4. EP Lab
• EP Studies
• Device Implants
• Catheter Ablation
5. Set Up the Equipment
1. EP Recording system
2. Stimulator
3. RFA generator ( IBI-1500T, XT 1000)
4. Electrodes
5. RFA catheter
6. Preparing the patient in the EP
Room-I
1. Electrocardiogram: Several sticky electrode patches
placed on chest, to monitor heartbeat throughout the
procedure.
2. Blood pressure monitor: A blood pressure cuff will be
placed on patient’s arm to automatically check blood
pressure throughout the study.
3. Oximeter monitor: This small device will be attached to
the finger to monitor the oxygen level of blood.
7. Preparing the patient
in the EP Room-II
4. The groin or groins and the neck are cleaned with an
antiseptic solution.
5. Venous Angio. (IC 20 or 22)
6. A Defibrillator on monitor and stand by for cardioversion in
case unexpected VT / Vf occurs. (VT/ Vf 先貼 TCP 貼片 )
7. A first aid kit should always in the workplace.
8. By order to administer sedation, such as
Midazolam.
9. Antibiotics using for preventing infection before the
implantation e.g. Cefamazine 1 gm
12. EP Study
• 電氣生理學檢 可以用來診斷出心臟電氣傳導的問題，醫師會從腹股查
溝旁的靜脈植入幾根 ( 三至四根 ) 導管，導管會沿著血管放至心臟內
去測量並記錄心臟電氣傳導訊號
• The electrodes detect the heart's electrical activity and
are used to check the heart's electrical system. 電極導管可
以接收到心臟放電的訊號，分析訊號可了解心臟的電衝動
• Electrical signals may be used to make the heart skip
beats or produce an abnormal heart rhythm. This can
help the doctor understand more about what is causing
the abnormal heart rhythm or where in the heart it is
starting.
• 電極導管可以傳送微小的電流刺激心臟，來改變心跳速率或節律。醫師可以
利用刺激來引發病患心臟不正常的節律的重現，藉以了解心律不整的原因及
機轉。
• Certain medicines may also be used for the same
purpose.
14. During the procedure
• 在病患被安置在心導管室檢 床上時，將被接上各種監測查
的儀器，同時在病患的身上，會覆蓋一層無菌巾。這時請
勿亂動或亂觸摸無菌巾， 因為整個侵入性的檢 過程必須查
是無菌以避免感染，再來醫師會在導管要插入的地方（鼠
蹊部、頸部或鎖骨下）消毒的十分乾淨。同時使用非常小
的針頭來做局部麻醉，使導管插入處失去感覺。首先以針
來扎血管（動脈或靜脈）再將皮膚切一小個切口便放入導
管護套，接著才將電極導管置入。電極導管是個含有電極
，及軟且可彎曲的導線，它可以傳送電流訊號。
15. EPS procedureEPS procedure
• A simple EPS lasts from 20 to 30 minutes. ItA simple EPS lasts from 20 to 30 minutes. It
may take longer if other procedures aremay take longer if other procedures are
involved.involved.
• How the test will feel:How the test will feel: During the test, patientsDuring the test, patients
will be awake and able to follow instructions. Tellwill be awake and able to follow instructions. Tell
patients may feel your heart skipping beats orpatients may feel your heart skipping beats or
racing at times.racing at times.
16. Nomenclature & Measurement ofNomenclature & Measurement of
baseline cond. intervalsbaseline cond. intervals
Cycle length = 60.000/ HR length of time bet. Heart beats
V
A
V
SCL
P
His electrogram (3 components) low RA- His-upper RV-no AVN
20. During Pacemaker implantation
• To prevent infection and to keep the pacemaker insertion site
sterile:
• An antibiotic will be given through the IV at the beginning of the
procedure.
• A special soap will be used to cleanse the area :
• (1.75% Alcohol 術前消毒，大塊燙傷紗布 cover ， 2. 術前再以
含有 Alcohol- BI 洗手液作三次消毒， 3. 術前撲無菌面時，再以
75% Alcohol 和 Alcohol- BI 消毒 3 次 )
• Sterile drapes are used to cover you from your neck to your feet
• A soft strap will be placed across your waist and arms to prevent
your hands from coming in contact with the sterile area
23. Implant Procedure-Venous
access and Lead placement
• Cephalic vein - via cut down (Cephalic approach –
cutdown ,reduces risk of pneumothorax)
• Subclavian vein - via puncture
• Axillary vein - via cutdown or puncture
Commonest
24.
25.
26.
27. During the Device Implant-I
• 1.The doctor will inject anesthetic drugs to "numb" or
"freeze" the skin where the pacemaker will be implanted.
•
• 2.Once the skin area is numb, the doctor will make a 1-2
inch incision in the skin and make a pocket under the
skin for the generator. The doctor will also use a needle
to find the vein under the collarbone.
• 3. One or more pacemaker leads will be inserted down
the vein and guided by X-rays into the right places in the
heart. These leads will be hooked or screwed into the
muscle to minimize the chances they will fall out of
place.
28. During the Device Implant-II
• 4.The nursing or technologist staff
will then take measurements from
the leads to make sure the pacing
leads will work well when needed.
• 5.The doctor will then tie the lead
down and plug the other end into the
generator. The generator is placed in
the pocket and the incision sewn up.
The sutures used will dissolve on
their own and will not need to be
removed.
51. • The EnSite NavX system (St. Jude Medical) consists of a set of
three pairs of 7 skin patches, a data module, a system
reference patch, ten ECG electrodes, and a display
workstation.
54. With the irrigated ablation
system there can be:
• Deeper lesion formation
• Less surface tissue damage with constant
cooling allowing more conductive heating
• Prevention of sudden impedance rise
• Less chances of coagulum formation at tip.
16 Venous Access site The implanting physician must know the acute and chronic complications associated with the various access sites. The physician should also be capable of accessing any and all of these sites. If the physician only knows one technique, that physician should not be doing implants. The recommended access site is the cephalic vein and if this is absent or inadequate, next is the axillary vein. The axillary vein is also called the extrathoracic subclavian vein. It is a continuation of the subclavian vein once it has crossed over the first rib. While venipuncture of the subclavian vein remains the most commonly used approach, it carries with it the highest incidence of acute and chronic complications. The external and internal jugular veins are rarely used today. When there is Superior Vena Cava syndrome or no venous access from above and the implanting physician still wants to use endocardial leads, extra-long (100 cm) leads can be inserted via the femoral vein with the pocket located in the lower abdomen. These should be active fixation. Slide Series: X-Ray-99.ppt
