storm. If the patient is in VT storm it may be worth discussing Precedex with Cardiology. Consider calling a cardiac anesthesiologist for consultation in these sick patients. Maintenance of general anesthesia with inhaled anesthetics is generally appropriate. Unless the patient is hemodynamically unstable in VT storm avoid Precedex due to significant sympatholysis. If there is VT storm and hemodynamic instability it may be appropriate to discuss Precedex and/or thoracic epidural with EP proceduralist. Communicate significant changes in hemodynamics with the EP proceduralist. Blood pressure management should be a team approach considering both the patient’s underlying physiology and the procedure. Fluid management is important, as these patients easily get volume overloaded. Hourly I/O will be recorded. Neuromuscular blockade may not be appropriate, so please discuss with the EP proceduralist ahead of time. Consider Remifentanil if patient movement will be dangerous and you are unable to use neuromuscular blockade. Emergence/extubation/disposition is at the discretion of the anesthesia team. Procedural risks include damage from vascular access, cardiac perforation, phrenic nerve injury and thromboembolic events. With epicardial ablations direct coronary injury and abdominal organ puncture from access are additional concerns. A description of the VT ablation procedure is below, provided by Dr. Wendy Tzou: General strategy for VT ablation **Note that there may be variations in order and content of what is performed based on patient, situation, and operator. The following is to function only as a very general guide Voltage map Performed in sinus rhythm Involves moving catheter within chamber of interest, collecting electrical and anatomic data to recreate a 3-dimensional shell of the endocardium illustrating areas of probable scar and sites of arrhythmia circuit(s) Frequently, pacing is performed at various sites within the endocardium to better identify potential areas of interest that may be targeted for ablation Additionally, the following may be caused from catheter stimulation: Isolated PVCs Runs of NSVT
storm. If the patient is in VT storm it may be worth discussing Precedex with Cardiology. Consider calling a cardiac anesthesiologist for consultation in these sick patients. Maintenance of general anesthesia with inhaled anesthetics is generally appropriate. Unless the patient is hemodynamically unstable in VT storm avoid Precedex due to significant sympatholysis. If there is VT storm and hemodynamic instability it may be appropriate to discuss Precedex and/or thoracic epidural with EP proceduralist. Communicate significant changes in hemodynamics with the EP proceduralist. Blood pressure management should be a team approach considering both the patient’s underlying physiology and the procedure. Fluid management is important, as these patients easily get volume overloaded. Hourly I/O will be recorded. Neuromuscular blockade may not be appropriate, so please discuss with the EP proceduralist ahead of time. Consider Remifentanil if patient movement will be dangerous and you are unable to use neuromuscular blockade. Emergence/extubation/disposition is at the discretion of the anesthesia team. Procedural risks include damage from vascular access, cardiac perforation, phrenic nerve injury and thromboembolic events. With epicardial ablations direct coronary injury and abdominal organ puncture from access are additional concerns. A description of the VT ablation procedure is below, provided by Dr. Wendy Tzou: General strategy for VT ablation **Note that there may be variations in order and content of what is performed based on patient, situation, and operator. The following is to function only as a very general guide Voltage map Performed in sinus rhythm Involves moving catheter within chamber of interest, collecting electrical and anatomic data to recreate a 3-dimensional shell of the endocardium illustrating areas of probable scar and sites of arrhythmia circuit(s) Frequently, pacing is performed at various sites within the endocardium to better identify potential areas of interest that may be targeted for ablation Additionally, the following may be caused from catheter stimulation: Isolated PVCs Runs of NSVT
Ablation%20of%20Ventricular%20Tachycardia.docx