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Cardiac electrophysiology and conduction pathway ablation

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Abstract

Invasive cardiac electrophysiological (EP) testing and transcatheter ablation are new methods available for the diagnosis and treatment of complex dysrhythmias. The purpose of this review is to familiarize anaesthetists with these procedures. The information presented combines a literature review with the authors’ experience. This article reviews normal cardiac conduction, tachycardia pathogenesis, principles of cardiac EP study and techniques of conduction pathway ablation. The anaesthetic considerations, including the choice of anaesthetic agent, monitoring problems, drug interactions, special methods ofdysrhythmia termination in the EP lab, and complications specific to these procedures, are detailed. Balanced general anaesthesia or monitored anaesthesia care (MAC) sedation with benzodiazepines, propofol and narcotics are acceptable. Several conclusions can be drawn: transcatheter ablation is an effective treatment for many reentry tachycardias; anaesthetic assistance for this procedure will increasingly be needed; anaesthesia can easily be provided without influencing accurate EP testing; overdrive pacing is the method of choice for terminating tachydysrhythmias in the EP lab.

Résumé

Les tests d’électrophysiologie (EP) invasive et l’ablation transcathétérisme cardiaque représentent des nouvelles méthodes de diagnostic et de traitement des arythmies complexes. Cet article vise à familiariser les anesthésistes avec ces interventions par l’association d’une revue de la littérature à l’expérience des auteurs. On y passe en revue la conduction cardiaque normale, la pathogénèse des tachycardies, les principes d’investigation EP et les techniques d’ablation des voies de conduction. Les considérations anesthésiques dont le choix des agents, le monitorage et ses problèmes, les interactions pharmacologiques, les principales méthodes d’arrêt des arythmie en laboratoire d’EP et les complications spécifiques à ces interventions sont abordés. L’anesthésie générale équilibrée ou la sédation monitorée avec les benzodiazépines, propofol et opiacés sont appropriées. On peut tirer plusieurs conclusions: l’ablation transcathétérisme est une traitement efficace pour plusieurs tachyarythmies de réentrée; on aura de plus en besoin de l’assistance des anesthésistes pour cette intervention; l’anesthésie elle-même n’interfère pas nécessairement avec les épreuves EP; l’entraînement électrosystolique rapide est la méthode de choix pour mettre fin aux tachydysrythmies en laboratoire d’EP

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Renwick, J., Kerr, C., McTaggart, R. et al. Cardiac electrophysiology and conduction pathway ablation. Can J Anaesth 40, 1053–1064 (1993). https://doi.org/10.1007/BF03009477

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Key words

  • Anaesthesia: cardiovascular
  • Heart: arrhythmia, electrocardiography