93618 Induction of arrhythmia by electrical pacing

Name of the Procedure:

Induction of arrhythmia by electrical pacing

• Common Name: Inducing arrhythmia
• Medical Term: Programmed Electrical Stimulation (PES)

Summary

This procedure involves using electrical pulses to intentionally create an abnormal heart rhythm, or arrhythmia, to assess the heart's electrical system and evaluate the effectiveness of treatments for abnormal heart rhythms.

Purpose

The main goal of inducing arrhythmia through electrical pacing is to diagnose and treat abnormal heart rhythms (arrhythmias). It helps to:

• Identify specific types of arrhythmias.
• Determine the best treatment approach.
• Test the effectiveness of medications.
• Evaluate the need for devices such as pacemakers or defibrillators.

Indications

• Unexplained fainting (syncope).
• Documented episodes of abnormal heart rhythms.
• Assessment of the effectiveness of anti-arrhythmic medications.
• Evaluating the success of past procedures or surgeries for arrhythmia.
• Prior to the implantation of a pacemaker or defibrillator.

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Certain medications may need to be adjusted or stopped.
• Pre-procedure tests like electrocardiograms (ECG) and blood tests.
• Patients should inform their doctor of all medications and allergies.

Procedure Description

1. The patient is given a sedative or local anesthesia.
2. An electrophysiologist inserts catheters through a vein, usually in the groin, and guides them to the heart.
3. Electrical pulses are delivered through the catheters to stimulate the heart.
4. The heart's response to these pulses is monitored and recorded.
5. If an arrhythmia is induced, additional tests or treatments may be performed simultaneously.

Duration

The procedure typically takes 1 to 4 hours, depending on the complexity of the heart rhythms being studied and treated.

Setting

The procedure is performed in a specialized electrophysiology lab within a hospital.

Personnel

• Electrophysiologist (a cardiologist with special training in the heart's electrical system).
• Nurses specialized in cardiac care.
• Anesthesiologist or sedation nurse, if needed.
• Technicians to operate equipment.

Risks and Complications

• Common risks: Minor bleeding or bruising at the catheter insertion site.
• Rare risks: Infection, blood clots, heart damage, unintended severe arrhythmia.
• Complications are managed with immediate medical intervention and monitoring.

Benefits

• Accurate diagnosis of the type and source of arrhythmias.
• Tailored treatment plan to effectively manage abnormal heart rhythms.
• Enhanced safety of anti-arrhythmic therapy and device implantation.
• Immediate evaluation of treatment effectiveness.

Recovery

• Monitoring in a recovery area for several hours after the procedure.
• Limited physical activity for a day or two.
• Instructions on wound care and signs of infection to watch for.
• Follow-up appointments to assess heart rhythm and discuss results.

Alternatives

• Medication management without induced testing.
• Non-invasive monitoring (e.g., Holter monitors, event recorders).
• Imaging tests like echocardiograms.
• Each alternative may have varying levels of effectiveness and risk depending on the patient's condition.

Patient Experience

• The patient might feel some discomfort during catheter insertion and mild chest sensations during pacing.
• Sedatives can help relax and ease any discomfort during the procedure.
• Post-procedure, some soreness at the catheter site and brief fatigue may occur.
• Pain management includes over-the-counter pain relievers and rest.