Sample Report: Electrophysiological (EPS) Study
PROCEDURES PERFORMED
1. Comprehensive electrophysiological study.
2. With left atrial recording.
3. Venous access x2.
4. Electrocardiogram x6.
5. Conscious sedation x1 hour.
6. Pulse oximetry.
COMPLICATIONS: None.
INDICATIONS:
1. Coronary artery disease.
2. Congestive heart failure.
3. Ventricular tachycardia.
4. Palpitations.
ANESTHESIA: ASA classification class III. Conscious sedation provided by surgeon. Over a period of 1 hour, a total of 2 mg of IV Versed and 25 mcg of IV fentanyl was given. The patient was under continuous electrocardiographic, hemodynamic, pulse oximetric and clinical evaluation. His level of consciousness was assessed throughout the procedure. At the end of the procedure, he was alert and oriented with no obvious complication from the sedation.
DETAILS OF PROCEDURE: After appropriate informed consent was obtained, the patient was taken to the clinical laboratory in the fasting state. Both groins were prepared in the usual sterile fashion. Local anesthetic was applied to the skin. One 6-French and one 7-French sheath were placed in the right femoral vein. Through these sheaths, a deflectable quadripolar and a deflectable octapolar catheter were advanced to the cardiac chambers. The quadripolar catheter was placed initially in the right ventricular (RV) apex. The octapolar catheter was placed in the coronary sinus. Ventricular pacing was performed. There was no VA conduction at 600 msec. The octapolar catheter was then placed in the atrioventricular (AV) junction. The quadripolar catheter was then placed in the right atrium. Basic intervals were measured. Rapid atrial pacing was performed. The AV node Wenckebach cycle length was 360 msec.
Ventricular stimulation was performed with the quadripolar catheter in the right ventricular apex. The right ventricular apex effective refractory period was 400/240. Ventricular stimulation was performed. Multiple episodes of nonsustained monomorphic ventricular tachycardia, which terminated spontaneously, were documented. The catheters were removed. Hemostasis was achieved. No immediate complications were noted.
FINDINGS:
1. Sinus cycle length 1095 msec; PR interval 183 msec; QRS interval 110 msec; QT interval 439 msec; AH interval 81 msec; HV interval 56 msec. The AV node antegrade Wenckebach was 316 msec. There was no VA conduction at 600 msec.
2. Inducible monomorphic ventricular tachycardia.
3. Significant sinus node dysfunction.
RECOMMENDATIONS: Implantation of a dual-chamber implantable cardioverter-defibrillator.