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What do we do?
Why an EP study?
Diagnoses abnormal heart rhythms and/or induces cardiac
arrhythmia's in order to:
Determine the source of arrhythmia symptoms
evaluate the effectiveness of certain medications in controlling the
heart rhythm disorder
predict the risk of a future cardiac event, such as Sudden Cardiac Death
assess the need for an implantable device (ICD or pacemaker) or
treatment procedure (ablation)
copyright Heart Rhythm Society 2004
Ablations
Radio frequency energy is delivered through EP
catheters to burn a small section of the
myocardium.
This prevents the arrhythmia from continuing or
returning.
At Mount Auburn, we do SVT and Atrial flutter
ablations (Afib and VT ablations are not done
here).
EP studies and ablations are typically done as
outpatient procedures.
HIS
CS
R
V
TEE
Transesophageal echocardiogram
Ultrasound probe passed into esophagus-posterior
view of heart.
Diagnoses thrombus, valve disease, septal defects
?source of embolus, bacteremia, or CVA/TIA.
Pre-cardioversion to rule out existing thrombus.
Patients get conscious sedation and generally need
to remain NPO for 4 hours after.
Cardioversion
Synchronized shock to terminate Afib or
flutter.
Pts receive MAC (monitored anesthesia carepropofol) by anesthesiologist
Chemical Cardioversions are when
medications are given like Ibutilide or
Flecainide and EKG is monitored for
conversion and arrhythmia.
Defibrillator Testing
DFTs: defibrillator threshold testing.
Usually done on ICD implant and yearly, or if
there is a potential device/lead issue.
Frequently outpatient basis.
Patient receives MAC (propofol).
The ICD programer is used to induce VF and
looks for the device to deliver
a
shock.
ICD
Post Op Care
Keep arm in sling overnight, affected arm stays lower
than shoulder height, no extended reaching
this helps prevent dislodgment of leads!
Next day chest X-ray to confirm lead placement, and
device interrogation.
Pt will have a Green/purple folder in chart to take
home. Please make sure to give them to patient on
discharge
Call MD regarding procedure site, orders, function
of pacemaker.
Leads...
Thin wires with
flexible silicone
coating
Connect the
pacemaker generator
to the myocardium
Sensing of heart
activity and discharge
of electrical impulse.
Atrial lead
Ventricular leads
What is a pacemaker or
Defibrillator?
Pacemaker is sensing and monitoring patients
own heart rate and delivers an impulse in either
the atrium or ventricle in the absence of a sensed
beat.
Defibrillator is sensing and monitoring the
patients own heart rate for a fast rate usually set
188bpm to deliver a shock to convert to NSR. Can
also pace if heart rate is slow usually 40 bpm.
Pacemaker Report
Pacemaker Report
_____________________________________________________________________________
Normal function
Non Sensing of R wave
Non Capture
ICD Report
ICD Report
Clinic Tel: 617/499-5628
________________________________________________________________________________
Date of ICD check: 05/05/11
ICD Type: Boston Scientific Cognis
Implanted: 01/19/11
VT Zone: 185
FVT:
VFIB: 220
ICD programmed rate: 60bpm
Mode: DDD
Response with magnet: Inhibits therapies, no effect on pacemaker
Presenting Rhythm: Unknown
Underlying Rhythm:
Pacemaker Dependent:
Arrhythmias Recorded on Diagnostics: none
Battery Life Stable: Y
Impedance: A= 439 ohms RV= 402 ohms LV= 949 ohms
Sensing: P-wave= mv R-wave= 7.0 mv LV-wave= 19.3 mv
LOC: A= @ ms RV= @ ms LV= @ ms
Comments: Latitude transmission, BiV pacing 92% of the time. Follow up in
30
25
Sensed
20
Paced
15
10
5
Rate (bpm)
180>
180
170
160
150
140
130
120
110
100
90
80
70
60
50
0
<40
% of Beats
35
Non capture or
intermittent
capture
broken lead on
x-ray
Thrombus/emboli
Atrial
vent
shock
QUESTIONS?