Atrial Fibrillation Induction by Transesophageal Electrophysiology Studies in Patients with Asymptomatic Ventricular Preexcitation

Hoyt, Walter J.; Thomas, Pradip Ninan; DeSena, Holly C.; Steinberg, J.S.; Harmon, Donald E.; Snyder, Christopher S.

doi:10.1111/j.1747-0803.2012.00689.x

Cited by 2 publications

(3 citation statements)

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“…TVEPS is an effective way to risk stratify patients; however, it is hampered by its invasiveness, cost, and potential complica-tions. TEEPS procedures have been shown to be an effective screening tool with potentially less complications; however no consensus anesthetic technique has been proven superior [2]. This study series describes our attempt to find the easiest, most effective anesthetic technique for the TEEPS procedure.…”

Section: Discussionmentioning

confidence: 98%

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Anesthetic Technique for Transesophageal Electrophysiology Studies in Pediatric Patients with Wolff-Parkinson-White Syndrome

Gilly¹,

Hoyt²,

Harmon³

et al. 2015

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Objective: Patients with Wolff-Parkinson-White (WPW) Syndrome require risk assessment to determine their potential for sudden cardiac death. Transesophageal electrophysiology studies (TEEPS) are an effective risk stratification tool. The purpose of this study is to describe a minimially invasive, effective anesthetic technique to employ during transesophageal electrophysiology studies. Methods: A retrospective review of anesthetic technique utilized during TEEPS. Inclusion criteria; WPW on ECG; age <18 years; and no history of tachycardia, palpitations, or syncope and patient had TEEPS under monitored anesthesia care (MAC). Midazolam, Fentanyl, and Propofol were used in various combinations. Sevoflurane was used during induction period in all GA cases and discontinued 10 minutes prior to initiation of TEEPS. Results: Inclusion criteria were met by 20 patients with an average age of 11.9 years, average weight of 48.9 kg and average height of 149.2 cm. IV sedation was performed on 15%, MAC on 10% and GA in remainder. Airway management techniques included 13.3% LMA, 20% endotrachael tube (ETT) and 66% mask. IV sedation, the initial anesthetic, was found to be cumbersome and uncomfortable. Next was ETT and LMA but trouble pacing was encountered due to positional change of the esophagus relative to the left atrium during ventilation. Mask induction was then performed in remaining 10 patients with TEEPS probe inserted through a nare while anesthesiologist continued mask ventilation. All mask * Corresponding author. G. M. Gilly et al.18 procedures were successful without complications. Conclusions: Induction of anesthesia to perform TEEPS procedures on pediatric patients with Wolff-Parkinson-White syndrome underwent numerous attempts to make the procedure easy, reliable and reproducible for anesthesia and electrophysiologist. The eventual technique that proved to meet these criteria during a transesopheagel electrophysiology procedure was utilization of mask induction with continuous IV sedation.

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Section: Discussionmentioning

confidence: 98%

“…TVEPS is currently accepted as the most effective way to assess the risk of these patients; however, this procedure is associated with increase cost, time, invasiveness, and risk. In contrast, a TEEPS is easy to perform, less costly, with less risk and excellent success rates [2].…”

Section: Introductionmentioning

confidence: 95%

Anesthetic Technique for Transesophageal Electrophysiology Studies in Pediatric Patients with Wolff-Parkinson-White Syndrome

Gilly¹,

Hoyt²,

Harmon³

et al. 2015

OJPed

Self Cite

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“…However, the hospitalization cost, invasiveness, and risk of intracardiac electrophysiological examination are relatively increased. In contrast, TEEPS is easier to perform because of its lower cost, less risk, and higher success rate (Hoyt et al., 2013a). In this case, TEEPS showed that the QRS wave was still transmitted through the accessory pathway in S 1 S 2 500–220 ms, and the atrium entered the refractory period in S 1 S 2 500–210 ms.…”

Section: Figurementioning

confidence: 99%

Successful risk stratification of a patient with ventricular preexcitation by improved transesophageal electrophysiological study

Qin

2021

Noninvasive Electrocardiol

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The patient is a 19 years‐old man who often wakes up in dreams with palpitations and fatigue. The ECG shows: 1. Sinus rhythm; 2. Preexcitation syndrome. Transesophageal electrophysiological study (TEEPS) diagnosis:High‐risk accessory pathway. During radiofrequency catheter ablation, the patient suddenly developed atrial fibrillation and quickly converted to ventricular fibrillation. After defibrillation, ventricular fibrillation is transformed into sinus rhythm. Subsequently, the patient's high‐risk accessory pathway was successfully ablated. Studies have shown that about 25% of patients with WPW syndrome have a refractory period of less than 250 ms, which is one of the risk factors for the conversion of atrial fibrillation to ventricular fibrillation. Therefore, risk stratification is recommended for these symptomatic patients. From 1980 to 1990, there were literature reports on risk stratification of patients with preexcitation syndrome by TEEPS. But it has not become a routine examination of risk stratification in patients with preexcitation syndrome.The reason may be related to the hardware conditions and risk stratification methods used at that time. The TEEPS equipment currently used in our hospital can control the pacing voltage at about 12 mv on average. The voltage in this case report is 9 mv only. In addition, we successfully stratified the risk of patient with preexcitation syndrome without inducing atrial fibrillation. All the electrophysiological records of the patient during the examination were recorded simultaneously with the 12‐lead ECG and the esophageal lead ECG. These improvements makes TEEPS a simple, safe and reliable non‐invasive cardiac electrophysiological detection technology, which is worth popularizing in hospitals.

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Atrial Fibrillation Induction by Transesophageal Electrophysiology Studies in Patients with Asymptomatic Ventricular Preexcitation

Abstract: TEEPS induced AFib in 88.5% of patients. Age, weight, height, and form of sedation had no effect upon AFib inducibility. TEEPS is an effective modality to induce AFib in pediatric patients with aVPE.

Cited by 2 publications

References 29 publications

Anesthetic Technique for Transesophageal Electrophysiology Studies in Pediatric Patients with Wolff-Parkinson-White Syndrome

Anesthetic Technique for Transesophageal Electrophysiology Studies in Pediatric Patients with Wolff-Parkinson-White Syndrome

Successful risk stratification of a patient with ventricular preexcitation by improved transesophageal electrophysiological study

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