Bundle of His recording
CPT4 code
Name of the Procedure:
Bundle of His Recording (Also known as His Bundle Electrogram)
Summary
The Bundle of His Recording is a diagnostic procedure that measures electrical activity in a specific part of the heart's conduction system to identify abnormalities.
Purpose
Medical Condition or Problem it Addresses: It is primarily used to diagnose arrhythmias or other conduction abnormalities within the heart. Goals or Expected Outcomes: To pinpoint where electrical disruptions are occurring in the heart, aiding in accurate diagnosis and treatment planning.
Indications
Symptoms or Conditions: Irregular heartbeats (arrhythmias), unexplained syncopal episodes, and abnormal ECG findings. Patient Criteria: Patients with persistent or unexplained symptoms related to heart rhythm issues.
Preparation
Pre-Procedure Instructions: Patients may need to fast for several hours before the procedure. Medication adjustments might be necessary, particularly for blood thinners. Diagnostic Tests or Assessments: An initial ECG, blood tests, and a thorough clinical cardiac examination may be required.
Procedure Description
- Setup: The patient is positioned flat on a bed, typically in a cardiac catheterization lab.
- Sedation and Anesthesia: Local anesthesia is applied to the insertion site, usually in the groin area.
- Insertion: A catheter is inserted into a vein and guided to the heart using X-ray imaging.
- Recording: Electrodes on the catheter measure electrical signals in the Bundle of His.
- Monitoring: Continuous monitoring of the patient's vital signs is done throughout the procedure.
Tools and Equipment: Catheter, electrodes, fluoroscopic imaging equipment, ECG monitors.
Duration
Typically 60 to 90 minutes.
Setting
Performed in a hospital, usually in a specialized cardiac catheterization lab.
Personnel
Healthcare Professionals Involved: Electrophysiologist, cardiac nurse, radiologic technologist.
Risks and Complications
Common Risks: Minor bruising or bleeding at the insertion site, transient arrhythmias during the procedure. Rare Complications: Infection, blood vessel damage, heart perforation. These are managed with immediate medical intervention.
Benefits
Expected Benefits: Accurate diagnosis of heart conduction abnormalities, leading to targeted treatment. Benefits can often be realized shortly after diagnosis.
Recovery
Post-Procedure Care: Patients are usually monitored for a few hours post-procedure. They might need to keep the insertion site dry and clean. Expected Recovery Time: Most patients can return to normal activities within a day but should avoid strenuous activities for a week. Follow-up Appointments: Scheduled for reviewing procedure results and discussing treatment options.
Alternatives
Other Treatment Options: Surface ECGs, Holter monitors, and wearable cardiac event recorders. Pros and Cons: Surface ECGs and monitors are less invasive but might not provide as detailed information as Bundle of His recording.
Patient Experience
During the procedure, the patient might feel pressure at the insertion site and some slight discomfort. Post-procedure, mild soreness at the insertion site can occur. Pain management includes local anesthetics and over-the-counter pain medications. Comfort is prioritized with continuous monitoring and support from the healthcare team.