Electrophysiological Procedures

Airway: As per duration. Consider ETT given remote setting.
Access: Arterial line may be requested.
Pain: Minimal.
Position: Supine on tilt table.
Time: Variable and may be up to 6 hours.
Blood loss: Usually minimal
. Special: Off-the-floor location in non-permissive environment with staff unfamiliar with conduct of general anaesthesia.

Ablation procedures can be performed under local and sedation or general anaesthesia. General anaesthesia is usually required for:

Preoperative

Assessment:

  • Arrhythmia
    • AF
      Ablation across all pulmonary veins. Usually right sided, guided through the FO or via transeptal puncture.
    • Atrial Flutter
      Single ablation line between IVC and TV.
    • AVNRT
      Ablation of slow pathway between the coronary sinus and the bundle of His. Usually LA and sedation.
    • VT
      RVOT VT usually short ablation of the focus.
    • AVRT
      Targeted pacing to identify pathway, which may be around the TV or MV. MV pathways require transseptal or transaortic approach.

Intraoperative

Preparation:

  • Off-the-floor
    • Non-permissive layout
    • Limited mobility of catheter table
  • Active warming available
  • Oesophageal temperature probe
    • Indicate if oesophagus is being heated and at risk of perforation (through SVC)
  • Consider arterial line

Maintenance:

  • Minimal stimulation
  • Stillness required
  • May require pharmacological control of heart rate at certain stages

Emergence:

  • Planned transfer to recovery room (usually located elsewhere)

Postoperative

Destination: Analgesia: Drugs:

Complications

Procedural complications:

  • Vascular puncture
  • Arrhythmias
  • Oesophageal injury
  • Vagal nerve injury
  • Burns
    At site of electrode.

References

  1. MC Ashley E. Anaesthesia for electrophysiology procedures in the cardiac catheter laboratory. Contin Educ Anaesth Crit Care Pain. 2012;12(5):230-236. doi:10.1093/bjaceaccp/mks032