Complications and risks of the electrophysiological study
Electrophysiological studies are less traumatic than they seem to be. By using the appropriate equipment and thanks to the specialist’s skills and experience, the complications are minimal.
1. Bleedings at the puncture site, which are usually insignificant in the case of a femoral vein approach. Arterial puncture is accompanied by increased bleeding. Limiting local bleedings can be done by compressing the puncture area for 10-20 minutes, after having removed the catheter, patient immobilization in bed for 6 to 12 hours, and tracking the bleeding area for prompt intervention in case of relapse.
2.Hematoma is the consequence of an uncontrolled hemorrhage along with the disregard of contraindications, and post study care.
3. Thromboembolism is relatively rare, so systemic heparinization of patients is not necessary. However, heparin treatment will be administered to patients on whom are being conducted studies on the left heart or prolonged studies on the right heart, especially in the presence of embolic risk factors.
4. Thrombophlebitis, especially the profound one, is a more rare complication. For this reason, antibiotic prophylaxis is not routinely indicated.
5. Cardiac arrhythmias may be the consequence of manipulation of the electrodes in cardiac cavities, but their induction can often be the very purpose of those studies. Triggering arrhythmias by using programmed electrostimulation in the atrium or ventricle is part of a complex study of the patient, induced arrhythmias being suppressed usually by electrostimulation. In case of necessity, external electric shock will be applied. Of course there is a risk of triggering a ventricular fibrillation, but this is rarely seen in conditions of a normal study, by using constant current intensity not greater than twice the threshold for stimulation. For the treatment of this complication it is necessary to apply external electric shock, accessible at any time.
6. Tamponade is possible because of the perforations of the ventricle of atrium, but it is a rare complication in the case of an experienced physician. Perforation of the atrium or coronary sinus is possible during catheter ablation procedures.
7. Hypotension can occur either in the context of vagal hypertonia, either after the induced arrhythmia, especially in patients with organic heart disease.
8. Pneumothorax is the consequence of unsuccessful attempted subclavian vein puncture. There are specialists who prefer external jugular vein for approaching the coronary sinus, precisely to avoid this complication.
9. Death is the most feared complication but fortunately, the most rare also. It occurs in less than 0.01% cases, that is much lower than the procentage given by mortality in cases of angiographic studies.