Electrophysiology Study/Ablation Procedure Note

Date: [Procedure date] ([Start time] - [End time])

Location: [EP lab / cath lab / hybrid OR] ([Room number or identifier])

Patient: [Full name], [MRN], [DOB]

Primary Operator: [Name, credentials]

Secondary Operator(s): [Name(s), credentials] (List all assisting operators, or state "None" if solo procedure)

Referring Physician: [Name, credentials]

Anesthesia: [Local only / Moderate sedation / MAC / General anesthesia] — [Anesthesiology / Operator-directed / CRNA]

Pre-Procedure Diagnosis/Indication

[Presenting rhythm disorder and indication for procedure] (Include pertinent history affecting risk or strategy: prior ablations, structural heart disease, anticoagulation status, CIED presence.)

Post-Procedure Diagnosis

[Final electrophysiologic diagnosis and confirmed mechanism(s)] (If diagnosis remains uncertain, document focused differential and specify which findings were inconclusive.)

Procedures Performed

(Checklist format. If a planned procedure was aborted, list as "Attempted: [procedure] — [rationale]")

• [Diagnostic EP study / 3D electroanatomic mapping / Transseptal puncture / Intracardiac echocardiography / Catheter ablation (RF/cryo/PFA) / Cardioversion / Defibrillation]

Consent & Verification

[Informed consent obtained prior to sedation; risks, benefits, and alternatives discussed. Pre-procedure verification/time-out performed confirming patient identity, intended procedure(s), allergies, and equipment availability.]

Sedation & Medications

• Sedation/anesthesia: [Type], [Airway management: none / nasal cannula / LMA / ETT] (Reference anesthesia record for titration details.)
• Key intraprocedural medications:
  • [Sedatives/analgesics: agent(s) and total dose(s)]
  • [EP-relevant agents: isoproterenol dose/rate, adenosine dose, antiarrhythmics, cardioversion/defibrillation energy]
  • [Antibiotic prophylaxis: agent/dose, or "Not given" with rationale]
  • [Reversal agents: agent/dose and indication] (Include only if given)

Anticoagulation

• Pre-procedure: [Agent(s)], [continued / held], [last dose timing] (Include INR or anti-Xa if relevant.)
• Intraprocedural: [Agent], [bolus dose], [infusion details]
• ACT monitoring: [Target ACT], [Measured values with times] (Required for left-sided procedures. If recorded elsewhere, state location.)
• Reversal: [Not given / Protamine (dose) — rationale]

Access & Hemostasis

(List each access site separately.)

• [Vessel and side]: [Ultrasound / fluoroscopy / landmarks] guidance — [Sheath size(s) and purpose] — Hemostasis: [Manual compression / figure-of-eight suture / closure device (type)] — Restrictions: [Bedrest duration, ambulation instructions]

Equipment

• Diagnostic catheters: [Type(s), electrode configuration, position(s)]
• Ablation catheter: [Type/model], [irrigated / non-irrigated], [contact-force: yes/no]
• Mapping catheter: [Circular / HD grid / other], [size/model]
• Sheaths: [Deflectable / fixed], [sizes and types]
• Mapping system: [System name/version]
• Adjuncts: [ICE / esophageal temperature probe / phrenic pacing / coronary imaging] (List those used.)
• Device identifiers: [List here / Refer to inventory log]

Diagnostic EP Findings

• Baseline rhythm and intervals: [Rhythm], PR [ms], QRS [ms], QT/QTc [ms], AH [ms], HV [ms] (Include those assessed.)
• SA/AV node function: [Sinus node recovery time, AV nodal conduction properties] (Only if assessed.)
• CIED status: [Device type], [programming changes], [testing results] (Only if applicable.)
• Induction protocol: [Pacing sites], [drive trains/extrastimuli], [burst pacing], [pharmacologic provocation with doses]
• Induced arrhythmia(s): [Morphology], [cycle length], [hemodynamic tolerance], [termination method] (For each arrhythmia induced.)
• Key diagnostic maneuvers: [Entrainment responses, VA linking, PPI-TCL, His-refractory PVC response] with results supporting mechanism
• Limitations: [Noninducibility / hemodynamic instability / other] and impact on diagnostic certainty (Only if applicable.)

Mapping Findings

• Objective: [Activation / Substrate / Trigger / Pace mapping]
• Chamber(s) and rhythm during mapping: [Chamber(s)], [rhythm]
• Catheter/system settings: [Mapping catheter], [voltage thresholds, filters] (Include settings affecting interpretation.)
• Key findings: [Earliest activation site, critical isthmus, fractionated/late potentials, gaps in prior lines, proximity to AV node/phrenic nerve/esophagus]
• Limitations: [Instability / noninducibility / anatomic constraints] and alternative strategy used (Only if applicable.)

Ablation

(Organize by clinical problem/arrhythmia in order of priority. Repeat block for each problem addressed.)

[Arrhythmia/Problem]

• Target rationale: [Concise rationale linking diagnostic/mapping evidence to target]
• Lesion set: [Anatomic description of ablation approach, lines/regions treated]
• Parameters: (Include only modality used.)
  • RF: [Power (W)], [irrigation rate], [temperature limit], [contact force/lesion index targets], [lesion duration]
  • Cryo: [Balloon/catheter size], [freeze duration(s)], [nadir temperature], [time-to-isolation]
  • PFA: [Catheter type], [applications per region], [generator settings]
• Responses and safety monitoring: [Tachycardia termination during ablation, acute signal changes], [phrenic pacing results], [esophageal temperature monitoring], [coronary checks] (Include safety actions taken.)

Endpoints & Post-Ablation Testing

(For each treated arrhythmia, state endpoint and verification method. Do not state endpoints achieved without documenting how verified.)

[Arrhythmia/Problem]

• Primary endpoint: [Achieved / Not achieved] — [PVI entrance/exit block / CTI bidirectional block / SVT noninducibility / VT noninducibility / substrate endpoint]
• Verification method: [Circular catheter recordings / differential pacing / adenosine challenge / isoproterenol challenge / waiting period (duration) / PES protocol] with [results]
• If incomplete: [What remains incomplete], [reason: safety / instability / anatomic limitation], [contingency plan]

Complications & Radiation

• Complications: [No immediate complications. / Complication: (type) — (management) — (outcome)] (Explicit statement required. Consider: vascular injury, pericardial effusion/tamponade, heart block, phrenic injury, stroke/TIA, esophageal injury.)
• Radiation exposure: Fluoroscopy time [min], Air kerma [mGy], Dose-area product [mGy·cm²] (Note if high exposure with follow-up plan.)

Post-Procedure Status

[Hemodynamic status], [rhythm], [airway status]. Disposition: [Recovery / telemetry / ICU].

Post-Procedure Plan

• Monitoring: [Telemetry duration], [vital sign and access site check frequency], [ECG timing], [labs/echo if indicated]
• Activity: [Bedrest duration], [ambulation timing], [lifting/driving restrictions], [wound care]
• Medications: [Anticoagulation resumption timing and agent], [antiarrhythmic strategy: continue/discontinue, blanking period], [GI protection], [pain control]
• Red flags: [Chest pain, dyspnea, syncope, neurologic symptoms, groin swelling/bleeding, fever, dysphagia] — instruct patient to seek urgent evaluation
• Follow-up: [EP clinic timeframe], [ambulatory rhythm monitoring plan], [CIED interrogation schedule] (Include CIED follow-up only if applicable.)

(If commonly expected elements were not performed, document "Not performed" with reason rather than omitting. Do not imply normality by omission. Always explicitly document endpoint verification method and complication status.)