Time, Staff, Problems and Costs

To assess time, staff, problems and costs involved in clinical electrophysiologic studies for documented or suspected tachycardia, 33 consecutive cases were analyzed prospectively. At least seven staff members were used for each study. Insertion of catheters required 24-105 minutes (mean 63 ± 20 minutes). Programmed stimulation required 12-210 minutes (mean 87 ± 38 minutes). Total fluoroscopy times were 6-67 minutes (mean 22 ± 15 minutes). Each study used 360-2100 feet (mean 1260 ± 390 feet) of recording paper. Detailed analysis of tracings took 1-11 hours (mean 5 ± 2.5 hours). Delays occurred during electrophysiologic study in 25 cases (76%), with multiple causes of delay in 14 cases (42%). These were caused by 1) difficulty in obtaining venous access (five patients); 2) difficult initial catheter placement (15 cases); 3) repositioning of catheters during stimulation (17 cases); 4) sustained atrial fibrillation (four cases). Coronary sinus catheterization was achieved from the groin in 21 of 27 cases (78%) in whom a sustained attempt was made. The approximate cost of each study was greater than $800. Our data show that clinical electrophysiologic studies in the investigation and management of tachycardia are difficult, time-consuming and expensive.