EP Study; is it worth it?

[Hearthealthy0514]

I am a 21 year old female and have some history of some cardiac problems.  I was born with a hole in my heart, which closed naturally, however I followed a cardiologist for many years until it was certain that no scar tissue remained.  I was perfectly healthy throughout middle and high school and remained very active.  About 1 year ago I began feeling palpatations about 3 times per week, but being a stressed out college student, I ignored them.  In the summer of 2011 I noticed my resting heart rate was consistently in the 80s, 90s, and 100s, and my blood pressure was always found to be relatively low.  In addition, I also often felt nauseated, dizzy and lightheaded.  I saw a doctor who did not perform any tests on me, but he diagnosed me with anxiety and gave me anxiety pills.  I had several episodes of chest pain, but they did not last more than 1-2 minutes.  The anxiety meds did nothing for me and I went to see a different doctor.  This doctor (in September 2011) performed an ECG and found that I have a short PR syndrome.  She referred me to a cardiologist and I had an echo done with a bubble study because of the history of a hole in my heart, as well as a holster monitor study.  The cardiologist found my pressures in my heart slightly elevated, but found the echo otherwise normal.  She scheduled another echo for 6 months later to follow that concern.  The holter monitor only found periods of tachycardia and nothing more.  I was referred to an electrophysiologist who recommended an EP study to find the source of my palpatations and fast heart rate.  

6 months later, my second echo came back 100% normal, and my cardiologist also began recommending the EP study.  I now get palpatations about  5 times per week and my heart seems to race at times I am at rest.  I have never measured my pulse (while at rest) with it reading any higher than 112.  I also experience frequent dizziness and find it difficult to breathe at times.  Other times I feel 100% normal and have no problems.  
My cardiologist made the EP study seem like a procedure that would simply improve my quality of life, however she seemed to be pushing the idea also.  

My questions are:
How risky is an EP study and what are the risks?
Why are they recommending this EP study if they don't really know what my problem is?
What are the doctors thinking is wrong with me? Do they have probable diagnoses that were not explained to me?
How successful are EP studies on curing palpatations and short PR syndrome?
If I have an EP study done with a catheter ablation, what does my future look like with medical tests and follow ups?

I am 21 years old and otherwise perfectly healthy.  I want to get married and have a family as well as finish my degree in biology education.  I have never passed out, but I am told that the biggest risk with these palpatations is losing consciousness at a bad time (such as while driving).  
I would rather put this test off until I achieve more goals in my life and am more comfortable with the idea of being put through such a procedure.  
What is the biggest benefit of this EP study and does it outweigh the risks?

[lka734]

Your situation sounds almost identical to mine and I have the same questions as you.  I got EKGs, holter monitor, and ECHO and the EKG showed some tachycardia and what they think could possibly be Wolff-Parkinson-White Syndrome. He said he doesn't think I have WPW but since the EKG looks like it, then he wants to do the EP studies to rule it out just in case. I am going to get a second opinion next week. other than the occasional lightheadedness and palpitations I'm a healthy 26 yr old and don't want to risk anything unnecessary. Have you heard anything since you originally posted this? Have you looked into WPW as something you might have? the doctor said it had something to do with the PR interval I think

[tom_h]

I had 54 years of AVRT type of SVT before I got mine fixed.  Episodes in the last few years were near 4 times per month.  I highly recommend getting the study done.  It messed with my life from my adolescent years, through my prime.  Now I'm 62, with my best years behind me.  Don't let this happen to you!

[riff649]

i had my first palpatation at 23 yro and then did the holter monitor which found nothing. i too have always had resting hr around 80-90s. over the years i could control the bouts of tachy with coughing and bearing down, deep breath and you know the drill.  well it has been a couple years since my last one and this time i happened to be at work (i'm a nurse now) and my hr was at 200bpm, and i was scared youknowwhatless because this time I couldn't fix it! i started sweating and turned pale. my cooworkers took me to the ER.  I never passed out and by the time I went to the ER the tachy stopped.  I had a normal EKG (as expected) but showed them the cardiac strip i printed from the monitor i put on.  I ended up having the EP study and they found I had WPW *google it and during the EP study did the ablation on a concealed pathway and now "i'm cured"   lil sore in the groin on both sides and taking it easy.....from my point of view from someone who just did it I say do it now while you are young.

[ireneo]

If the echo and ecg's are not showing much of anything but you're still extremely symptomatic, I can understand why they might recommend an EP study. That's all it is to begin with: going in, trying to trigger arrhythmias and finding where they originate. However, if they go in and can't trigger anything (that does happen), then you're done with the study but no answers. Kind of frustrating. When I went in I knew they were going to map out my heart's electrical activity and then ablate the trouble spots. Your EP doesn't seem to have as clear a plan yet.

The tachy they found, what was the rate? Typically tachy under 120 shouldn't be that noticeable (you mention short of breath and light headed). I only feel that way when mine pushes close to 200.

I can't see where a plain EP study will improve your quality of life. It's just a test, not a cure. I do understand why they want to do it, to gather more information on your heart. Have they mentioned what they think may be going on?

Risks: typical - possible infection or puncture (rare) and possible hematoma at sight of catheter insertion (sometimes although I've never had it happen).

I've had 3 EP studies with ablations (radio frequency type) and follow up was minimal. Questions about how I'm feeling, check catheter sites and instructions to call if I have further arrhythmia problems.

If I was in your shoes, I would ask more questions: what are they looking for? What is the cost? How does PR interval fit into all this (I've never heard of EP studies for PR interval problems but I don't know everything)

Also, just out of curiosity - read up a little on IST (inappropriate sinus tachycardia) and see if that is similar to what you experience.

I've had tachy arrhythmias all my life and haven't passed out yet. But each person is different. I'm one of the lucky ones.

[itdood]

I'm as baffled as you are based on what you've told us.  You haven't even ruled out anxiety as a cause.

The end game of an EP study to do an ablation.  If they are still poking around in the dark you can't make an informed decision on whether to ablate if they should recommend that.  

My concern being that they do the mapping then find a diagnosis.  They would probably want to do the burns right then and there but I feel that would require more analysis.

I've heard of that happening to people, and the person would appoint a loved-one to make the decision if you are unable (due to anesthesia).  I'm too much of a control freak to let it play out like that.

If I were you, I'd get a 2nd opinion.

[Jerry_NJ]

I do not understand why you haven't yet gotten an input from one or more of the many who frequent this board, and have undergone a EP study.

I have not undergone an EP study, but I have been examined by an EP, in addition to two cardiologists and a couple of primary care doctors since I developed atrial fibrillation - but I will offer my opinion that a young person should seek a cure, not just take medications.  I believe an EP study is low risk, but I do understand it is invasive, so there is some risk.  

Given the symptoms you describe I think you should work with your doctors.  I do not think an EP study would take you out of class/work for very long, maybe just the day of the study...again I am going from recall of what I have read and I bet you have read a lot more than I have.

Good luck, you have some great life goals, get on with them.