HRS Board Review 2025 New Courses (Reviewers Copy)-This Is Not What It Looks Like: Spotting Foolers in the EP Lab

Video Transcription

Video Summary

In his presentation on electrophysiologic challenges, John Miller from the Heart Rhythm Society discusses unexpected issues that clinicians might face during electrophysiology (EP) procedures. He emphasizes the importance of being vigilant and prepared for complications that can arise unexpectedly. Key points include ensuring accurate connections and placements of ECG leads and catheters, acknowledging the significance of properly assessing electrical signals, and recognizing subtle discrepancies that could affect diagnosis and treatment.<br /><br />Miller highlights various scenarios where potential pitfalls may occur, such as issues with AV conduction, the interpretation of retrograde conduction, and understanding the nuances of accessory pathways during mapping and ablation. For instance, the importance of accurately interpreting atrial signals during pulmonary vein isolation is emphasized, noting how deeply seated catheters can miss signals, leading to insufficient ablation.<br /><br />He further delves into pacing techniques, cautioning against misinterpretation of artifacts and pseudo-signals that might appear during these procedures. Through specific examples, he illustrates how misleading signals such as valve artifacts and artifacts from non-captured pacing can confound accurate mapping and treatment.<br /><br />Miller's overarching advice involves thorough testing and validation of signals using available knowledge, ensuring redundancy through reproducibility, and maintaining a problem-solving approach to diagnose and solve unforeseen issues effectively. This meticulous and informed strategy, he insists, minimizes errors and optimizes patient outcomes in electrophysiology practices.

Keywords

electrophysiology

John Miller

Heart Rhythm Society

ECG leads

catheters

AV conduction

retrograde conduction

accessory pathways

pulmonary vein isolation

pacing techniques

signal artifacts

patient outcomes