Anesthesia for electrophysiology procedures

Cardiac electrophysiologic (EP) procedures are becoming more frequent and complex. The addition of the anesthesia team to the EP lab improves efficiency and adds expert care in providing sedation, airway management, hemodynamic management, anticoagulation monitoring, and general anesthesia. The EP lab is usually located in a remote location away from the main operating rooms. This can create logistical challenges and requires the lab to be set up for anesthesia personnel like an operating room. Equipment creating barriers between anesthesia providers and the patient, such as fluoroscopes and EP monitors, and remotely-located backup personnel are potential problems. The various procedures performed on patients in the EP lab include cardioversions, device implantations, ablation of various arrhythmias, lead extractions, and hybrid procedures in collaboration with cardiac surgeons. Complications including arrhythmia, vascular injury, cardiac perforation, and pericardial tamponade are thankfully rare, but can be life-threatening. This review discusses the various procedures common in the EP lab, the anesthetic management of patients with varying degrees of heart disease and other comorbid diseases, and the unique requirements for managing these patients during procedures in which life-threatening complications can occasionally happen. Collectively, we believe that anesthesiologists are a critical component of an efficient and effective EP lab.