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C HAPTER 1 8 / Cardiac Electrophysiology Procedures 417
catheter ablation procedure, or both. The need for patient edu- 7. Cobb, L., & Hallstrom, A. P. (1977). Clinical predictors and characteris-
cation during all phases of the arrhythmia experience has been tics of the sudden cardiac death syndrome. Proceedings USA/USSR First
well documented. 78–80 Teaching before the study must include Joint Symposium on Sudden Death. DHEW Publication no. (NIH)
78–1470. Washington, DC: National Institutes of Health.
discussions about the nature of the test, a description of the pro- 8. Greene, H. L. (1990). Sudden arrhythmic cardiac death: Mechanisms, re-
cedure, procedure length, success rates, and complication rates. suscitation, and classification. American Journal of Cardiology, 65, 4B–12B.
Nurses must also include postprocedure instructions and dis- 9. Skale, B. T., Miles, W. M., Heger, J. J., et al. (1986). Survivors of cardiac
charge instructions. After the procedure, the patient must keep arrest: Prevention of recurrence by drug therapy as predicted by electro-
physiologic testing or electrocardiographic monitoring. American Journal
the affected leg(s) straight for 3 to 4 hours to allow the venous of Cardiology, 57, 113–119.
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puncture site to heal and for 4 to 6 hours if the femoral artery 10. Wilber, D. J., Garan, H., Finkelstein, D., et al. (1988). Use of electro-
was punctured. The preliminary results of the procedure should physiologic testing in the prediction of long-term outcome. New England
be shared immediately with the patient and family. Frequent ex- Journal of Medicine, 318, 19–24.
planations may be required at first if the patient is recovering 11. AVID Investigators. (1997). A comparison of antiarrhythmic drug therapy
with implantable defibrillators in patients resuscitated from near-fatal ven-
from heavy sedation. After a successful ablation, patients have tricular arrhythmias. New England Journal of Medicine, 337, 1576–1583.
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no restrictions and antiarrhythmic medications are usually dis- 12. Buxton, A. E., Lee, K. L., Fisher, J. D., et al. (1999). A randomized study
continued. of prevention of sudden death in patients with coronary artery disease:
Most of the intraprocedure and postprocedure nursing care Multicenter Unsustained Tachycardia Trial Investigators. New England
Journal of Medicine, 341, 1882–1890.
is centered on monitoring the patient for potential complica- 13. Connolly, S. J., Gent, M., Roberts, R. S., et al. (2000). Canadian im-
tions related to the procedure. In most instances, patients are plantable defibrillator study (CIDS): A randomized trial of the im-
anxious before and during EP procedures. Adequate sedation to plantable cardioverter defibrillator against amiodarone. Circulation, 101,
allow for patient comfort should be provided. Oversedation 1297–1302.
must be prevented. Nurses must be alert for major complica- 14. Kuck, K., Cappato, R., Siebels, J., et al. (2000). Randomized comparison
of antiarrhythmic drug therapy with implantable defibrillators in patients
tions directly related to placement of catheters inside the heart. resuscitated from cardiac arrest: The Cardiac Arrest Study Hamburg
Bleeding from catheter insertion sites, tamponade from perfo- (CASH). Circulation, 102, 748–754.
ration, and tachyarrhythmias and bradyarrhythmias can all oc- 15. Moss, A. J., Hall, W. J., Cannom, D. S., et al., for the Madit Investigators.
cur during and after the EP procedure. Nurses who care for pa- (1996). Improved survival with an implantable defibrillator in patients
with coronary artery disease at high risk of ventricular arrhythmia. New
tients with arrhythmias in any setting should be prepared to England Journal of Medicine, 335, 1933–1940.
handle any emergency that may arise. Other potential problems 16. Moss, A. J., Zareba, W., Hall, J., et al. (2002). Prophylactic implantation
to be monitored include thrombophlebitis, thromboembolism, of a defibrillator in patients with myocardial infarction and reduced ejec-
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and infection. tion fraction. New England Journal of Medicine, 346, 877–883.
The Heart Rhythm Society, formerly known as the North 17. Bardy, G. H., Lee, K. L., Mark, D. B., et al. (2005). Sudden cardiac death
in heart failure trial (SCD-HeFT). New England Journal of Medicine, 352,
American Society of Pacing and Electrophysiology, has developed 225–237.
standards of professional practice for allied professionals (nurses, 18. Dongas, J., Lehman, M. H., Mahmud, R., et al. (1985). Value of preex-
nurse practitioners, physician assistants, technicians) caring for isting bundle branch block in the ECG differentiation of supraventricular
patients with cardiac rhythm disorders. The standards for EP pro- from ventricular origin of wide QRS tachycardia. American Journal of Car-
diology, 55, 717–721.
cedures are three-fold and include: (1) the application of scientific 19. Wellens, H. J. J., Brugada, P., & Heddle, W. F. (1984). The value of the 12
principles related to clinical EP to provide technical support and lead ECG in diagnosis type and mechanism of a tachycardia: A survey among
patient care services; (2) the demonstration of technical knowl- 22 cardiologists. Journal of the American College of Cardiology, 4, 176–179.
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edge and clinical skills to operate laboratory equipment and trou- 20. Zipes, D. P., Camm, A. J., Borggrefe, M. (2006). ACC/AHA/ESC 2006
bleshoot equipment malfunction; and (3) the integration of car- Guidelines for the management of patients with ventricular arrhythmias
and the prevention of sudden cardiac death: Executive summary. Journal
diovascular and electrical knowledge to effectively monitor the of the American College of Cardiology, 9, 539–548.
patient throughout the procedure. 81 21. Hess, D. S., Morady, F., & Scheinman, M. M. (1982). Electrophysiologic
testing in the evaluation of patients with syncope of undetermined origin.
Acknowledgment: The cardiac images were created by Claude Rick- American Journal of Cardiology, 50, 1309–1315.
erd of St.Jude Medical. 22. Kapoor, W. N. (2000). Syncope. New England Journal of Medicine, 343,
1856–1862.
23. Strickberger, S. A., Benson, D. W., Biaggioni, I. (2006). AHA/ACCF sci-
R EFE R E NC ES entific statement on the evaluation of syncope. Journal of American College
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2. Josephson, M. E. (1993). Electrophysiologic investigation: General con- American Journal of Cardiology, 60, 1073–1077.
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tients undergoing electrophysiologic procedures. Annals of Internal Medi- cope in patients with negative tilt table and electrophysiology testing. Cir-
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