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Active tests
In some cases, your doctor will want to provoke an arrhythmia so that he or she can study it as it happens. In that case, one of several tests may be used:
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Stress test: This test is a general screening tool to measure the effect of exercise on your heart and to detect heart and coronary artery disease. Because some arrhythmias are influenced by exercise, the test is used to capture those abnormal rhythms where your doctor can read them. Usually you'll exercise on a treadmill or a stationary bicycle while connected to an ECG (electrocardiogram).
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Tilt-table test: If you've had fainting spells (syncope), your doctor may recommend this test to simulate the action of getting up from a prone position. Your heart rate and blood pressure are recorded while you are lying down on the table. The table is then tilted, just as if you were standing up. Your doctor measures how your heart reacts to the change in position. A catheter may be placed in an artery to monitor blood pressure during the test.
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Electrophysiologic testing and mapping (EP): An electrophysiology study can determine the presence and cause of abnormal heart rhythm and localize its origin in the heart. Typically, it takes about four hours and must be done after a fast. EP studies involve X-ray equipment, computer monitors, and equipment used to record the heart's electrical activity. The patient has an intravenous (IV) catheter in the arm to give any medication needed during the procedure. He or she may receive mild sedation for the procedure (children under 12 usually receive general anesthesia).
An electrode catheter--a thin, flexible tube with an electrode at the end--may be put in through a neck vein, while others are put in a vein in one or both legs. They're threaded to various parts of the heart to record impulses in different regions of the heart and can also measure how your heart conducts the impulse from one area to another. This helps your doctor construct a "map" of your heart's electrical system and localize the origin of an abnormal heart rhythm. The electrodes may also be used to stimulate or calm arrhythmias and to test the effectiveness of different treatments. The risk of complications from this test is relatively low, occurring in about 1 to 2 percent of the procedures, and is mostly related to inserting the catheters in your blood vessels. The doctor performing the test will discuss possible complications with you.
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