Acute complications of electrophysiology and pacing procedures: identification and management

Non-pharmacologic interventional techniques for treatment and management of almost all cardiac arrhythmias have greatly expanded over the past decade. These newer interventional electrophysiologic techniques continue to demonstrate increasing success at achieving their targeted goals, and enhancing the patient's quality of life. However, like all interventional procedures, complications may result. In this article we provide the reader with an overview of the more common and significant adverse events that may follow electrophysiologic and pacing procedures, and how best to recognize and manage these complications. After providing the reader with an overview of the complications inherent to all electrophysiologic procedures, we will detail the adverse events intrinsic to specific therapeutic electrophysiologic interventions (DC cardioversion, pharmacologic-based cardioversion, antitachycardia pacing, and ablation of specific arrhythmias). In the last part of the review, we will delineate complications associated with pacing procedures (pacemaker and defibrillator implantation, biventricular pacing and pacing lead extraction).