Name of the Procedure:

Intra-operative Epicardial and Endocardial Pacing and Mapping

• Other names: Intra-operative Electrophysiological Mapping, Intra-operative Tachycardia Localization

Summary

This procedure involves using electrical stimulation and mapping techniques on the heart's surface (epicardium) and inner lining (endocardium) during surgery to identify the exact location responsible for abnormal heart rhythms. This information guides the surgical correction of heart rate disturbances, often tachycardia.

Purpose

Intra-operative epicardial and endocardial pacing and mapping are performed to:

• Identify the specific area of the heart causing abnormal fast heartbeats (tachycardia) or slow conduction.
• Guide surgical intervention to correct these areas and restore normal heart rhythm.

Indications

• Persistent or recurrent episodes of tachycardia.
• Failure of medication to control abnormal heart rhythms.
• Structural heart abnormalities known to cause arrhythmias.
• Patients undergoing other heart surgeries where arrhythmias are identified or suspected.

Preparation

• Patients may need to fast for 8-12 hours before surgery.
• Medications may need adjustment; some might be stopped, especially blood thinners.
• Pre-operative tests include an Electrocardiogram (ECG), Echocardiogram, blood tests, and imaging studies like MRI or CT scans.

Procedure Description

1. The patient is given general anesthesia.
2. The surgeon accesses the heart through an incision in the chest.
3. Electrodes are placed on the heart's outer surface (epicardial) and within its chambers (endocardial).
4. Electrical stimulation is applied to locate the precise area causing abnormal rhythms.
5. Mapping data is collected and analyzed to pinpoint zones of slow conduction or tachycardia.
6. The identified areas are surgically treated, which might involve cutting, ablating, or modifying tissue to restore normal rhythm.
7. The surgical site is closed, and the patient is taken to recovery.

Tools used: Electrodes, pacing catheters, mapping systems, surgical instruments. Anesthesia: General anesthesia is administered.

Duration

The procedure typically takes 3-6 hours, depending on its complexity.

Setting

Performed in a hospital operating room, often as part of or in conjunction with other cardiac surgeries.

Personnel

• Cardiothoracic Surgeon
• Electrophysiologist
• Anesthesiologist
• Surgical Nurses
• Cardiac Technologists

Risks and Complications

• Common: Bleeding, infection, minor arrhythmias post-surgery.
• Rare: Stroke, heart attack, major arrhythmias requiring emergency intervention.
• Complications: Management may include medications, additional interventions, or supportive care.

Benefits

• Enhanced localization of arrhythmia sites leading to targeted surgical correction.
• Potential for long-term control or elimination of abnormal heart rhythms.
• Improvement in symptoms such as palpitations, dizziness, or fainting.

Recovery

• Post-procedure, patients are monitored in the Intensive Care Unit (ICU).
• Pain management and monitoring of heart function.
• Recovery time varies; typically, 1-2 weeks in the hospital followed by several weeks of outpatient recovery.
• Follow-up appointments for ECGs and evaluations.

Alternatives

• Medications: Antiarrhythmics, beta-blockers.
• Catheter ablation (non-surgical).
• Implantable devices like pacemakers or defibrillators.
• Pros and cons: Each has varying success rates, risks, and suitability depending on individual patient factors.

Patient Experience

• During the procedure: Under general anesthesia, the patient will be unconscious and feel no pain.
• After the procedure: Some pain or discomfort at the incision site, managed with medications.
• Gradual improvement in heart rhythm and symptoms, with close follow-up care to ensure recovery.

Pain management and comfort measures include prescribed pain relievers and supporting measures from the healthcare team to ensure a smooth recovery.