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PreCatheterization: Palpitations and arrythmia PostCatheterization: Palpitations and arrythmia Name of Procedure: EP study, ablation, coronary angiogram, balloon angioplasty and stenting Description of Procedure: The patient was taken to the cardiac catheterization laboratory for ablation. The patient was prepped and draped in a sterile fashion and a time out was performed. Local anesthetic was given in bilateral groins and access was obtained using a modified Seldinger technique. Catheters were placed under fluoroscopic guidance without difficulty. An EPS was performed demonstrating no inducible supraventricular tachycardia. The AP ERP was 600/350 and 400/320 with AVN ERP as well some time before this SPERRI was 450 msec. A 4mm tip D/F curve Biosense catheter was used to map. Mapping in atrial pacing and sinus showed earliest antegrade activation in a right posteroseptal location along the anterior rim of the CS ostium. With multiple lesions, there was loss of preexcitation but then would come back within a minute. Stability was a question so the catheter was exchanged for a D/F 3.5 mm tip ThermoCool Smar Touch catheter. With 30 W of power and contact of 15-20g of force, there was loss of preexcitation at 5 seconds. A second lesion was placed and following the placement of a second lesion, there was noted to be change in surface QRS with ST elevation. With serial ECG, there was resolution of the changes within 10 minutes back to normal. The blood pressure is completely stable 100 to 110 range. Given this, we proceeded to evaluate the coronary arteries. Using the right femoral artery access, a 4 French 1.5 JL catheter was utilized and angiograms were taken in the left coronary artery and right coronary artery with 4 French 1.5 JR catheter. We did selective coronary angiography and this demonstrated a near occlusion of the the left circumflex not previously identified. At this point we intervened on the left circumflex coronary using 1.5, 1.75, 2, 2.5 coronary balloons and a bare metal stent. Post stent placement angiogram demonstrated normal flow in the circumflex artery with no evidence of thrombi noticed. There is normal perfusion distally with no evidence of extravasation of contrast or dissection of the coronary artery noted. No hemodynamic data was obtained. Total Omnipaque contrast utilized: 64ml.

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