93603 Right ventricular recording

Name of the Procedure:

Right Ventricular Recording
Common Name(s): Right Heart Recording
Technical Term: Right Ventricular Electrophysiological Study (EPS)

Summary

Right Ventricular Recording is a diagnostic procedure where electrical activity in the right ventricle of the heart is recorded. It helps in evaluating heart rhythms and identifying any abnormalities in the heart's electrical system.

Purpose

Medical Condition or Problem: This procedure mainly addresses arrhythmias, which are irregular heartbeats originating from the right ventricle.
Goals/Expected Outcomes: It aims to diagnose the type and source of arrhythmic events, assess the severity of arrhythmias, and guide further treatments like medication, catheter ablation, or implantable devices.

Indications

Symptoms/Conditions:

• Palpitations
• Syncope (fainting spells)
• Unexplained rapid heartbeats or tachycardia
• Suspicious findings from routine ECG or Holter monitor

Patient Criteria: Patients with a history of or suspicion of ventricular arrhythmias, those unresponsive to initial treatments, or candidates for more invasive arrhythmia therapies.

Preparation

Pre-procedure Instructions:

• Fasting for at least 6-8 hours before the procedure.

• Stopping certain medications as directed by the physician (particularly anti-arrhythmic drugs).

  Diagnostic Tests/Assessments:

• Blood tests
• ECG (Electrocardiogram)
• Echocardiogram (Ultrasound of the heart)

Procedure Description

1. Initial Setup: The patient is given mild sedation and local anesthesia at the catheter insertion site (usually the groin or neck).
2. Catheter Insertion: A catheter is inserted into a vein and guided to the right ventricle.
3. Recording: Electrical signals from the heart are recorded via electrodes on the catheter.
4. Stimulation: In some cases, the heart may be stimulated to provoke arrhythmias for accurate recording.
5. Completion: Once recordings are sufficient, the catheter is removed, and the insertion site is compressed to prevent bleeding.

Tools/Equipment: Catheters, electrophysiological recording system, fluoroscopy (X-ray) for guidance.

Anesthesia/Sedation: Local anesthesia with sedation.

Duration

Typically, 1-3 hours.

Setting

Performed in a hospital's cardiac catheterization laboratory or an electrophysiology lab.

Personnel

• Cardiologist specialized in electrophysiology (Electrophysiologist)
• Nurses
• Radiology Technologist (for imaging guidance)
• Anesthesiologist or Nurse Anesthetist (if deeper sedation is needed)

Risks and Complications

Common Risks:

• Bruising or bleeding at the catheter insertion site
• Minor pain or discomfort

Rare Risks:

• Infection
• Perforation of the heart or blood vessel
• Arrhythmia induction requiring urgent intervention

Management: Monitoring during and after the procedure to manage complications effectively.

Benefits

Expected Benefits:

• Accurate diagnosis of arrhythmias
• Informed decision-making for further treatment
• Relief from symptoms post-treatment

Onset of Benefits: Immediate to short-term, particularly if subsequent treatment is initiated based on findings.

Recovery

Post-procedure Care:

• Observation for a few hours to ensure stability
• Instructions to avoid strenuous activities for 24-48 hours

• Keeping the catheter site clean and dry

  Recovery Time: Generally, one to two days. Follow-up: Appointments may be set up for discussing results and next steps.

Alternatives

Other Options:

• Basic ECG monitoring
• Holter monitor (24-48 hour continuous monitoring)
• External Event Recorders

Pros/Cons:

• Non-invasive methods are low-risk but may not capture intermittent arrhythmias as effectively.
• Right Ventricular Recording provides more detailed information but carries higher procedural risks.

Patient Experience

During the Procedure:

• Mild discomfort at the catheter insertion site
• Sensation of the catheter moving within the heart, generally painless

After the Procedure:

• Soreness at the insertion site

• General fatigue

  Pain Management/Comfort: Local anesthesia at the insertion site, pain medications post-procedure if needed.