**********EP STUDY (VT)*************

EP PROCEDURE NOTE 

DATE:  

PRE-OPERATIVE DIAGNOSIS:

POST-OPERATIVE DIAGNOSIS:

PROCEDURES PERFORMED:
1.  EP Study with induction
2.  Isoprel infusion

ELECTROPHYSIOLOGIST:  Michael Bui, MD 

ASSISTANT: 

CLINICAL PROFILE:

COMPLICATIONS: None. 

ESTIMATED BLOOD LOSS: 10 cc. 

MEDICATION USED:
Please see anesthesia note for regarding sedation records.

FLUOROSCOPY TIME =
DAP =  Gycm2
AIR KERMA = 

DETAILS OF PROCEDURE:
The risks and benefits of the procedure were explained to the patient in
full, and in simple terms.  Alternative therapy options were given,
including no procedure.  The risks of the procedure include, but are not
limited to: pain, bleeding, infection, pneumothorax, perforation of
vessels or heart, pericardial effusion, unstable heart rhythm, lead
dislodgement, inappropriate shocks, and death. The risks of blood
transfusion were discussed, and include fever, transfusion reaction, and
infection. All questions were answered, and the patient voices
understanding.  The patient acknowledged the risks of the procedure,
and still wanted to proceed. 

The patient was brought into the Electrophysiology Lab in a fasting and
hemodynamically stable condition. 

SHEATHS AND CATHETERS:
Access the femoral vein and femoral artery were obtained using the
seldinger technique:  The right femoral vein was successfully cannulated
with the needle. A guidewire was then passed through the needle easily. 
A blade was used to make a nick at the entry site to widen the entry point. 
The needle was then retracted.  A sheath was then placed over the guidewire
and then flushed.  This was repeated in a similar fashion for the right
femoral artery:

Right Femoral Vein:
6Fr Sheath:  A non-deflectable quadripolar catheter was positioned into the
Right Ventricle. 

Right Femoral Artery:
5Fr Sheath:  arterial line for hemodynamic monitoring

We next proceeded with pacing from the right ventricular apex.  We performed
an aggressive VT stimulatoin protocol using the Morady Protocol.  We used
drive trains of 600, 400, and 350 msec with triple extra-stimuli from the RV
apex.  We then moved the catheter into the RV outflow tract and repeated the
protocol.  No sustained ventricular tachyarrhythmias was observed, so we then
started isoprel at 1 mcg/min and titrated until the baseline heart rate
increased by 20% over baseline.  We then performed the above protocol on
isoprel (drive trains of 600, 400, 350 msec with extra stimuli, pacing from
both the right ventricular outflow tract and the right ventricular apex). 

***As the patient therefore had inducible sustained monomorphic VT resulting
in hemodynamic collapse, class I criteria for a ICD has been met.**** 

At this point, we scrubbed out and re-prepared the patient.  

****INSERT ICD TEMPLATE HERE**************