed to assess conduction system function and arrhythmia inducibility as a potential cause.
Heart Block Abnormalities of conduction between the atria and ventricles, assessed in detail during EPS to determine the level of block and guide pacemaker decisions. Covered in detail in our Pacemaker service page.
Treatment: Catheter Ablation
When an arrhythmia has been precisely located during electrophysiology study, it can often be treated at the same sitting through catheter ablation — a procedure that destroys or isolates the abnormal tissue responsible for the arrhythmia.
How Ablation Works
An ablation catheter is guided to the precise location of the abnormal tissue or pathway identified during mapping. Energy is delivered through the tip of the catheter to create a small area of controlled, irreversible injury that eliminates the arrhythmia’s substrate.
Radiofrequency Ablation (RFA) The most widely used energy source. Radiofrequency electrical current heats the catheter tip and creates a small, well-defined lesion in the targeted tissue. Used for the majority of ablation procedures including SVT, atrial flutter, AF, and VT.
Cryoablation Uses extreme cold (typically -40°C to -70°C) delivered through a cooled catheter tip or balloon to freeze and destroy abnormal tissue. Particularly used for AF ablation (pulmonary vein isolation with a cryoballoon) and for AV nodal arrhythmias where the proximity to normal conduction tissue makes radiofrequency energy less desirable.
Ablation for Specific Conditions
SVT Ablation Ablation for AVNRT, AVRT, and atrial tachycardia has very high success rates — typically 90 to 98% — and is considered curative in most patients. It eliminates the need for lifelong antiarrhythmic medication.
Atrial Flutter Ablation Typical right atrial flutter is treated by ablating a narrow band of tissue in the cavotricuspid isthmus — a critical part of the re-entry circuit. Success rates exceed 95% and recurrence is uncommon.
Atrial Fibrillation Ablation (Pulmonary Vein Isolation) The most common EP procedure worldwide for rhythm control of AF. The triggers for AF arise predominantly from the pulmonary veins — four veins that bring oxygenated blood from the lungs to the left atrium. Ablation creates a circle of lesions around the openings of the pulmonary veins, electrically isolating them from the left atrium and eliminating the triggers.
AF ablation is more complex than SVT or flutter ablation:
- Success rates are highest for paroxysmal AF (60 to 80% single procedure success at 12 months)
- Persistent AF has lower single-procedure success rates and may require repeat procedures
- Significant symptom improvement is achieved even in cases without complete arrhythmia elimination
- Antiarrhythmic medications and anticoagulation management are integral to the overall AF ablation strategy
VT Ablation Ventricular tachycardia ablation targets the scar tissue — most commonly from previous heart attack — that forms the substrate for re-entrant VT circuits. It is an important tool in patients with recurrent VT causing ICD shocks or haemodynamic compromise, reducing VT burden and improving quality of life.
Accessory Pathway Ablation (WPW) Ablation of the accessory pathway in WPW syndrome is highly effective — success rates exceed 95% — and eliminates both the arrhythmia and the associated risk of sudden cardiac death from rapid AF conduction.
Non-Ablation Electrophysiology Treatments
Not all arrhythmias are treated with ablation. Electrophysiology encompasses a broader range of management strategies:
Antiarrhythmic Medications A range of medications affect cardiac ion channels and alter the electrical properties of the heart. Used to prevent or reduce arrhythmia frequency, control ventricular rate in AF, and maintain sinus rhythm. Require careful selection, dosing, and monitoring.
Electrical Cardioversion (DCCV) A controlled electric shock delivered under brief general anaesthesia to restore sinus rhythm in persistent AF or atrial flutter. A planned procedure performed electively with appropriate anticoagulation management.
Implantable Cardioverter-Defibrillator (ICD) For patients at high risk of ventricular fibrillation or sustained ventricular tachycardia — particularly those with reduced heart function following heart attack or with inherited channelopathies — an ICD provides life-saving therapy by detecting and treating dangerous rhythms automatically. Covered in detail in our Pacemaker service page.
Cardiac Resynchronisation Therapy (CRT) A specialised pacing strategy for patients with heart failure and abnormal ventricular conduction. Covered in detail in our Pacemaker service page.
The Electrophysiology Study: What to Expect
Preparation
- You will be asked to fast for 4 to 6 hours before the procedure
- Blood tests, ECG, and echocardiogram are performed beforehand
- Antiarrhythmic medications may be stopped for several days before the study to allow arrhythmias to be inducible
- Anticoagulation management will be discussed and planned individually
During the Procedure
- You will lie on the catheterisation table under sterile conditions
- Local anaesthesia is administered at the catheter insertion sites in the groin
- Sedation is provided to keep you comfortable; general anaesthesia is used for some complex procedures
- Electrode catheters are advanced under X-ray guidance into the heart
- The electrical study is performed — you may experience brief palpitations as arrhythmias are induced and terminated; this is expected and controlled
- If ablation is performed, you may feel a brief sensation of warmth or pressure at the ablation site
- The procedure typically takes between 1 and 4 hours depending on complexity
Recovery
- You will rest in a recovery area for several hours after the procedure
- Pressure is applied to the groin sites to prevent bleeding; you will be asked to lie flat for 2 to 4 hours
- Most patients are discharged the same day or after one overnight stay
- Avoid strenuous activity for 48 to 72 hours
- Driving is typically restricted for 24 to 48 hours
- A follow-up appointment will be arranged to review the procedure results and plan ongoing management
Risks of Electrophysiology Procedures
EP procedures carry a small but real risk of complications. These are uncommon in experienced hands but important to understand before consenting to the procedure.
General risks:
- Bruising or haematoma at the catheter insertion sites
- Vascular injury at the access site
- Infection
Procedure-specific risks:
- Cardiac tamponade — bleeding around the heart from catheter perforation; rare but requires urgent treatment
- Stroke or transient ischaemic attack — from clot formation during left-sided procedures; minimised by anticoagulation
- Damage to normal conduction tissue — risk of inadvertent heart block during ablation near the AV node; may require pacemaker implantation
- Pulmonary vein stenosis — narrowing of the pulmonary veins after AF ablation; uncommon with modern techniques
- Radiation exposure from fluoroscopy — minimised through careful technique
Your cardiologist will discuss the specific risk profile of your planned procedure in detail before you consent.
Frequently Asked Questions
Q: How do I know if I need an electrophysiology study?
An EPS is typically recommended when you have symptoms of arrhythmia — palpitations, syncope, pre-syncope, or documented rapid heart rate — that have not been fully explained or characterised by non-invasive tests such as ECG, Holter monitor, or echocardiogram. It is also performed when a decision about ablation or device therapy needs to be supported by invasive electrical data.
Q: Is catheter ablation a permanent cure for arrhythmias?
For many arrhythmias — particularly SVT, atrial flutter, and WPW — ablation is highly likely to be curative, with long-term success rates of 90 to 98%. For AF, ablation significantly reduces arrhythmia burden and improves quality of life, though some patients require repeat procedures or ongoing medication. Success rates and the likelihood of recurrence depend on the specific arrhythmia, its duration, and the presence of underlying heart disease.
Q: I have been diagnosed with atrial fibrillation. Should I have ablation?
AF management is highly individualised. Ablation is most beneficial in younger, symptomatic patients with paroxysmal or early persistent AF who have not responded adequately to antiarrhythmic medication, or who prefer a rhythm control strategy without lifelong medication. It is not appropriate for all patients. Dr Kushaal Vikram will assess your specific situation — AF type, symptom burden, heart structure, and overall health — and discuss whether ablation is a suitable option for you.
Q: Is an electrophysiology study painful?
The procedure is performed under local anaesthesia and sedation, so discomfort is minimised. You may experience brief palpitations when arrhythmias are induced — these are controlled and intentional. Some patients feel a brief sensation during ablation. The majority of patients tolerate the procedure well with appropriate sedation.
Q: How long will I be off work after an ablation procedure?
Most patients return to desk-based or light work within 2 to 3 days. Those with physically demanding jobs may need a week or more. Driving is usually restricted for 24 to 48 hours after a straightforward procedure. Your cardiologist will provide specific guidance based on your procedure and occupation.
Q: Can arrhythmias come back after ablation?
Recurrence is possible, particularly in the first 3 months after the procedure — a period sometimes called the “blanking period” during which early recurrences do not necessarily predict long-term failure. For SVT and flutter, long-term recurrence rates are low. For AF, recurrence is more common, particularly for persistent or long-standing AF, and some patients require a second procedure. Continued monitoring and follow-up are important for all patients after ablation.
Q: What is the difference between a pacemaker and an ICD?
A pacemaker treats bradycardia — a heart rate that is too slow — by delivering low-energy pacing impulses to maintain an adequate heart rate. An ICD monitors for life-threatening fast rhythms — ventricular tachycardia and ventricular fibrillation — and treats them with a high-energy shock if detected. Many ICDs also have built-in pacemaker function. The choice between devices depends on the specific condition and risk profile of the patient.
Q: Is electrophysiology available in Patna?
Yes. Electrophysiology study and catheter ablation services are available at Vikram Heart Care Centre, Dr K K Kantha Memorial Hospital, Patna, under the care of Dr Kushaal Vikram.
Book a Consultation
If you are experiencing palpitations, racing heartbeat, unexplained fainting, or have been told you have an arrhythmia, a specialist electrophysiology consultation is the right next step.
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