Sample Report: EPS Study, Left Atrial Recording, Mapping, and Repeat Simulation
PROCEDURES PERFORMED: Comprehensive electrophysiologic testing, left atrial recording, and repeat stimulation on isoproterenol.
MEDICATIONS: Versed 3 mg, fentanyl 100 mcg, and isoproterenol 5 mcg bolus x2.
INDICATIONS: Palpitations and near syncope and wide-complex tachycardia during exercise testing.
ASA CLASS: II
SEDATION: Conscious sedation was performed for a total of 60 minutes using Versed and fentanyl as described above. Continuous oximetric airway and heart rate monitoring as well as intermittent noninvasive blood pressure monitoring were performed throughout. At the end of the procedure, the patient was awakened from conscious sedation and returned to his room in good condition.
DETAILS OF PROCEDURE: After informed consent was obtained, the right and left femoral areas were prepped and draped in the usual sterile fashion. Then 15 mL of 1% Xylocaine was used for local anesthesia. Using a modified Seldinger technique, 6- and 7-French sheaths were inserted in the right femoral vein. Three 6-French sheaths were inserted in the left femoral vein. Under fluoroscopic guidance, a deflectable quadripolar catheter was placed in the high right atrium, deflectable octapolar was placed in the His bundle, deflectable quadripolar placed in the right ventricular apex, and deflectable decapolar was placed in the coronary sinus. Program stimulation was performed, see results below. Repeat testing was performed with isoproterenol, see results below.
At the end of the procedure, catheters were withdrawn, sheaths removed, and pressure was held tightly until hemostasis was obtained.
FINDINGS:
1. Baseline showed sinus rhythm with sinus cycle length 656, PR interval 234, QRS interval 120, AH interval 98, and HV interval 63.
2. Carotid sinus massage produced no sinus slowing.
3. Antegrade Wenckebach was 470, retrograde there was no PA conduction. AV node-ERP 600/400. Dual AV nodal physiology was not present.
4. There was no block below the His with atrial overdrive pacing.
5. There was no evidence for an accessory pathway.
6. Right ventricular apex ERP 600/240 and 400/230. Repeat testing was performed with isoproterenol with single and double premature atrial contractions as well as burst atrial pacing. Program stimulation was performed in the ventricle with up to quadruple extrastimuli at 3 drive cycle lengths in 2 right ventricular locations without production of arrhythmia.
IMPRESSION:
1. Normal sinus node.
2. Normal atrioventricular node without dual physiology.
3. Moderate His-Purkinje system disease.
4. No inducible ventricular tachycardia.
RECOMMENDATIONS:
1. Would increase Cardizem to 240 mg daily for better blood pressure control.
2. Would check outpatient event monitoring.
3. Would initiate aspirin therapy.