programmed electrical stimulation (PES); electrophysiologic testing
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Indications
- evaluation of complex cardiac arrhythmias
- 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
- invasive procedure with some risk
- time consuming & expensive
- some arrhythmias may not be inducible, particularly if the patient is sedated[2]
Adverse effects
- occur in about 1% of patients
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:
- ventricular & atrial stimulation to induce arrhythmias
- testing sinus node recovery time after atrial pacing
- testing for AV nodal refractoriness
More general terms
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 165
- ↑ Jump up to: 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 15, 17. American College of Physicians, Philadelphia 2009, 2015