Cardiac Catheterization (Electrophysiology Study) Medical Transcription Sample Reports

DATE OF PROCEDURE:  MM/DD/YYYY

PREPROCEDURE DIAGNOSES:1.  Nonsustained ventricular tachycardia.
2.  Normal left ventricular ejection fraction.
3.  History of coronary disease.  Status post coronary artery bypass graft with patent bypass grafts on cardia cath.
PROCEDURE:  Electrophysiology study.
DETAILS OF PROCEDURE:  The patient was brought to the electrophysiology lab where ECG and vital signs were continuously monitored.  The right groin was meticulously prepared with Betadine solution and was draped in the usual sterile fashion.  Lidocaine 1% was administered subcutaneously for local anesthetic.  Using modified Seldinger technique, two #6 French introducer sheaths were inserted into the right femoral vein.  Two quadripolar EP catheters were inserted into the sheaths and advanced under fluoroscopic guidance.  One was positioned in the area of the high right atrium and one in the area of the His bundle.  The high right atrial catheter was later moved to the RV apex for ventricular stimulation.  Endocardial potentials were recorded and baseline measurements were performed.  The sinus cycle length was 1195 milliseconds.  The AH interval was 115 milliseconds.  The HV interval was 45 milliseconds with a pacing cycle length of 800 milliseconds.  The sinus node recovery time was 1430 milliseconds with the pacing cycle length of 700 milliseconds.  The sinus node recovery time was 1465 milliseconds with a pacing cycle length of 600 milliseconds.  The sinus node recovery time was 1570 milliseconds.  AV Wenckebach recorded an atrial pacing cycle length of 450 milliseconds.  The AV node effective refractory period was 320 milliseconds with the pacing cycle length of 600 milliseconds and 240 milliseconds with a pacing cycle length of 600 milliseconds.  The pacing threshold from the right ventricular apex was 0.5 milliamps, 1:1 VA conduction was present at a ventricular pacing cycle length of 600 milliseconds.  The ventricular effective refractory period was 240 milliseconds with a pacing cycle length of 600 milliseconds and 240 milliseconds with a pacing cycle length of 400 milliseconds.  After single, double and triple extrastimuli were performed at two pacing cycle lengths from the RV apex, Isuprel was started at 2 mcg per minute.  This was gradually increased to 4 mcg per minute in order to achieve a good heart rate response.  The ventricular effective refractory period was 220 milliseconds with the pacing cycle length of 400 milliseconds.  All ventricular pacing was performed from the RV apex.  After completion of programmed electrical stimulation, catheters were removed.  Good hemostasis was achieved using manual compression.  The patient was then transferred to the recovery room in good condition.
IMPRESSION:
1.  Mildly abnormal sinus node function.
2.  Normal atrioventricular node function without evidence of dual atrioventricular node physiology.
3.  Normal His-Purkinje function without evidence of infra-His block.
4.  Frequent nonsustained ventricular tachycardia with single, double and triple ventricular extrastimuli from the right ventricular apex.  The morphology of the nonsustained ventricular tachycardia varied between left bundle, left axis and left bundle right axis morphology.  Nonsustained ventricular tachycardia or prolonged nonsustained ventricular tachycardia was induced.

RECOMMENDATIONS:  The patient will be continued on beta blocker, which should be increased as tolerated.  If the patient has recurrent symptoms, despite medications, an ablation procedure may be considered.  However, given the differing morphologies of the nonsustained VT, this may make ablation difficult.

 

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