Name of the Procedure:

Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away
Common name(s): Intracardiac Electrophysiological Sheath Insertion
Technical/medical terms: Intracardiac Electrophysiological Guided Introducer/Sheath (Fixed-Curve, Non-Peel-Away)

Summary

This procedure involves the insertion of a specialized sheath (a thin, flexible tube) into your heart to assist with electrophysiological studies or treatments. The sheath is fixed-curve and does not peel away, meaning it maintains its shape to help guide various catheters used during the procedure.

Purpose

The procedure addresses heart rhythm disorders by allowing precise placement and movement of diagnostic and therapeutic catheters within the heart. The goal is to facilitate treatments like ablations or detailed mapping of electrical activity in the heart.

Indications

• Symptoms of irregular heartbeats (arrhythmias), such as palpitations, dizziness, or fainting.
• Conditions like atrial fibrillation, atrial flutter, supraventricular tachycardia (SVT), or ventricular tachycardia.
• Previous failed therapy with medications or non-invasive methods.

Preparation

• Fasting for 6-8 hours before the procedure.
• Adjustments to medications as directed by your doctor, particularly blood thinners or anti-arrhythmic drugs.
• Pre-procedure assessments such as EKG, echocardiogram, or blood tests.

Procedure Description

1. Anesthesia: The procedure typically requires sedation or general anesthesia to ensure patient comfort.
2. Access: A small incision is made, usually in the groin area, to access a major vein.
3. Insertion: The sheath is inserted through the vein and guided towards the heart.
4. Guiding Catheters: Diagnostic or therapeutic catheters are then introduced through the sheath to perform the needed electrophysiological work.
5. Monitoring: Continuous X-ray imaging (fluoroscopy) and electrogram recordings help guide the procedure.

Duration

The procedure typically takes between 1 to 3 hours, depending on its complexity and the specific treatments being performed.

Setting

The procedure is performed in a hospital, specifically in an electrophysiology (EP) lab or cardiac catheterization lab.

Personnel

• Electrophysiologist (a cardiologist specializing in heart rhythm disorders)
• Nurses with expertise in electrophysiology
• Anesthesiologist or nurse anesthetist
• Radiologic technologist

Risks and Complications

• Common: Bruising or bleeding at the insertion site, minor pain or discomfort.
• Rare: Infection, damage to blood vessels, heart perforation, blood clots, stroke, or arrhythmias induced by the procedure.
• Management: Immediate medical intervention to address any complications.

Benefits

• Accurate diagnosis and effective treatment of heart rhythm disorders.
• Potential long-term relief from arrhythmias, reducing the need for medications or preventing severe complications.

Recovery

• Short observation period in the hospital for monitoring (often same-day discharge or one overnight stay).
• Instructions to avoid strenuous activities for a few days.
• Follow-up appointments to monitor the heart’s response to the treatment.
• Potential medication adjustments based on procedure outcomes.

Alternatives

• Medication therapy for arrhythmias.
• Non-invasive procedures like electrical cardioversion.
• Catheter ablation without the use of a fixed-curve sheath.
• Surgical options (e.g., Maze procedure) for more complex cases.

Patient Experience

During the procedure, patients are sedated and typically feel minimal discomfort. Post-procedure, patients may experience mild soreness at the insertion site and fatigue. Pain management includes over-the-counter pain relievers, and most patients can return to normal activities within a few days.