Intracardiac electrophysiological examination and radiofrequency ablation routine
I. Preoperative.
1, routine examination: chest X-ray, 12-lead ECG, cardiac ultrasound, Holter if necessary, exercise load ECG left atrial and pulmonary vein CT, CAG (surgical access, peripheral vessels, embolism possible situation-TEE except left atrial thrombus, etc.) examination.
2, routine laboratory tests: nail function, urgent blood analysis, coagulation triple, ion (E4A), biochemical combination (blood glucose, liver function, kidney function, myocardial muscle enzyme spectrum if necessary, etc.), blood sampling for hepatitis virus markers, anti-HIV, syphilis, retention of urine routine, stool routine, etc. If the preoperative blood infectious disease indicators (hepatitis 7, anti-HIV, syphilis) are not returned, the patient and his family must agree and sign that “all postoperative results have nothing to do with the intervention”.
3, preoperative signature must be signed by the patient and family members to sign the surgical protocol, in addition to the common dangers and complications (see interventional consultation report form), but also need to explain.
(1)Unsuccessful surgery.
(2) Postoperative recurrence;
(3) 111 degree AVB with permanent pacemaker at own expense: sudden death.
4, under medical orders, skin preparation (left and right inguinal region, bilateral neck and chest).
5, age ≥ 40 years, routine preoperative aspirin 80-120mg.
6.If the operator has no special requirements, discontinue antiarrhythmic drugs for more than 5 half-lives before surgery (except for amiodarone).
Touch both femoral and dorsalis pedis arteries and listen to the femoral artery for vascular murmurs before surgery.
8.Complete the preoperative discussion and record it in detail.
II. Postoperative.
1.Electrocardiogram: immediate postoperative, 1-2 days postoperative, and 12-lead electrocardiogram before discharge, with additional ones done at any time if necessary. Observe the heart rate, heart rhythm, P-R interval (pay attention to the presence of atrioventricular block), the presence of pre-excitation, and the presence of ST-T changes compared with the preoperative period.
2. Routinely measure the heart rate, blood pressure, feel the dorsalis pedis artery and observe the local bleeding of the puncture, 4 times immediately and every half an hour after the operation. If there is any change in the condition, observe closely according to the specific situation. Write down the postoperative course record at least once.
3. Decide the time of bed rest according to the arterial or venous puncture route. If it is the arterial route, lie flat for 8-12 hours and sandbag compression for 6 hours, then turn over in bed or lie on your side, and get out of bed for 16-24 hours. In the case of venous route, the patient should lie flat for 3–6 hours and then get out of bed (usually 4 hours to get out of bed). The joints of the non-punctured limb can be flexed and turned in and out, and the foot of the lower limb on the punctured side can be rotated by positive hooking and lateral hooking. For patients who have been lying flat for too long or are elderly, instruct the patient to gradually adapt to different positions (15′—30′, 45′—60′) before getting out of bed, and then get out of bed in sitting or upright position to avoid the occurrence of postural hypotension.
4. Routinely take aspirin 80~120mg, 1/El, for 1~2 months after surgery; reduce the dosage for children as appropriate. Special antiplatelet and anticoagulation therapy is prescribed by the postoperative doctor.
5.If the patient has obvious chest tightness, shortness of breath, dyspnea, tachycardia or bradycardia, accompanied by a significant decrease in blood pressure that does not respond well to antihypertensive drugs, the possibility of pericardial tamponade and bedside cardiac ultrasound should be considered to confirm the diagnosis if other factors (such as vagal reflex) are excluded, followed by timely resuscitation and treatment.
6.If the possibility of pericardial tamponade cannot be ruled out, the treatment procedure is as follows.
(1) Perform cardiac fluoroscopy and/or cardiac ultrasound in the catheterization laboratory, and perform pericardiocentesis immediately after the diagnosis is clear.
(2) Bedside cardiac ultrasound (precordial endoscopy) and determination of peripheral venous pressure if already back in the ward.
(3) Perform bedside pericardiocentesis in critically ill patients with high suspicion of pericardial tamponade.
(4) If the above three measures are not effective, consult with cardiac surgery urgently and perform open pericardiotomy and myocardial repair if necessary.