EKG basics
What does the "p wave" represent?
atrial depolarization
What is a common class of drugs in which patients with Afib are prescribed to prevent stroke?
NOAC- novel oral anticoags- more specifically direct factor Xa inhibitor (eliquis)
What is the first step in the event a patient experiences an unstable ventricular arryhtmia?
immediate defibrillation
This device can a shock for life threatening ventricular arrythmias and is indicated for patients with a low EF and assistance with ventricular synchronization.
BiV ICD
What are the three most common types of ablation energy/methods used?
Pulse field ablation, Radiofrequency ablation, cryo ablation
What cardiac rhythm has a classic "sawtooth" pattern?
atrial flutter
What electrolyte is critical to monitor to prevent ventricular arrythmias?
What is a complication that can occur from femoral access and presents as back/flank pain?
retroperitoneal bleed
Name two sites for a transvenous pacing catheter
Femoral vein and internal jugular vein
What structures in the LA and RA has very thin tissue and should be avoided with catheters/equipment/wires when maneuvering?
appendage (L and R)
SVT
What antiarrhythmic drug prolongs QT interval and is used to treat ventricular arrythmias in acute situations and atrial arrythmias for chronic arrythmias or short-term oral usage?
amiodarone
What is the target ACT for left atrial EP procedures and when should it be given?
350 or above; prior to transeptal puncture
What pacing mode paces and senses both atria and ventricles?
DDD
Why should patients be paralyzed when undergoing a pulse field ablation for afib?
The PFA pulses may induce muscle stimulation and cause the patient to move, which can shift the map; the pulses are also extremely uncomfortable for the patient
What do the H and V stand for in an "H-V interval" and what is a normal value?
bundle of his and ventricle ;30-50ms
What drug is used to reverse heparin at the end of an EP case and what are precautions to use when giving the drug and why?
Protamine sulfate- should be pushed slowly (1mL/min) to avoid risk or hypotension and stroke
What are symptoms you would expect to see if a patient on the table experienced a perforation during an EP procedure?
hypotension, maybe ST elevation, change is HR or rhythm, effusion seen on ICE imaging
Describe "failure to capture" when it comes to pacemaker functioning.
The pacemaker delivers an electrical stimulus that does not result in myocardial tissue depolarization
Biosense Webster steerable CS catheter (place in CS for reference catheter and to pace- assist with EP study and helps to test CTI line), Octaray mapping catheter (for mapping with Carto system), Medtronic Pulse Select catheter (for PFA ablation for afib)
What is a delta wave on an EKG and what does it suggest?
A delta wave represents the preexcitation of the ventricle during conduction of an accessory pathway, commonly known at AVRT or WPW.
What is the mechanism of action of Isuprel? (specifically in EP lab?)
Isuprel is a beta-adrenergic agonist that increases inotropic and chronotropic effects on the heart, which increases HR and CO. We use it the EP lab to help induce tachycardias.
What catheter should the monitor always be set up to pace should the patient experience bradycardia or an arrythmia?
coronary sinus
Describe "failure to sense" when it comes to pacemaker functioning.
occurs when the device fails to detect the heart's intrinsic electrical activity, leading to inappropriate pacing and potential complications.
What is the purpose of the Carto front and back patches (circular patches- yellow and green cables attached) that are placed on the patient?
They create a magnetic field on the patient in which the mapper can create a matrix in order to visualize catheters on the mapping system and locate them in space (Carto is a magnetic based mapping system)