Related Experiment Videos
Risks and complications of clinical cardiac electrophysiologic studies: a prospective analysis of 1,000 consecutive
Insights
Clinical cardiac electrophysiologic studies carry small risks, with a low mortality rate. These diagnostic procedures are generally safe and acceptable for evaluating heart rhythm disorders.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Procedures
Background:
- Cardiac electrophysiologic studies are crucial for diagnosing heart rhythm disorders.
- Assessing the safety and complication rates of these studies is vital for patient care.
Purpose of the Study:
- To prospectively evaluate the complications of clinical cardiac electrophysiologic studies.
- To determine the risks associated with these procedures in a large patient cohort.
Main Methods:
- Prospective evaluation of 1,000 consecutive patients undergoing cardiac electrophysiologic studies.
- Unaltered protocol used throughout the study period.
- Data collected on patient demographics, heart conditions, indications for study, and complications.
Main Results:
- One death occurred in 1,000 patients (0.1% mortality).
- Major complications included arterial injury (0.4%), thrombophlebitis (0.6%), and embolism (0.1-0.3%).
- Arrhythmic complications were infrequent, with severe proarrhythmic events in 3% of drug studies.
Conclusions:
- Clinical cardiac electrophysiologic studies are associated with a low rate of serious complications.
- The risks are generally small and acceptable given the diagnostic benefits.
- These studies are a valuable tool for managing patients with cardiac arrhythmias.
Abstract:
The complications of clinical cardiac electrophysiologic studies were prospectively evaluated in 1,000 consecutive patients studied in one laboratory with an unaltered protocol to better assess the risks of this procedure. There were 728 men and the mean age of the entire group was 58 years (range 16 to 84). Coronary artery disease was the most common type of heart disease (56%) and 200 patients had no identifiable organic heart disease. The indication for study was a ventricular tachyarrhythmia or cardiac arrest in 582 patients. Each patient underwent an initial (baseline) study and 444 patients underwent serial drug studies (2.7/patient). There was one death during these studies. Other major complications included arterial injury (0.4%), thrombophlebitis (0.6%), systemic arterial embolism (0.1%), pulmonary embolism (0.3%) and cardiac perforation (0.2%). Significant arrhythmic complications included catheter-induced permanent complete atrioventricular (AV) block in 1 patient, nonclinical atrial fibrillation that required therapy in 10 patients and severe proarrhythmic events in 12 (3%) of 397 patients undergoing drug studies for ventricular tachyarrhythmias. Cardioversion was required for termination of ventricular tachyarrhythmias in 179 baseline studies (53% of patients with inducible arrhythmia), and in an additional 35 patients, cardioversion was required at least once during follow-up studies. Although clinical cardiac electrophysiologic studies are associated with complications, the risks are small and acceptable.