Intro to EP Study

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  1. The goal of the EP study is to?
    find the sight of arrthymia
  2. 4 types of noninvaise EP evaluations
    • -12 ECG
    • -Signal-averaged ECG
    • -Exercise Testing
    • -Tilt table tests
  3. Two types of Invasive EP
    • Diagnostic procedures
    • Interventional procedures
  4. Singnal-Averaged ECG's
    • Not very common anymoe
    • Multiple ECg's are blended over a certian time period
  5. Components of EP study
    • EP workstation
    • Stimulator (either bloom or computer)
  6. Arrhythmia Diagnosis
    • Bradycardia
    • Tachycardia
    • -Supraventricular & Ventricular
  7. What treatment do you do for Supra-ventricular arrhythmia?
  8. What device therapy do you do for Bradycardia
  9. What devicetherapy do you give to ventricular arrythmias
  10. Typical venous access site for EP study?
    • Right femoral VEIN!
    • -could go jugular or subclavian
  11. What speed is EP tracing usually at
    50-100ms and not 25ms
  12. 4 main cathodore placements
    • 1. High right atrium
    • 2.Coronary Sinus
    • 3. His Bundle
    • 4. Rv Apex

    -RVOT & LV
  13. Whats the most important aspect of EP study
    • Timing!
    • -Not concerned with morphology
  14. Basic Cycle Length (BCL) aka Sinus Cycle Length (SCL)
    • measured AA or VV
    • 1000-600ms (60-100 ppm)
  15. AH interval
    • time from firing of SA node through the AV node to the bundle of his
    • -inital artial deflection to deflection on his channel
    • -60-120ms
  16. HV interval
    • time it takes singnal to travel from bundle of His to ventricles
    • 35-55ms
  17. AH abnormal values
    Less than 60ms= enhanced atrial conduction or low atrial pacemaker

    Longer than 120ms= conduction delay
  18. Abnormal HV values
    Less than 35ms = ventricular preexcitation

    More than 55ms= His delay or Bundle Bloclk
  19. Train
    single burst of paced stimuli
  20. Burst Pacing
    Delivery of multiple fast stimuli
  21. 4 things you look at in a Brady EP study
    • 1. cycle length
    • 2. AH interval
    • 3. HV interval
    • 4. SNRT
  22. SNRT
    Sinus Node Recovery Time

    • -Overdrive SA node for 30-60 secs
    • -Stop and see how long it takes to recover
    • -under limit is 1500ms (1.5 sec)
  23. PES
    • Programmed Electrical Stimulation
    • -run of rapid pacing pulses
    • Pacing output pulss from external equipment are delivered to the heart

    -trying to enduce tachycardia
  24. Why do we do programed stimulation?
    • Induce re-entrant arrhythmias
    • Rule out re-entrant arrhythmias
    • Identify extra pathways
    • Terminate arrythmias
  25. How long does an arrhythmia have to last to be substained?
    over 20 seconds
  26. What signifys a positive EP study?
    If you can induce an arrythmia
  27. NIPS
    none-invasie programable stimulation
  28. DFT testing
    Only different between ICD implant and Pacemaker implant

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Intro to EP Study
2013-10-23 16:42:19

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