Heart rhythm problems (arrhythmias) can be diagnosed using a variety of methods. The method depends upon the suspected heart rhythm disturbance and the physician. An ECG (electrocardiogram) is the most common test. Holter monitors, external loop recorders, implantable loop recorders, and tilt-table tests may be used when the ECG does not record the arrhythmia. An electrophysiology (EP) study may be indicated when the arrhythmia is identified as a fast heart rhythm problem (tachyarrhythmia) and deserves further diagnostic evalutation.

Cardiac Catheterisation: A small amount of a special dye is injected into the left ventricle and the resulting image (angiogram), viewed with an X-ray shows the left ventricle's shape before and after contraction to measure its ejection fraction (EF).

Echocardiogram (echo): An Echocardiogram is the most common test used to measure ejection fraction.In this short painless test, sound waves are bounced off the heart to show its internal structure and to determine the quality of the heart's pumping function.

Electrocardiogram (ECG): An ECG is a graphical record of the heart's rhythm and rate. To record the ECG, patches with wires are placed on the chest and the wires are connected to a monitor. This is typically done in a physician's office or hospital setting.

Exercise ECG or Stress Test. This test is a graphical recording of the heart's rhythm during exertion which may be created using a bicycle, a treadmill or by using medications that mimic exercise. It helps evaluate whether exercise can create an arrhythmia or make it worse. It can also show if there is enough blood flowing to the heart (ischemia), or to examine response to exercise.

Holter monitor (24-72 hour ECG): This device measures and records the heart's rhythm over 1-3 days. This test may be done when an ECG does not show the arrhythmia and it still is suspected to be the cause of symptoms.
Patches with wires are placed on the chest. The wires are connected to a portable monitor that can be attached to a purse or belt.

External loop recorder: This device monitors heart rhythm and rate for up to one month. During this test, a device is worn on the wrist or around the waist. When symptoms are experienced a button on the device can be pressed to record of the heart activity that just occurred.

Implantable loop lecorder. This device continuously monitors the heart rhythm for up to 14 months. It is placed under the skin during ashort procedure using a local anaesthetic. When symptoms are experienced a hand-held activator is placed over the device. Later, a physician analyses the stored information.

Tilt-table test: This procedure attempts to simulate conditions that may cause the arrhythmia. It enables a physician to understand how blood pressure, heart rate and rhythm respond to a change in position from lying down to standing. The patient is positioned on a table and given medication. The table is then tilted by varying degrees. The test typically lasts for 20 to 45 minutes.

Electrophysiology (EP) study: An EP study may be done when the arrhythmia is suspected or identified as a fast heart rhythm problem (tachycardia). This test is performed in a special lab in the hospital and can take 1 to 3 hours: it helps in the location and classification of the type of arrhythmia, and in the assessment of possible treatment options.
During an EP study, the patient is sedated and small catheters are placed inside the heart. The heart's rhythm is recorded while stimulated electrically via the catheter. This internal recording is often compared with an external recording (from electrodes placed on the patient's chest and back) taken at the same time.

Last Updated on: 20.01.2005