Index
Ep Defined | Getting Started | Working in the EP Lab
Right Atrium | Right Ventricle | Left Atrium | Left Ventricule | Cardiac Conduction | Cardiac Cell Properties | Action Potential | Sympathetic or Not | Med Page
Electrograms Defined | Recording Modes | Electrode Spacing | Filters | EGM Interpretation | Arrhythmia Analysis
The Physical Lab | Tools of the Trade
Setting Up | Catheter Placement | Baseline Measurement | SNRT | Conduction Study | Arrhythmia Induction | Pacing Protocols | Ablation | Tilt Table | Secrets to Success
Bradycardia | Atrial Tach | Atrial Flutter | Atrial Fibrillation | AVNRT | AVRT | Ventricular Tachycardia
Surface ECG's | Intracardiac Questions | Med Challenge | Advanced

Tools of the Trade - Recording Systems

Recording Systems

          The purpose of an electrophysiology study is to identify the source of abnormal cardiac rhythms, or arrhythmias. To achieve this, the electrophysiologist records information about the electrical activity of the patient’s heart. Signals from the surface electrocardiogram and intracardiac signals from catheters placed inside the heart allow the physician to determine where any abnormal signals originate. Once the origin of an abnormal rhythm is located, it is often possible to ablate these cells and eliminate the arrhythmia.
          Documenting the signals during an EP study is accomplished using a specialized recording system designed specifically for this type of medical procedure. There are several different companies that make and sell EP recording systems. While all of these systems perform basically the same functions, each company’s product has slightly different setups. Some of these differences will be addressed following the overview of general system functions.

Recording System Overview

          Every EP recording system will have similar basic functions that are presented in a format that is determined by the manufacturer. This section lists some of the primary functions that these systems should contain. There is also a list of tools that these systems may or may not have. If you are considering purchasing an EP recording system, be sure to do a thorough comparison of all the systems available.

System structure

Computer – All the EP recording systems available are computer based, most on windows based software. When comparing different companies products, it is advisable to consider processing capabilities, software platform stability and integration capabilities. As EP expands, the functionality of these systems can become dependant upon the expandability and integration capabilities that each provide.
Software – While the basic computer functionality on most EP recording systems is relatively similar, the application software can provide major differences in how each system performs. The type and number of tools used in electrophysiology procedures is extensive. How the application is set up will have a significant impact on the ease of use of the system utilized. Each application will have similar functions along with product specific features. When considering a purchase, overall functionality along with ease of use should both be given strong consideration.
Patient / Procedure Database – This is one area where it is difficult to demonstrate the superiority of one product over another. Patient and procedural data entry is a relatively standard process. It is in integration that specific systems can provide a level of functionality that differentiates one product from another. When looking at the various EP recording systems, consider what tools have been provided to make data entry easier and more accurate. Does the system being considered integrate with hospital information systems or with additional equipment in the lab? Each time data has to be entered is another opportunity for error. Ideally, every system in the EP lab should be capable of retrieving patient information from a common source such as the hospitals primary data management system.
Signal Inputs – During EP procedures, a variety of different signals are collected for analysis. These signals primarily include surface and intracardiac electrograms. Additional signals from cardiac stimulators, arterial pressure lines, O2 saturation monitors and blood pressure cuffs may be utilized. As far as signal input goes, limitation is the key factor to avoid. Given the processing power of computers in today’s market, any limitations on signal inputs would almost certainly be due to poor hardware or software design. When evaluating an EP recorder, be sure to look carefully at some of the following items;

What is the total number of signal input channels available? The ideal recording system should provide the following as the minimum number of different inputs;

- 12 Surface ECG Leads - The inputs for the surface ECG should not diminish the number of intracardiac channels available.

- 2 pressure waveform traces

- 2-4 pacing channels

- 64 intracardiac signal input channels. This number represents the absolute minimum that should be considered and is based upon the following formula; (4 RA) + (4 His) + (4 RV) + (10 CS) + (4 RF) + (20-24 Specialty Catheter) = 50 Specialty catheters are designed for specific purposes and can have from 20 to 24 or more electrodes. Examples of some of these catheters are the Reflexion Spiral (St. Jude) or the Halo (J&J). If you have any physicians that use the 64 electrode Basket Catheter (EPT) you should look at a system that offers around 120 channels. Note that you will rarely use all of the intracardiac channels available to you. There are, however, times you when the flexability of having this number of channels will make life in the EP Lab much easier.

 

The EP Lab would like to display images of various equipment used in EP Labs. If you have an image you would like to see in this section, please contact us by clicking on Submit Information .

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