• Evaluation of tachycardia mechanism, in preparation
for catheter ablation procedure.
• Evaluation of wide QRS tachycardia, where ECG interpretation
does not clarify mechanism of tachycardia.
• Evaluation of sudden cardiac arrest.
• Evaluation of unexplained syncope.
• Risk stratification for risk of cardiac arrest in patients with
repaired congenital heart disease.
• Evaluation of conduction system, or risk of tachycardia, particularly
prior to surgery for congenital heart disease.
• Cardiac catheterization laboratory; nursing and
technical support staff.
• Biplane fluoroscopy.
• Electrode catheters, usually multiple, with recording equipment.
• Sedation and intravenous access as necessary.
• Cardiac defibrillator.
• Resuscitation medications.
• Vascular injury, peripheral or coronary.
• Cardiac perforation.
• Initiation of hemodynamically unstable arrhythmia, or conversion
of one mechanism of tachycardia into another tachycardia.
• Arrhythmias may require direct current cardioversion or defibrillation.
• Radiation exposure.
• Risk of death: < 0.5%.
• Invasive electrophysiology studies are performed
prior to virtually all ablation procedures.
• Patients with unexplained cardiac arrest, particularly with congenital
heart disease, may undergo electrophysiologic studies to identify
cause and direct therapy.
• In the setting of structural heart disease, electrophysiologic
studies may help identify patients at increased risk of sudden cardiac
arrest, such as patients with repaired tetralogy of Fallot.
• Patients with cardiac ion channelopathies, such as long QT syndrome,
do not generally undergo invasive electrophysiology studies.
• Patient should not have any oral intake for at
least 4 hours before the study.
• Sedation is administered; general anesthesia is often preferred
for lengthy procedures or for younger patients.
• Intravenous access is necessary, usually femoral venous, often
bilaterally and multiple, in addition to internal jugular or subclavian
• Supine, with protection of airway.
• Arms are positioned at sides for long procedures, to avoid potential
brachial plexus injury.
• Adequate padding to avoid pressure injury is needed for extremities
• Shielding of gonads from radiation is necessary.
• Catheters are positioned in atria, at atrioventricular
nodal region, and in right ventricular apex for basic procedures.
• Additional catheters are positioned in coronary sinus, coursing
posteriorly to mitral valve, to record left atrial activation.
• Left ventricular or esophageal recordings may be added.
• Using sterile preparation with Seldinger percutaneous entry
technique into veins or an artery, electrode catheters are advanced
to the heart through vascular sheaths, and positioned using fluoroscopy.
• Catheters are connected to recording equipment and filter box
to allow electrogram display and recording; real-time and review
mode of tracings available.
• Catheter positioning is optimized based on size of electrograms
recorded, pacing capture thresholds, and anatomic positioning.
• For diagnostic purposes, pacing may initiate reentrant cardiac
arrhythmias, allowing interpretation of mechanism of tachycardia.
• Mapping may be performed to precisely localize critical part
of tachycardia circuit, or origin of automatic arrhythmia;
performed in preparation for ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPediatrics Full Site: One-Year Subscription
Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.
Pay Per View: Timed Access to all of AccessPediatrics
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.