Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording (when n
CPT4 code
Name of the Procedure:
Comprehensive Electrophysiologic Evaluation including Insertion and Repositioning of Multiple Electrode Catheters with Induction or Attempted Induction of an Arrhythmia with Right Atrial Pacing and Recording, Right Ventricular Pacing and Recording.
Summary
This complex cardiac procedure entails placing multiple electrode catheters into the heart to record electrical activity and to pace the heart in specific areas. The goal is to diagnose heart rhythm problems and sometimes to induce arrhythmias in a controlled environment for better understanding and treatment planning.
Purpose
The procedure addresses heart arrhythmias (abnormal heart rhythms). The goals are to diagnose the type of arrhythmia, understand its origin, and evaluate the effectiveness of therapies and treatments.
Indications
- Unexplained episodes of palpitations or fainting
- Suspected or confirmed arrhythmias that need further evaluation
- Pre-treatment planning for ablation therapy
- Assessment of the effectiveness of antiarrhythmic medications.
Preparation
- Patients should fast for at least 6-8 hours before the procedure.
- Certain medications, especially blood thinners, may need to be adjusted or stopped as advised by the doctor.
- Pre-procedure tests like blood work and electrocardiograms (ECG) to assess the heart condition.
Procedure Description
- The patient receives local anesthesia at the insertion site and possibly mild sedation.
- Catheters are inserted through veins in the groin, neck, or arm and guided to the heart using imaging technology.
- Electrical recordings of the heart's activity are taken.
- The heart is paced in different chambers (right atrium and right ventricle) to test the heart's electrical system and, if needed, to induce arrhythmias.
- Catheters may be repositioned multiple times to get comprehensive data.
- The procedure typically concludes with the removal of the catheters and application of pressure or a closure device to the insertion site.
Duration
The procedure generally takes between 2 to 4 hours.
Setting
This procedure is typically performed in a hospital setting, specifically in a specialized electrophysiology lab.
Personnel
- An electrophysiologist (a cardiologist specializing in heart rhythms)
- Nurses and technicians specializing in electrophysiology procedures
- An anesthesiologist or nurse anesthetist (if sedation or general anesthesia is required)
Risks and Complications
- Bleeding or infection at the catheter insertion site
- Damage to blood vessels or the heart
- Arrhythmias or worsening of existing arrhythmias
- Rarely, stroke or heart attack
- Allergic reactions to medications or contrast dye
Benefits
- Accurate diagnosis of the type and source of arrhythmia
- Precision in planning treatment strategies
- Potential resolution of symptoms like palpitations and fainting
- Informed decisions regarding medication adjustments or the need for ablation therapy
Recovery
- Patients are typically monitored for a few hours post-procedure.
- Instructions include resting and avoiding strenuous activities for a few days.
- Follow-up appointments are crucial to review results and plan any further treatment.
- Mild soreness or bruising at the catheter insertion site may occur.
Alternatives
- Non-invasive monitoring techniques like Holter monitors or event recorders
- Medication management without invasive procedures
- Cardiac ablation directly, if the type of arrhythmia is already known and treatment is urgent
Patient Experience
- Patients might feel slight pressure during catheter insertion but not significant pain due to local anesthesia.
- Some discomfort from lying still for an extended period.
- Post-procedure, there might be mild soreness at the catheter site, managed with over-the-counter pain medications.
- Detailed post-procedure care instructions will be provided by the healthcare team to ensure a smooth recovery.