ELECTROPHYSIOLOGY

INTRODUCTION

The Electrophysiology Service consists of the electrophysiology procedure labs, inpatient consultations, outpatient clinic, and an inpatient post-procedure consults (Cards E). Inpatient consults are focused predominantly on patients with procedural management issues: complex arrhythmia evaluations, including assessment of pacemaker/defibrillator candidacy, implantable pacemaker or defibrillator device evaluation, and complex arrhythmia diagnosis and management.

The average census is ~8.

2022-2023 Learning Objectives

Event Monitor Policy

PACER & ICD BASICS

Identify PPM/ICD by CXR

Perioperative Programming

CIED INTERROGATION TEMPLATE

POST-LVAD ICD PROGRAMMING

ATTEND ELECTROPHYSIOLOGY Clinic

Typically Wednesday morning with Kris Patton- contact her for details

ATTEND Weekly Sign-out Meeting

Wednesday at 5pm, ask attending for Zoom link
Be prepared to sign out the current consult list to the incoming attending

Perform cardioversions on patients with a Device

Check the daily cardioversion schedule in Epic (under ML ICRU) and figure out which ones you will be responsible for (consult fellow does cardioversions for patients without devices, echo fellow does cardioversions for patients who need TEE with or without devices).
Verify that the scheduled cardioversion is appropriate and that there are no contraindications (NPO status, INR therapeutic, whether or not a TEE is needed).
Make sure the consult attending is aware of any cardioversions for the day. If they are unavailable, it is their responsibility to find another attending to staff the procedure.
Contact Betsy Davidson (EP scheduler, 8-2441) with any changes or new cardioversions you would like to add on for the day. Ask the primary team to place the cardioversion order using the EPIC cardioversion order set.
Write cardioversion orders in Epic (use the "peri-procedural" powerplan) for outpatients when they arrive in ICRU.
Consent patients for the procedure.
Write the procedural and device interrogation notes in ORCA. Don’t forget to leave recommendations on anticoagulation, especially for patients on non-cardiology services.
If you are unavailable for a cardioversion, your back-up is the Consult Fellow, then the Echo fellow, then the ACHD fellow.

RHYTHM-STAR REMOTE MONITORING ACCESS INSTRUCTIONS

Website: https://www.rhythmstar.com/

Password: EKGlab2019

Peri-Surgical Cardiac Implantable Electronic Device (CIED) Management Algorithm

The Anesthesiology Device Service (ADS) and the EP service at UW have collaborated to improve the care of patients with CIEDs in perioperative care.

All programming notes and plan should be documented in a note in Epic.

· From 7AM to 5PM, Monday through Friday, there should be a member of the ADS available to provide CIED pre/post operative programming

o If a patient has had preoperative ADS programming, the ADS service will reprogram the device post-operatively during normal working hours.

o If a patient has had preoperative CTA programming, but the case is finished after-hours, the device can be left overnight and reprogrammed the next morning by the ADS service

o If a patient has had preoperative ADS programming, and the case is finished after hours on a Friday, reprogramming can be done the next day by the EP service, if no ADS member is available. If for some reason the ADS is of the opinion that restoration of programming may need to be done immediately after surgery, the ADS will discuss the situation with EP.

· On off hours and weekends, emergent periop programming falls to the EP service.

o A magnet can be used to disable ICD therapies or set a pacemaker VOO/DOO in truly emergent cases (when no one in house is available to program the device before surgery to prevent a delay). Please note that a magnet application does not affect pacing therapies in an ICD.

o If questions arise, contact the EP fellow, the EP fellow covering Card E, the EP attending on-call, or the device company. Some of the cardiology hospitalists who are in house are also able to reprogram CIEDs.

· Post-LVAD EP specific programming is not urgent and does not need to be done at night or on weekends. New LVAD implantation CIEDs should be managed as above.

· Should the ADS come across a circumstance that needs attention beyond what the ADS feels comfortable handling on their own, the ADS will contact EP for assistance.