Anesthesia for Electrophysiological Studies and Catheter Ablations

Abstract

Cardiac arrhythmias may be divided into disorders of impulse formation due to abnormal automaticity or triggered activity and disorder of impulse conduction due to reentry or a combination of both. Electrophysiological studies nowadays are used to diagnose wide range of cardiac rhythm abnormalities, it can also asses function of SA node, AV node and His-Purkinje system. Arrhythmia can be intentionally triggered, their location mapped and response to therapy evaluated. Catheter ablation is an option for patients who respond poorly to medical therapy. This includes persistent symptoms, frequent recurrences of arrhythmia while on medical therapy, and intolerance to medication side effects.

Technologies for the treatment of arrhythmias and catheter ablation are rapidly developing. The ablation procedure generally is performed by achieving vascular access, induction of arrhythmia to confirm the diagnosis, locating the source by mapping, performing ablation and testing to confirm the results of ablation. Catheter ablation using electrophysiological studies is not an easy procedure. Also patients undergoing these interventions usually have medical comorbidities. So anesthesia for these procedures can be a great challenge for the anesthesiologist. The anesthesiologist‘s knowledge of different techniques for catheter ablation procedures, patient preparation, room setup, radiation safety, anesthetic management and complications became important as the role of the anesthesiologist in the EP labs is increasing every day. Anesthetic drugs may affect the electrophysiology of cardiac cells making difficulties in initiation, detection, ablation and post procedural testing for arrhythmias. That’s why knowing the properties of different anesthetic drugs mandatory during the EP procedures The design of the EP lab must be suitable for anesthesia team to improve workflow and to make the patient the main focus. Also communication between anesthesiologists, cardiologists and nurses is very important during catheter ablation procedure for good outcomes.