Cardiology
EP Study
NAME OF PROCEDURE:
1.
WPW ablation.
2.
WPW mapping.
3.
Conscious sedation.
4.
Comprehensive cardiac electrophysiology study with left atrial recording.
5.
Repeat stimulation.
6.
Transseptal cardiac catheterization.
PREOPERATIVE
DIAGNOSIS:
WPW
with supraventricular tachycardia.
POSTOPERATIVE
DIAGNOSES:
1.
Successful WPW ablation.
2.
Normal sinus node.
3.
Normal atrium.
4.
Normal AV node.
5.
Normal His-Purkinje system.
6.
Normal retrograde conduction.
7.
No inducible AV nodal tachycardia after ablation.
POSTOPERATIVE
RECOMMENDATIONS:
1.
Observation.
2.
Discharge on aspirin with a follow up with her primary doctor and Dr.
Stark as needed.
SURGICAL
TECHNIQUE:
1.
Six-French Decapolar catheter placed at the coronary sinus from the right
subclavian vein.
2.
Six-French quadripolar catheter placed at the RV apex of the left femoral
vein.
3.
Six-French quadripolar catheter placed at the His bundle area for the
left femoral vein.
4.
Seven-French, quadripolar, 5-mm Cook catheter, placed to the mitral valve
annulus per mapping ablation from the right femoral vein utilizing transseptal
approach, Brockenbrough needle, fossa ovalis subsequent puncture, documented by
contrast injection, and placement of the sheath and catheter.
At the
beginning of the transseptal catheterization, heparin 8,000 units IV given,
then, the catheter was removed without any complications.
Additional heparin given every 10+ plus minutes, monitoring ACT.
RESULTS:
1.
Rhythm, sinus, cycle length 681 milliseconds, PR 130, QRS 120, Q-T 375
with evidence of preexcitation.
2.
Sinus cycle, maximal, corrected, sinus recovery time, was normal at 128
milliseconds.
3.
Atrium: P-wave duration was
normal at 75 milliseconds. The conduction time within the right atrium was normal at 29
and to the distal coronary sinus, 70 milliseconds.
Atrial stimulation with no induced atrial tachyarrhythmias.
4.
AV node: Resting A-H
interval 75 milliseconds. The onset
of AV nodal Wenckebach could not be ascertained due to overt preexcitation.
5.
His-Purkinje system: Resting
H-V interval was 6 milliseconds consistent with preexcitation and with the
induced circus-movement tachycardia, the H-V interval is now 46 milliseconds.
6.
Retrograde conduction occurred initially as a fusion complex and
subsequently only over the left lateral pathway with the ERP less than a paced
cycle length of 330 milliseconds.
7.
Accessory pathway, left lateral, the antegrade ERP was 260 milliseconds
with 1-1 pacing and less than 330 milliseconds with retrograde pacing.
The morphology was slightly negative in lead 1 and AVL, and positive in
leads 2, 3, AVF and lead V1. Circus-movement
tachycardia was induced with a single atrial extrastimuli.
The cycle length was 664 milliseconds and the V-A interval at the His
bundle area is 139, at the proximal coronary sinus 95 milliseconds, with the mid
coronary sinus 80 milliseconds, and the distal coronary sinus 85 milliseconds.
Pacing was required for termination of the SVT.
Ablation _____, utilizing
antegrade and retrograde mapping techniques, earliest activation mid lateral
location, approximately 9 o'clock in the LAO view, and within a few seconds,
specifically 4, within the R-pulse, the accessory pathway one came back, and
then was going again and remained absent over 30 minutes of observation.
POSTABLATION:
1.
Rhythm, sinus, cycle length, 617 milliseconds, PR 150, QRS represented a
catheter-induced right bundle branch block with a QRS duration of 117, Q-T
330.2.
2.
AV node: Resting A-H 95
milliseconds. The onset of AV nodal
Wenckebach occurred at a paced cycle length of 320 milliseconds.
With a single atrial extrastimuli, there was no induced AV nodal
tachycardia.
3.
His-Purkinje system: H-V 50
milliseconds.
4.
Retrograde conduction was now completely normal, V-A block at a paced
cycle length of 300 milliseconds.
CONCLUSION
AND PLAN:
Noted
above.
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