# Electrophysiologic Testing with Induction of Arrhythmia



## brownie (May 2, 2014)

Second opinion- how would you code this ?

Procedures: Electrophysiologic Testing with Induction of Arrhythmia 
with drug stimulation 
with left atrial pacing and recording 
Standard Mapping 
With left ventricular pacing and recording 
LV pacing and mapping 
3D Mapping 
Standard mapping 
Intracardiac Echocardiography 
Indication: Ventricular Tachycardia 
Ischemic Cardiomyopathy 
Medications: Heparin 20000 units 
Isuprel 12 Micrograms/min 
Epinephrine 15 micrograms/min 
Dopamine 10 micrograms/min 
Input/output: 2400 / 400 cc 
PROCEDURE DESCRIPTION: 
The patient was prepared and draped in sterile fashion. Following local anesthesia with 1% xylocaine, sheaths were inserted percutaneously into the right femoral vein and the left femoral vein and femoral artery for administration of IV fluids and introduction of catheters. 
A 10.5 F phased array ultrasound catheter was inserted through the left femoral vein and positioned in the right atrium for imaging. Intracardiac Echocardiography was performed. The left ventricul, right ventricle, RVOT, Aortic valve and pulmonic valve were mapped. Multipolar catheters were positioned at the right ventricular apex, right ventricular outflow tracts, His bundle and high right atrium for pacing and recording. Programmed atrial stimulation was performed to assess the EP properties of the atrium and AV conduction system, and for arrhythmia induction. Programmed ventricular stimulation was performed to assess the electrophysiologic properties of the ventricul, and for arrhythmia induction. Stimulation during cathecholamine infusion was performed. These results are reported below. 
Following induction of ventricular tachycardia. Activation mapping and pacemapping were performed using 3.5 mm Thermacool Navistar D Cure Mapping was performed in SR to delineate the scar. Detailed results of mapping are reported below. 
Ablation was not done given the fact we could only induce NSVT and the scar and fractinoated signals are very close to the HIS bundle. We attempted induction by pacing in the RV apex and RVOT with two cycle lenghts and up to 3 extra stimuli. We did that on isuprel at 12 mcgm / min, with epinephrine at 15 mcg/min and on dopamine 10 mcg/ min. During the entrie prior of left heart catheterization, intravenous heparin was administered to maintain ACT at > 320 seconds. 
At the end of the procedure. The catheters and sheaths were removed and hemostasis obtained by manual compression. 
PROCEDURAL DATA: 
Cardiac Intervals : 
	Rhythm 	CL 	PR 	QRS 	QT 	AH 	HV 
Baseline : 	Sinus 	915 	138 	101 	431 	114 	63 
Post procedure : 	Sinus 	794 	149 	101 	427 		

Access 	Catheter 
LFV 	11F Siemens Sound Star 
RFV 	7F Bidirectional FJ Decapolar catheter 
RFA 	3.5 mm Thermacool 
Spontaneous or Induced Arrhythmias: NSVT. 
Refractory periods 				
	Baseline 	Isuprel 	Dopamine 	Epinephrine 
HRA 				
AVN 				
RV 	600/270 
400/250 	400/250 (apex) 
400/230 (RVOT 	400/230 (apex) 
400/220 (RVOT) 	400/240 (apex) 
400/230 (RVOT) 
Mapping Results: The scar is near the mitral annulus and most of the fractionated signals are near the HIS bundle 
Total Procedure Time: 245 min 
Total Fluoroscopy Time: 17.8 min 
Complications: none 
SUMMARY 
1.	Comprehensive EP study with attempted induction of VT. We could only induce NSVT despite aggressive PES on isuprel, epinephrine and dopamine.
2.	3 D mapping with scar mapping, ICE and Drug study. The scar is near the mitral annulus and most of the fractionated signals are near the HIS bundle. Given the location we elected not to deliver RF on the fractionated signals unless we induce and study the VT


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## jlb102780 (May 6, 2014)

brownie said:


> second opinion- how would you code this ?
> 
> Procedures: Electrophysiologic testing with induction of arrhythmia
> with drug stimulation
> ...



93620
93613
93662-26
93623-26

hth


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