Procedure technique & setup.

Catheter-based pulmonary vein isolation to eliminate AF triggers. Energy options include pulsed field, radiofrequency, and cryoballoon; PVI is the foundation, with adjunctive lesions reserved for persistent disease.

Catheter ablation of the cavotricuspid isthmus to interrupt the typical right atrial flutter circuit. High success, short procedure, low complication rate.

Catheter ablation of the AV node to produce complete heart block in patients with refractory atrial tachyarrhythmias who already have (or will receive) a ventricular pacing system. A short, high-yield procedure with a predictable workflow.

Non-thermal ablation using irreversible electroporation. Tissue selectivity spares the esophagus, phrenic nerve, and vessels — reshaping AF ablation and expanding into flutter and VT.

Catheter ablation of AVNRT, AVRT, or focal atrial tachycardia. Diagnostic EP study identifies the mechanism, ablation targets the critical substrate. High success, low complication rate.

Substrate and activation-based catheter ablation of ventricular tachycardia. Strategy varies by substrate — idiopathic outflow tract VT differs fundamentally from scar-mediated VT in ischemic cardiomyopathy.

Cardiac resynchronization therapy implant — adds an LV lead through the coronary sinus to a standard pacemaker (CRT-P) or ICD (CRT-D) to restore biventricular synchrony in heart failure with conduction delay.

Transvenous ICD implantation for primary or secondary prevention of sudden cardiac death. Workflow mirrors a pacemaker but with a high-voltage lead in the RV and tailored programming to minimize inappropriate shocks.

Removal of chronically implanted pacing/defibrillator leads using locking stylets and powered sheaths. Indicated mainly for infection and lead failure; SVC laceration is the feared complication and demands surgical backup.

Standard transvenous pacemaker implantation — single- or dual-chamber — performed in the EP lab with venous access, lead placement under fluoroscopy, generator pocket creation, and intraoperative parameter testing.

Diagnostic electrophysiology study to characterize sinus node function, AV conduction, accessory pathways, and inducible arrhythmias. Foundation case for the lab — every fellow does dozens before they ablate.

Synchronized direct-current shock to restore sinus rhythm in AF, flutter, and organized tachycardias. The procedure is quick; the anticoagulation and synchronization details are where safety lives.