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Electrophysiology study - Radiofrequency or Cryoablation

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The procedures are performed by Dr Skinner, commonly assisted by cardiology fellow or registrar. He will advise whether special tests are required beforehand. They are performed under general anaesthetic in children. The first case is at 9 am on Wednesday. Two or three cases are done in a day. Children can often go home (or to Ronald McDonald house if they do not live locally) the night before having been seen by Dr Skinner or the fellow, the anaesthetist and medical staff. If monitoring is required after stopping any anti-arrhythmic they should stay overnight (Dr Skinner to advise)

On admission

  • Anti-arrhythmic medication should have been stopped 4-5 days prior to the admission (eg Flecainide and Sotalol). Amiodarone should have been stopped 4-6 weeks beforehand. If medications have not been stopped prior to admission, contact:
    • EPS booking administrator on Ph 23664
    • And contact Dr Skinner immediately as EPS procedure may need to be rescheduled
  • Echocardiography is required in all patients where one has not been performed beforehand. This is primarily to exclude Ebstein's anomaly (because of its association with accessory pathways), to see if there is a patent foramen ovale (for access to the left side of the heart) and to establish that the aortic and mitral valves are normal (since these may need to be crossed retrogradely during the procedure).
  • All patients should have an ECG.
  • A recent chest x-ray (< 1 month) is usually required by the anaesthetist.
  • All patients should have a full blood count, electrolytes and group and hold. Sodium and particularly potassium levels should be written clearly in the notes.
  • Review patient notes and provide printout of any documented arrhythmia including Holter results, from 3M and insert into patient notes if not already done
  • Antibiotic cover is not required pre procedure. In the event that antibiotics are required they are usually administered by the anaesthetist during the procedure.
  • Ages and Stages Questionnaire are to be completed on all children >6 weeks of age to 6 years of age.

Consent: This is obtained by Dr Skinner or his assistant

Post Procedure

  1. RMO checks pulses shortly after arrival on the ward (the femoral artery is  entered in about a ΒΌ of the cases).
  2. The patient to remain on bed rest for 4 hours post procedure
  3. Monitoring:
    Continuous cardiac monitoring overnight + 4 hourly TPR and BP.
  4. Tests prior to discharge:
    1. All patients should have an ECG. 
    2. Echocardiography if a left sided ablation to check for aortic and mitral valve regurgitation and pericardial effusion.

Medication on discharge

  • If procedure successful anti-arrhythmics are discontinued.
  • If procedure is unsuccessful then anti-arrhythmics may be recommenced as ordered (check with Dr Skinner prior to discharge).
  • For left sided ablation Aspirin at 3-5 mg/kg (maximum 75 mg/day) is given once a day for one month.

Follow Up

  • Book for follow up clinic - usually at 4-6 weeks in the arrhythmia clinic with ECG for local patients. 
  • Distant follow up will be arranged by Dr Skinner.

Nursing Care Plan

Click on this link for the Electrophysiological Study +/- Radiofrequency Ablation Care Plan

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Document Control

  • Date last published: 18 January 2016
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Cardiology
  • Author(s): Jon Skinner
  • Editor: Marion Hamer