programmed electrical stimulation (PES); electrophysiologic testing

Indications

• evaluation of complex cardiac arrhythmias
  • supraventricular arrhythmias
  • ventricular arrhythmias
• primarily used for catheter ablation of cardiac foci of arrhythmias, not for diagnosis

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

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

• electrophysiologic measurement