Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted inducti
CPT4 code
Name of the Procedure:
Comprehensive Electrophysiologic Evaluation with Right Atrial Pacing and Recording, Right Ventricular Pacing and Recording, His Bundle Recording, Including Insertion and Repositioning of Multiple Electrode Catheters (without induction or attempted induction).
Summary
A comprehensive electrophysiologic evaluation is a procedure used to study the electrical activity of the heart. It involves placing multiple electrode catheters into the heart to measure electrical signals and test how well the heart's electrical system is working. This specific procedure includes pacing and recording from the right atrium and right ventricle, as well as recording from the His bundle, which is a collection of heart muscle cells specialized for electrical conduction.
Purpose
The procedure aims to diagnose and evaluate the electrical activity of the heart to identify abnormalities such as arrhythmias (irregular heartbeats) or conduction issues. By locating the source of the electrical problem and determining the best treatment strategy, it helps manage conditions that affect heart rhythm.
Indications
This procedure is indicated for patients experiencing symptoms such as:
- Unexplained fainting (syncope)
- Palpitations
- Dizziness or lightheadedness
- Documented arrhythmias It is also recommended for those at risk of certain heart conditions that affect the heart's electrical system.
Preparation
Patients may be instructed to:
- Avoid eating or drinking for several hours before the procedure.
- Adjust or temporarily stop certain medications, as advised by their doctor.
- Undergo diagnostic tests such as an electrocardiogram (ECG) or blood tests.
Procedure Description
- Insertion of Catheters: A local anesthetic is applied to the insertion site, typically in the groin, neck, or arm. Catheters are then inserted through veins and guided to the heart. Fluoroscopy (live X-ray imaging) is often used for guidance.
- Positioning: The catheters are positioned in the right atrium, right ventricle, and near the His bundle to record electrical activity.
- Pacing and Recording: Electrical signals are recorded, and pacing is performed to stimulate the heart at various rates to assess the heart's response.
- Data Analysis: Collected data is analyzed to identify any abnormalities in electrical conduction within the heart.
- Repositioning: If necessary, catheters may be repositioned to obtain more precise measurements.
Duration
The procedure typically takes 1 to 4 hours, depending on the complexity of the evaluation.
Setting
The procedure is performed in a specialized electrophysiology lab within a hospital.
Personnel
The healthcare team usually includes:
- A cardiologist specialized in electrophysiology.
- Nurses or technologists trained in electrophysiologic procedures.
- Anesthesiologists or sedation nurses if deeper sedation or general anesthesia is required.
Risks and Complications
Common risks include:
- Bleeding or infection at the catheter insertion site
- Minor bruising or swelling Rare risks include:
- Damage to the heart or blood vessels
- Blood clots
- Heart block or arrhythmias Any complications are managed promptly by the experienced medical team.
Benefits
The primary benefit is the accurate diagnosis and evaluation of heart rhythm disorders, which can lead to effective treatment. Patients may start experiencing improvements soon after appropriate therapy is initiated.
Recovery
Post-procedure care involves:
- Monitoring in a recovery area for several hours.
- Instructions to avoid strenuous activities for a few days.
- Keeping the catheter insertion site clean and dry.
- Follow-up appointments to discuss findings and further treatment.
Alternatives
Other treatment options include:
- Non-invasive tests such as Holter monitoring or event recorders.
- Medication management to control arrhythmias.
- Lifestyle modifications to lessen symptoms. The choice of alternatives will depend on the severity and type of arrhythmia and patient-specific factors.
Patient Experience
During the procedure, patients are usually awake but may feel slight discomfort from the catheter insertion. Relaxation medications can be given to ease anxiety. After the procedure, mild pain or bruising at the insertion site is possible, and pain management options will be provided for comfort.