Name of the Procedure:

Comprehensive Electrophysiologic Evaluation (EPS) with Transseptal Catheterizations

Summary

This procedure involves using specialized catheters to map the electrical activity within the heart and potentially induce an arrhythmia (abnormal heart rhythm). It helps diagnose the type and source of heart rhythm disorders.

Purpose

The primary goal is to diagnose and assess the nature of arrhythmias by studying the heart's electrical system. This helps in determining the best treatment strategy. It can also sometimes fix the arrhythmia through targeted ablation (destroying small areas of heart tissue causing the problem).

Indications

• Unexplained fainting or dizziness
• Rapid, slow, or irregular heartbeats
• Pre-surgical evaluation in patients with known arrhythmias
• Persistent palpitations
• History of sudden cardiac arrest in need of further investigation

Preparation

• Fast for 6-8 hours before the procedure
• Adjust or stop certain medications as per the physician's advice
• Blood tests and imaging studies, such as an echocardiogram or CT scan, may be required beforehand

Procedure Description

1. The patient is connected to monitors and given a sedative.
2. Local anesthesia is used to numb the area where catheters will be inserted, typically in the groin.
3. Catheters are threaded through veins and into the heart, with one crossing the septum between the heart's chambers (transseptal catheterization).
4. Electrodes on the catheters help create detailed maps of electrical signals.
5. Pacing may be performed to try to induce arrhythmias.
6. If an arrhythmia is induced, the precise location of the abnormal signals is identified.
7. The procedure can also include ablation to correct the arrhythmia if applicable.

Duration

Typically, it takes 2-6 hours, depending on the complexity of the case.

Setting

Performed in a hospital's electrophysiology lab or a specialized cardiac catheterization lab.

Personnel

• Electrophysiologist (specialized cardiologist)
• Nurses
• Cardiac technicians
• Anesthesiologist/Anesthesia nurse

Risks and Complications

• Bleeding or infection at the catheter insertion site
• Damage to the blood vessels or heart
• Arrhythmias during the procedure
• Stroke or heart attack (rare)
• Reaction to sedation or anesthesia

Benefits

• Accurate diagnosis of heart rhythm disorders
• Identification of treatment strategies
• Potential immediate treatment of the arrhythmia through ablation Benefits might be realized soon after the procedure if ablation is successful.

Recovery

• Patients may need to stay in the hospital overnight for monitoring.
• Rest for a few days; avoid strenuous activities.
• Follow any prescribed medication regimen and attend follow-up appointments.
• Bruising or mild pain at the catheter insertion site is common and typically resolves quickly.

Alternatives

• Medications to manage arrhythmias
• External monitoring systems like Holter monitors
• Non-invasive imaging tests Medications may often require long-term use and regular adjustments, whereas non-invasive tests may not provide as much detailed information.

Patient Experience

Patients might feel pressure but should not feel pain due to local anesthesia. Post-procedure, there may be some discomfort at the insertion site, and there can be a brief period of grogginess due to the sedation. Pain management includes over-the-counter medications and rest.