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programmed electrical stimulation (PES); electrophysiologic testing

Indications: 1) *evaluation of complex cardiac arrhythmias a) supraventricular arrhythmias b) ventricular arrhythmias 2) primarily used for catheter ablation of cardiac foci of arrhythmias, not for diagnosis [2] Advantages: - the origin & mechanism of an arrhythmia can be precisely define Disadvantages: 1) invasive procedure with some risk 2) time consuming & expensive 3) some arrhythmias may not be inducible, particularly if the patient is sedated [2] Procedure: - percutaneously placed endocardial catheter electrodes are used to record intracardiac electrograms & provide programmed electrical stimulation (PES) for the evaluation of complex supraventricular & ventricular arrhythmias - in the evaluation of supraventricular arrhythmias, PES is useful in replicating the clinical arrhythmia, determining the arrhythmia mechanism, &, when appropriate, ablating the arrhythmia - ablation procedures use radiofrequency energy to induce localized thermal injury - PES induces sustained ventricular tachycardia or fibrillation in 75% of survivors of sudden cardiac death & 95% of patients with sustained monomorphic ventricular tachycardia Electrophysiologic testing includes: 1) ventricular & atrial stimulation to induce arrhythmias 2) testing sinus node recovery time after atrial pacing 3) testing for AV nodal refractoriness Adverse effects: - occur in about 1% of patients

General

electrophysiologic measurement

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 165
  2. Medical Knowledge Self Assessment Program (MKSAP) 15, 17. American College of Physicians, Philadelphia 2009, 2015