-
•
Preparation for EP procedures requires a preprocedural history and physical examination by a physician, NP, or PA.
-
•
As many management strategies for arrhythmias require chronic and/or periprocedural anticoagulation, careful evaluation, assessment, and planning are needed.
-
•
In patients undergoing pacemaker or defibrillator lead extraction, or who require pericardial access for epicardial ablation or left atrial ablation ligation, additional preparation may be required on a case-by-case basis, such as typing and crossmatching of blood products in select patients and immediate availability of thoracic surgical backup.
-
•
In most diagnostic and ablation cases, rhythm active drugs (including β-blockers and calcium-channel blockers) are discontinued five half-lives before the procedure to allow the target arrhythmia to be induced, mapped, and ablated.
-
•
A complete description of the procedure, including the anticipated success rates and possible complications, is best delivered in the outpatient setting before the EP procedure.
-
•
A “time-out” must be performed immediately before the initiation of the procedure when all key personnel are present.
-
•
Health care facilities should insist that clinicians administering or supervising the administration of moderate sedation meet the requirements of the American Society of Anesthesiologists.
-
•
Anticoagulation is necessary for all left heart procedures with heparin (activated clotting time ≥250–350 seconds) or with bivalirudin in patients allergic to heparin.
-
•
It is important to achieve the lowest possible noise signal with all recording systems.
-
•
All physicians and staff are required to be familiar with identifying all potential procedural complications and to understand their role in managing them.
-
•
The decision for patient discharge takes into account procedural detail, patient age and health status, potential for complications (such as blood loss), and the ability of the patient (or caregivers) to evaluate signs of concern.
-
•
The procedure report should include, at minimum, all the following: the primary and secondary operators, the indication for the procedure, names and doses of any medications administered, catheter/pacing/ICD lead model and serial numbers, insertion sites and intracardiac destinations, findings and procedure performed, complications encountered, and fluoroscopic exposure (fluoroscopy time, radiation dose, and the dose-area product) by an Advanced Cardiac Life Support (ACLS)/Pediatric Advanced Life Support (PALS)-certified nurse.
