EP Fellows Curriculum: Avoiding Complications-Avoiding Complications

Video Transcription

Video Summary

In this video, Dr. Susan Kim discusses strategies for minimizing complications in electrophysiology (EP) procedures. She begins by addressing device complications, focusing on pacemaker implantation. She highlights the importance of minimizing lead complications, such as infection and thoracic trauma, and discusses the higher risk associated with additional leads. Dr. Kim also emphasizes the role of experience in reducing complications, citing a study that showed lower complication rates in higher-volume EP centers.<br /><br />Next, she discusses minimizing complications during ablation procedures. She emphasizes the importance of ultrasound-guided access in reducing vascular complications. Dr. Kim also addresses strategies for minimizing perforation and tamponade during ablation, including avoiding excessive force and recognizing complications early.<br /><br />Dr. Kim then discusses the use of anticoagulation during EP procedures. She highlights the benefits of uninterrupted warfarin and uninterrupted NOACs in reducing complications. She also recommends holding one or two doses of anticoagulation prior to the procedure and discusses the use of aspirin post-procedure.<br /><br />Finally, Dr. Kim provides advice on how to approach and manage complications with patients. She emphasizes the importance of being frank and clear with patients, providing them with a roadmap of what to expect, and involving their family in the discussion. She encourages fellows to not abandon their patients and to seek support from colleagues, mentors, and family members. Dr. Kim concludes by reminding fellows that complications are normal and that learning from these experiences can help improve future practice.

Keywords

complications

electrophysiology

EP procedures

pacemaker implantation

lead complications

ablation procedures

ultrasound-guided access

anticoagulation

family involvement