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Does my patient need an electrophysiological study?

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The decision to refer a patient for an electrophysiological study is based upon the type of conduction abnormality present.

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HPI: Episode of sudden cardiac arrest, palpitations, dyspnea, syncope, fatigue, lightheadedness.

PMH: Cardiac arrest, atrioventricular block, atrial fibrillation, atrial flutter, ventricular tachycardia.

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P waves absent, biphasic “sawtooth” flutter waves present, narrow QRS complex, prolonged PR interval of fixed duration followed by a P wave that fails to conduct to the ventricles, dissociation between P wave and QRS.

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EP = Refer patient for ElectroPhysiological study.

RS = Patient with Recurrent Syncope that remains unexplained after an appropriate evaluation.

SND = Patient with Sinus Node Dysfunction.

S-AVB = Symptomatic (palpitations, dyspnea, syncope, lightheadedness) patients in whom AtrioVentricular Block is suspected.

IVCD = IntraVentricular Conduction Delay in symptomatic (palpitations, dyspnea, syncope, lightheadedness) patients.

NCT = Narrow Complex Tachycardia.

WCT = Wide Complex Tachycardia.

SRCA = SuRvivor of Cardiac Arrest without obvious reversible cause.

C-ABL = Patients with symptomatic supraventricular tachycardia due to AVNRT, symptomatic atrial tachyarrhythmias, or ventricular tachycardia amenable to Catheter ABLation.

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RS = EP

SND = EP

S-AVB = EP

IVCD = EP

NCT = EP

WCT = EP

SRCA = EP

C-ABL = EP

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Electrophysiological studies provide valuable diagnostic information as they can determine the mechanisms of arrhythmia and help in the decision of whether drug, device, or ablation therapy is suitable.

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The most common arrhythmia found by EPS studies is ventricular tachycardia, and the most powerful predictor is an ejection fraction of <40%.

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1. Tracy CM, Akhtar M, DiMarco JP, et al. American College of Cardiology/American Heart Association Clinical Competence Statement on invasive electrophysiology studies, catheter ablation, and cardioversion: a report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence. Circulation. 2000;102:2309–2320.

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When do I need to order a stress test?

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Stress testing is used in diagnosis and prognosis of coronary artery disease. It is done via exercise (treadmill, bicycle) or pharmacologic agents (adenosine, regadenoson, persantine, dobutamine).

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Patients with symptoms of known/probable ischemic heart disease, stable angina controlled by medicine. The most important clinical finding is chest pain.

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Determine if the patient has functional capacity to perform exercise or will need pharmacologic aid to achieve stress.

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J point depression of 0.1 mV or more and/or ST segment slope of 0 or –1 mV/s in 3 consecutive beats (during stress).

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Echocardiogram-check LVEF, wall motion abnormalities, hypertrophy.

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CAD = Coronary Artery Disease. Patients with intermediate pretest probability of CAD based on age, sex, and symptoms.

RA = Risk Assessment and prognosis of ...

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