electrophysiology procedure

7/31/2019 Electrophysiology Procedure

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Cardiac electrophysiology is the science of

elucidating, diagnosing, and treating the electrical

activities of the heart.

Studies of such phenomena by invasive (intracardiac)

catheter recording of spontaneous activity as well asof cardiac responses to programmed electrical

stimulation (PES).


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Explain the procedure to patient.

Clear all the doubts.

Not to eat or drink for up to 12 hours before the procedure.

A site will be prepared that will allow access to the heart via an

artery or vein, usually in the wrist or groin.

ECG

Patients with prosthetic valves need preop antibiotics

Blood investigations.


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A pulse oximeter is placed on one of the patient's fingers which

steadily monitors the patient's pulse and oxygen saturation of the

blood.

Defibrillator pads on patient

Monitor HR, BP,Sao2, temp,RR

Prep-venous access

Sedation

Administer oxygen


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A metal plate is placed underneath the patient between the

shoulder blades, directly under the heart. An automated blood

pressure cuff is placed on the arm which periodically measures the

patient's blood pressure.

Emergency drugs (Vasopressors on hand,Atropine 1 mg ready)

Emergency airway equipment ready.

Articles and equipments.(catheters,etc.)


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E P LAB


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Venous Access:-the right and

left femoral vein


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Give proper position to the patient.

Put ECG electrode pads on the patients chest, shoulders

and legs.

As a safety precaution, a pair of large defibrillation pads

will be placed the patients back and chest and are

connected to an external cardiac defibrillator.(to control a

run-away or dangerous heart rhythm)


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Insert an IV line.(If not preinserted)

administer short-acting sedative drugs that will initially

help the patient relax.

At all times during time in the EP laboratory the patients

heart rate, blood pressure, respiration, blood oxygen level,

and electrocardiogram are continuously monitored by the

nurses and doctors in the room.


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The patient is covered with a blue sterile drape to create a

sterile field

During an electrophysiology procedure, 2-4 temporary

electrode catheters are inserted into multiple heart

chambers.

The catheters, or wires, are usually inserted into a large

vein in the right groin area while the patient lies on the

procedure table.

The electrode catheters are positioned in characteristic

locations in the heart.


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The wires permit electrical stimulation (electrical pacing) of

the heart tissue and recording of electrical conduction

properties throughout the heart.

The patterns of the electrical conduction through the heart

are displayed on a computer monitor and recorded on an

optical disk.


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Shown here is the distal end of an

electrode catheter. Catheters are about

50 inches long and the electrodes are

located near the tip (shown here).

These electrodes come in contact with

the patients heart tissue. Some have a

fixed curve; others have a capability for

producing a variable curve using a

hand-held controlling shown).


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During an EP study, electrode catheters

may be positioned in multiple locations inthe heart. However, usually they are

positioned in 1) the right atrium, 2) the AV

node and His bundle region at the junction

between the right atrium and right

ventricle,

3) the right ventricular apex and, 4) the

coronary sinus and great cardiac vein. The

coronary sinus catheter is generally only

used in patients with certain types of

supraventricular tachycardia.


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Skin overlying these veins must be anesthetized using a local

anesthetic injected into the skin using a very tiny needle.

The patient may still feel a pressure and pushing sensation as the

physician proceeds with the insertion of the catheters, but there

should be little or no pain.

Once the wires are inserted into the veins through small veinpunctures produced using a larger needle, the wires are positioned

into the patients heart in characteristic locations (Figure 3) by

advancing them through the veins that are in direct connection

with the heart.


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The x-ray (fluoroscopy) machine overlying the patient is used to

guide the positioning of the wires.

After insertion of the wires, the diagnostic portion of the

electrophysiology study will begin.

This involves electrical pacing of the heart and recording ofelectrical signals.

This may cause the patient to feel their heart beating fast

tachycardia or palpitations


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The electrophysiology physicians performing the study analyze

these electrical signals to determine the type of supraventricular

tachycardia the patient has and the location of the abnormal

circuit.

A crucial part of the study is to provoke, or induce, the

tachycardia, particularly if curative catheter ablation is

contemplated.


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If at any step during the EP study the electrophysiologist

finds the source of the abnormal electrical activity, he/she

may try to ablate the cells that are misfiring. This is done

using high energy radio frequencies (similar to microwaves)

to effectively "cook" or burn the abnormal cells.


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At the end of the procedure all the catheters and monitoring

equipment are removed and the patient is taken to a regular

hospital room where monitoring of vital signs and heart rhythm is

continued.

Firm pressure is applied to the site to prevent bleeding.

The patient will probably be asked to lie flat for several hours (3 to

6) to prevent bleeding or the development of a hematoma.

The patient will be moved to a recovery area where he/she will be

monitored.


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The most serious reported complications in the medical literature

include death, stroke, heart attack, cardiac perforation requiring

emergency surgery, heart valve damage, artery damage, lung

damage, blood clots, bleeding, or infection are rare.

Some patients with supraventricular tachycardia undergoing

catheter ablation have a risk of complete heart block requiring

implantation of a permanent pacemaker.


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Some patients with supraventricular tachycardia

undergoing catheter ablation have a risk of complete heart

block requiring implantation of a permanent pacemaker,

although in our experience the risk is still low.


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Ambulatory electrocardiography device)

electrophysiology procedure

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