Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (List separately in addition to code for prim
CPT4 code
Name of the Procedure:
Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (List separately in addition to code for prim.)
Summary
This procedure involves a detailed examination of the heart’s electrical system. It includes placing multiple electrode catheters into the heart to monitor its electrical activity, purposely inducing arrhythmias (irregular heartbeats) to identify issues, and pacing the left ventricle to assess its function. All these steps help determine the heart's electrical properties and pinpoint regions causing arrhythmias.
Purpose
The procedure is used to diagnose and evaluate arrhythmias, which are problems related to the rate or rhythm of the heartbeat. It aims to identify the precise location and nature of abnormal electrical activities within the heart, guide treatment decisions, and assess the risk of future arrhythmias.
Indications
- Unexplained episodes of fainting (syncope)
- Palpitations or irregular heartbeats
- History of heart disease with suspected arrhythmias
- Evaluation for treatment options, such as catheter ablation or implantation of a pacemaker or defibrillator
Preparation
- Fasting for at least 6-8 hours before the procedure
- Medications may need adjustment, especially blood thinners and heart medications
- A complete medical history and physical examination
- Pre-procedure tests, including blood tests, EKG, and imaging studies
Procedure Description
- The patient is taken to an electrophysiology lab.
- Sedation or anesthesia is administered for comfort.
- Catheters are inserted through a vein in the groin, neck, or arm and guided into the heart.
- The catheters are repositioned as necessary to ensure accurate measurements.
- Electrical activity is recorded, and arrhythmias are intentionally induced under controlled conditions to study abnormal rhythms.
- Left ventricular pacing and recording are performed to analyze and measure the heart's response.
Duration
The procedure typically takes 2 to 6 hours, depending on the complexity and findings.
Setting
The procedure is performed in a hospital's electrophysiology (EP) lab.
Personnel
- Electrophysiologist (a cardiologist specializing in heart rhythm disorders)
- Nurses
- Anesthesiologist or sedation nurse
- Radiology technician
Risks and Complications
- Bleeding or bruising at the catheter insertion site
- Infection
- Damage to blood vessels
- Arrhythmias
- Blood clots
- Stroke (rare)
- Heart perforation (rare)
Benefits
- Accurate diagnosis of heart rhythm abnormalities
- Personalized treatment plan
- Improved management of arrhythmias, potentially preventing serious events like stroke
- Can guide the decision for further interventions like ablation or device implantation
Recovery
- Monitoring in a recovery area for several hours
- Instructions include avoiding strenuous activity for a few days
- Keeping the catheter insertion site clean and dry
- Follow-up appointment with the electrophysiologist to discuss results and next steps
Alternatives
- Holter monitoring: Wearing a portable EKG to record heart's electrical activity over time
- Event monitoring: Recording heart's activity during symptomatic events
- Non-invasive tests: EKG, stress tests, echocardiograms
- Medication management without invasive diagnostics
Patient Experience
During the procedure, the patient may feel slight pressure or discomfort at the catheter insertion site. Sedation ensures they are relaxed and comfortable. Post-procedure, there might be mild soreness or bruising where the catheters were inserted, manageable with over-the-counter pain medication and rest.