A few decades ago, it was almost impossible to cure heart problems. Any problem was established only with the help of a conventional stethoscope, which could not accurately determine the causes of violations. Although not many people now know how the EFI of the heart is done correctly, doctors are increasingly starting to use electrophysiological studies to establish heart rhythm disturbances. At the moment, this procedure can be called the most complex and invasive method for assessing the condition of the heart.
Historical reference
Despite the fact that the EFI procedure on the heart began to be applied relatively recently, the experiments on electrophysiological methods themselves began to be used at the end of the 18th century by the famous doctor Luigi Galvani. He did not achieve any particular results, but over the following years his experiments continued to be developed by his students and followers.
A new round begins in the 1970s, when a group of scientists reopened interest in this diagnostic method. Now an increasing number of doctors in their activities use the EFI method of the heart.
The essence of the technique
Currently, studies of heart EFI are being conducted to diagnose cardiac muscle conduction and rhythm disturbances. Ultimately, the doctor can fully assess the state of the electric cardiac system, and with the knowledge gained, it is optimal to select the treatment principle.
During an EFI of the heart, various parts of the heart are stimulated to detect existing heart rhythm disturbances. Widely used ECG and daily monitoring of electrocardiography do not allow to achieve the desired result in this situation.
In medicine, two types of EFI operations on the heart are used, each of which in turn is divided into subtypes.
Invasive research
Such a diagnosis is carried out exclusively in stationary conditions and is divided into 3 subspecies depending on how the EFI of the heart is done.
1. Endocardial EFI is performed during stimulation of the inner lining of the heart itself - the endocardium. The procedure itself does not lead to pain, since there are no pain receptors, so you do not need to anesthetize or give medications to the patient.
2. Epicardial EFI of the heart stimulates the epicardium during the procedure, therefore it is used only in cases of operations on the open heart muscle.
3. A combined study applies both methods together.
The invasive EFI method has several advantages over non-invasive - in the first place, in this way, one can stimulate any of the chambers of the heart, and there are four of them in the body.
Non-invasive method
This technique is better known as transesophageal EFI of the heart or transesophageal electrical stimulation. Distributed more widely, since no hospital conditions are required. The procedure can also be carried out under simple outpatient conditions, since only 2 departments of the heart are stimulated: the left ventricle and the left atrium. Anesthesia is required during the operation, since the consequences of heart EFI will be not only unpleasant, but also very painful.
All the features of carrying out such a procedure must be preliminarily decided and discussed together with the patient before direct dispatch. But at the same time, only one procedure performed can completely open the picture to an unclear diagnosis and establish the tactics of treating arrhythmia in a patient.
Doctor's prescription
Because of the modern rhythm of life, more and more often people turn to doctors with the problem of arrhythmia, that is, a violation of the heart rhythm. By default, in a healthy person, electrical signals pass through the heart monotonously and very clearly. But at the same time, increased pressure, aging, heart attacks and many other reasons can lead to the fact that gradually the heart begins to become covered with scars or calcium deposits. All this greatly inhibits impulses. Which leads to heart rhythm disturbances - will it be regularity or pulse sequence. Similar disturbances also can reveal EFI of heart.
The main indications for invasive diagnosis
Depending on the research technique, electrophysiological stimulation of the heart requires the following indications.
An invasive EFI is performed to establish a diagnosis of such heart disorders:
- atrial fibrillation and nodular tachycardia, as well as other supraventricular tachycardia;
- bradyarrhythmias with attacks of MAS;
- any degree of blockade of an anti-ventricular nature;
- paroxysmal ventricular tachycardia with spontaneous fibrillation;
- blockade of His, followed by a transition to a blockade leading to the death of the heart;
- before conducting operations to establish a pacemaker, during radiofrequency ablation and cardioversion.
Key indications for non-invasive stimulation
For conducting transesophageal stimulation, a number of the following indications are required:
- Frequent slowdown of heart rate.
- Supraventricular tachycardia of paroxysmal nature.
- Simultaneous bradycardia and tachycardia syndrome.
- The decision on the subsequent installation of a pacemaker in cases where treatment with medications did not bring success.
- Evaluation of the effectiveness of antiarrhythmic therapy to which the patient is exposed.
Radiofrequency ablation
To solve problems with tachycardia, which manifests itself in an accelerated heartbeat, EFI RFA of the heart is used. This is most often called cauterization, since in this case a small area of the heart in which the pathology of frequency excitation is formed is completely destroyed. Those who are interested in how EFI RFA of the heart is done should be aware of the effects on the tissue of radio frequency signals that have a damage effect. This prevents the appearance of other pulse paths. But it does not harm the normal heartbeat, so the heart continues to function in a natural state.
Number of contraindications
Despite the effectiveness of the procedure, there are a number of contraindications, in the presence of which in no case can EFI be performed. Currently, they include problems with internal organs, mainly cardiovascular:
- prolonged angina pectoris for at least a month;
- acute myocardial infarction;
- aneurysm in the heart or aorta;
- heart defects with the presence of heart failure;
- thromboembolism;
- stroke - hemorrhagic or ischemic;
- fever;
- circulatory disorders along with cardiomyopathy;
- digestive system inflammation;
- tumors and strictures of the esophagus.
Preliminary preparation
The appointment of the procedure begins with a mandatory study of the medical history. The entire procedure is negotiated with the patient, since a signed consent is required. Depending on the type of procedure, it is performed in an inpatient or outpatient setting.
When conducting it on an outpatient basis, the patient must arrive at the clinic several hours before the procedure itself, since a preliminary blood test is often required. The doctor is obliged to familiarize the patient with the nutrition plan, but it is best not to drink and eat nothing at least 8 hours before the procedure, although this period may be longer.
You may also need to take a number of medicines - they are prescribed exclusively by a doctor and are intended to narrow the blood vessels and normalize the heart rhythm. You may need to stop taking certain medications a few days before the procedure, so you should first tell your doctor about all the drugs that the patient takes to avoid complications.
After this, a dropper for sedation and anesthesia is required before the procedure. Often it remains for the entire period of the operation, and even after the study itself.
Features of EFI
According to reviews, EFI of the heart is not a pleasant procedure, but it cannot be denied that it can effectively diagnose existing problems with heart rhythm disturbances.
To perform an invasive EFI procedure, the doctor inserts into the blood vessel, usually the femoral vein, the thinnest tube called a catheter. This vessel must necessarily move to the heart muscle. The electrode located on the catheter periodically allows you to send signals, but at the same time record your own electrical activity of the heart. A procedure is usually performed under sedation (mild anesthesia), or when the patient is conscious.
The procedure requires hospital conditions, so the patient goes to hospital for at least 2 days. The procedure itself does not normally take more than 45 minutes.
Non-invasive examination is carried out by a different method, since access to the vessels is not required. The procedure itself is very unpleasant, therefore, a doctor should be immediately informed of any inconvenience. To obtain the result, a normal electrocardiogram is pre-recorded, and then a probe with an electrode is inserted into the mouth or nose, which is gradually inserted into the esophagus. It is stopped near the heart, and then the results are compared.
Such an EFI can last from an hour to four hours. It may be accompanied by chest pain or a gag reflex, which greatly complicates the study.
Side effects
During the operation, although not dangerous, but unpleasant side effects are often manifested. These include:
- Cardiac arrhythmia, which often leads to severe dizziness and even fainting. This is considered a completely normal situation, so the doctor does not interrupt the EFI of the heart, but simply sends a small electric discharge for the subsequent restoration of the heart rhythm.
- Blood clots at the end of the inserted catheter. At times, they can come off, and therefore block other blood vessels. To avoid such situations during an EFI, heparin-based blood thinners are introduced.
- In areas where the catheter is inserted directly, bruising or bleeding may begin. It is also possible to catch an infection, so you should carefully listen to the advice of doctors.
Effects of EFI
After the immediate end of the procedure, the patient should rest in a supine position for another hour to three hours. During this period of rest, the following recommendations should be observed: in no case do not move until the nurse permits. The limb used in the procedure should be kept relaxed.
For some time after the procedure, the patient’s condition must be monitored by the nurse in order to immediately reveal the appearance of bleeding or swelling. After the patient moves away from anesthesia, the doctor explains the results of the study, and then lets go home or every other day.
Before discharge, the doctor also necessarily gives instructions for further treatment, which must be followed. Meals and medications are usually allowed within 4 hours after diagnosis. A person can return to normal life after a day. Within a few days, the puncture site will be unpleasantly painful, a bruise or bruising may appear - this is quite normal.
Possible complications
In some situations, you should definitely call an ambulance:
- strong and sudden increase in swelling at the puncture site;
- the inability to stop bleeding, despite all the recommendations;
- numbness or tingling of the limb through which the doctor conducted the study;
- an arm or leg begins to change color or feel cold;
- a bruise or bruising begins to become larger, spreading on different sides;
- there are discharge at the puncture site, or it swells.
In fact, EFI is considered a low-risk procedure, so complications are extremely rare. A correctly carried out procedure with disinfection and all devices does not lead to complications, but it allows you to accurately establish the diagnosis. It is quite possible to endure the unpleasant sensations that arise during the procedure, but still it is necessary to notify the doctor about all changes.