(FIT)-Module 6 Lectures: Special Technology Sessions-This Is Not What It Looks Like: Spotting Foolers in the EP Lab

Video Transcription

Video Summary

In his presentation, John Miller from the Heart Rhythm Society discusses unexpected challenges in electrophysiologic procedures, sharing insights from his experiences to help others avoid similar pitfalls. He highlights the importance of maintaining a vigilant mindset during electrophysiology (EP) studies, where results may differ from expectations. Miller emphasizes the need for thorough checks, such as ensuring proper connection of ECG leads and catheters, since simple errors can lead to significant complications. For instance, misplaced ECG leads can mimic arrhythmias or suggest the presence of multiple pathways.<br /><br />He also mentions technical nuances like maintaining catheter stability to ensure accurate activation mapping and understanding potential interferences during ablations, such as differentiating true pulmonary vein signals from far-field recordings or dealing with valve closure artifacts. When conducting pacing maneuvers to diagnose arrhythmias, Miller advises being careful with post-pacing intervals, as incorrect interpretations can be made if the signals are not precisely identified.<br /><br />Furthermore, Miller stresses the importance of recognizing potential for pseudo-conduction and ensuring arrhythmias are fully engaged before making diagnostic conclusions. He advises exercising patience, double-checking results, and leveraging techniques like differential pacing when necessary. Ultimately, the presentation is a call for maintaining a meticulous and questioning approach to avoid misinterpretations and ensure the most accurate diagnoses during EP studies.

Keywords

John Miller

Heart Rhythm Society

electrophysiologic procedures

electrophysiology studies

ECG lead placement

catheter stability

activation mapping

pulmonary vein signals

far-field recordings

valve closure artifacts

pacing maneuvers

pseudo-conduction