| **DO |
Take your medicines as usual, unless the doctor tells you
otherwise. Please inform our office if you are on warfarin/coumadin or
medications for your heart rhythm. |
| **DO |
Bring your medicines to the hospital. |
| **DO |
Bring any medical records or lab results that your personal
physician asks you to take to the doctors who will be performing
your electrophysiology study. Make sure your referring doctor has
sent copies of any cardiac studies you might have had, and ECG’s
of your arrhythmia (if available) to us at St Vincent's. |
| **DO |
Pack a small bag with personal toiletries if you like for your
hospital admission. |
| **DO |
Eat a regular supper the evening before your electrophysiology
study. |
| **DO NOT |
Eat or drink anything after 12:00 midnight, the night before
your test. Also, do not drink any water unless you need to take your
regular morning pills on the day of the procedure, but take your
pills with only a sip of water enough to swallow them. You may brush
your teeth and rinse your mouth the morning of the procedure. |
| **DO NOT |
Bring large sums of money or valuables to the hospital unless
family or friends coming with you will hold them during the
electrophysiology study. |
Commonly
Asked Questions
1. Since this is a teaching
hospital, who will be doing my procedure?
2.
Will the Electrophysiology Study and Catheter Ablation procedure be
performed at the same time?
3. How many
Electrophysiology Studies and Catheter Ablation procedures have you
done?
4. Will the procedure hurt?
5.
Is the electrophysiology study and catheter ablation procedure safe?
6.
How long is the procedure?
7. Why does a
catheter need to go in my neck?
8. How long
will I need to stay in the hospital?
9.
When can I resume my normal activities?
10.
When can I go back to work?
11. Will I
come back here for follow-up?
1. Since this is a teaching
hospital, who will be doing my procedure?
During your
electrophysiology study and procedure, catheters may be placed by one of the Electrophysiologists or one of our
Electrophysiology fellows, who are cardiologists that are specializing
in Electrophysiology, the electrical conduction system of the heart. If the Fellow is placing the catheters, the
Electrophysiologist, whom you have
scheduled to do the procedure with, is at the control station- viewing
and directing the placement of the catheters on our X-Ray screen,
stimulating and diagnosing your abnormal heart rhythm, locating the
exact spot where your abnormal rhythm is coming from and directing where
radiofrequency energy should be applied to "cure" you of your
abnormal heart rhythm. There will also be two electrophysiology lab
nurses and technicians to provide care and comfort to you during the
procedure.
2. Will the
Electrophysiology Study and Catheter Ablation procedure be performed
at the same time?
Yes, the Electrophysiology Study and
Catheter Ablation procedure will be performed during the same session.
Once we locate exactly where your abnormal rhythm is located by the
Electrophysiology Study, we will ususally apply radiofrequency energy to this
area during the Radiofrequency Catheter Ablation procedure. We wouldn't
want to put you through two different procedures when it can all be done
at one time.
3. How many Electrophysiology
Studies and Catheter Ablation procedures have you done?
We perform around 250 electrophysiology studies and 200 pacemakers annually; and have performed over 400 catheter ablation
procedures.
4. Will the procedure hurt?
You
may feel minor discomforts during the Electrophysiology Study and
Catheter Ablation Procedure from lying flat on our X-Ray table, or
from the injection of the numbing medicine where catheters will be
placed, or intermittently feel your heart racing when the doctors try
to induce your abnormal heart rhythm. But through most of the
procedure, you should be sound asleep. To minimize any discomforts
during the procedure, you will be given short acting sedatives to make
you calm and sleepy throughout the procedure.
5. Is the electrophysiology
study and catheter ablation procedure safe?
Yes, the
electrophysiology study and catheter ablation procedure are relatively
safe. With any procedure, there are potential risks. The risks will be
fully covered by our physicians before you have your electrophysiology
study and catheter ablation procedure. The electrophysiology
study and
catheter ablation procedure are generally safe.
6. How long is the procedure?
During the Electrophysiology Study and Radiofrequency
Catheter Ablation Procedure, you will be in our EP lab for 3 to 6
hours. Please let your family and friends know the length of the
procedure time so that they do not worry.
7. Why does a catheter need to
go in my neck?
There are two large vessels that enter
the right side of the heart where the catheters are placed. The
catheter placed at the neck site will enter from the top of the heart
and that from the groin will enter the bottom. By allowing the
catheters to enter the heart from two directions, it allows your
doctor to maneuver the catheters in different directions to locate
where your abnormal rhythm is coming from and to ablate it.
Once
the catheters are removed from the neck and groin site, you will have
a very tiny hole, looking very much like an "insect bite". The
site should not leave a scar and there are no sutures to be removed.
8. How long will I need to stay
in the hospital?
For the Electrophysiology Study and
Catheter Ablation procedure, you will be able to go home the same day
or the next day, around 9:30 to 10:30 A.M.
9. When can I resume my normal
activities?
You can resume your normal daily activities
(walking, bathing, showering, etc.) upon discharge from hospital
unless instructed differently. The only restriction is straining or
lifting heavy objects more than 10 pounds for a few days so that the
incision site can heal.
10. When can I go back to
work?
Unless your job requires you to lift heavy
objects, you can return to work in a day or two.
11. Will I come back here for
follow-up?
Upon discharge from the hospital, you will
receive specific follow-up instructions by our Electrophysiology team.
Our physicians will write a detailed letter, describing your hospital
stay and treatment, to your personal physician. We suggest that you
see your personal physician in 2 to 4 weeks.
The
Electrophysiology Study
Before
the procedure:
Final preparations for the procedure include:
- For your comfort, empty your bladder as
completely as possible before the study starts (a bedpan or urinal
will be available during the procedure);
- A small intravenous needle ("IV line")
will be inserted into a vein in your arm, for drugs to be injected
if necessary.
The EP study is performed in the
electrophysiology laboratory of the hospital, where you will be placed
on an x-ray table. A camera and television screens will be close by,
as will heart monitors and various instruments. You will be connected
to monitors with electrodes and gelatin patches. A blood pressure cuff
will be put onto your upper arm so that we may monitor your blood
pressure frequently.
A nurse will shave and cleanse the area where
the catheters will be inserted (the groin and/or neck) to protect
against infection. The area will be cleansed with an orange-brown,
sticky antiseptic. Sterile sheets will he draped over your body. It is
important you find a comfortable position so that once the study
begins, you will not touch the sterile working area.
During the
study you may be given some sedative medications by intravenous
infusion to make you sleepy. This will serve to reduce your anxiety
and relieve your discomfort. In addition, a local anesthetic will be
given with a tiny needle to numb the area where the catheters are
placed. You'll feel a pinprick and possibly a stinging sensation from
the anesthetic for just a few seconds.
| One or more catheters (thin, long, flexible
wires) will be inserted into a large vein in your groin and/or neck,
and advanced to your heart. The positioning of catheters inside your
heart will be monitored on a screen. You may feel pressure when the
catheters are inserted but no other discomfort. The incision site is
less than a quarter-inch and should not leave a scar after it heals. |
 |
There are two
parts to the EP study:
- recording the heart's electrical signals to
assess the electrical function;
- and pacing the heart to bring on certain
abnormal rhythms for observation under controlled conditions.
Medications are sometimes used to stimulate your
arrhythmia, so you may feel your heart racing or pounding. This may
make you anxious, but you needn't be alarmed. The doctors want to
induce the abnormal rhythm causing your problem, so that they can
treat the arrhythmia. If you have any uncomfortable symptoms -- chest
pain, dizziness, shortness of breath, nausea or pain -- tell your
nurse or doctor.
Your Role During the
Study
The EP study should not cause you any pain. It
is important that you stay calm and relaxed, and not move your arms or
legs in the sterile working area. If you feel any discomfort, let your
doctors or nurses know, so they can help you get comfortable.
In
the controlled condition of the EP laboratory, induced arrhythmias are
handled by well-trained personnel with state-of-the-art equipment.
And, perhaps most importantly, the doctor uses the information
gathered from the induced arrhythmia to prevent future occurrences.
After the Study: The
Recovery
- The catheters will be removed and pressure
applied to the groin and/or neck to prevent bleeding.
- You will lie still in bed for four to six
hours to allow the site of the catheter to seal. You must not move
or bend your leg.
- You will be checked frequently, but if you
feel sudden pain or see bleeding at the site, you will be asked to
call the nurse immediately.
- You may be able to discuss some of the
preliminary findings with your doctor after the test.
- You may he able to eat or drink if you feel
well enough.
Before discharge, your doctor or nurse will instruct you about restrictions to normal
activities, medications and follow-up care.
After the Study: At
Home
- Limit your activity for the first 24 hours.
Don't strain or lift heavy objects more than 10 kg for the first
week.
- If traveling home takes a long time, stop
every hour and stretch your legs -- walk a few minutes to prevent
formation of blood clots in your legs.
- Press firmly on the incision site for about
20 minutes, if you notice new blood on the dressing. If bleeding
continues, call your doctor or go to the nearest emergency room
while still applying pressure.
- Leave the dressing on until the day after the
study; your nurse will show you how to remove it.
Don't worry if you see a bruise or small lump
under the skin at the insertion site; it will disappear within three
to four weeks.
Call your doctor or the arrhythmia
nurse coordinator:
- if the site becomes painful or warm to the
touch
- if you have chest pain, palpitations,
shortness of breath, lightheadedness or fever.
Treatments
Depending on the type and severity of your
arrhythmia, and the results of various tests including the EP study,
there are several treatment options. You and your doctor will decide
which one is right for you.
Medications
Certain anti-arrhythmic drugs change the
electrical signals in the heart and help prevent abnormal sites from
starting irregular or rapid heart rhythms.
Follow-up EP
Study
To make sure the medication is working properly
after two or more days in the hospital, you may be brought back to the
EP laboratory for a follow-up study. Our goal is to find the drug that
works best for you.
Artificial
Pacemaker
Implanted inside the body, ready to pace the
heart, this device is used to treat very slow heart rhythms. A pulse
generator is implanted beneath the skin below the collarbone; a pacing
wire connects the pulse generator to the heart and carries electrical
impulses.
Information about pacemakers and aftercare
Catheter
Ablation
Radiofrequency
catheter ablation destroys or disrupts parts of the electrical
pathways causing the arrhythmias, providing relief for patients who
may not have responded well to medications, or for whatever reason
would rather not or cannot take medications. This technique has a high
percentage of successfully "curing" many types of
arrhythmias.
Radiofrequency catheters are positioned close to the
abnormal electrical pathway and high frequency current is passed
through them. The tip of the catheter - about the size of a pencil
eraser - ablates (destroys) the site of the abnormal pathway using
radio waves. Since scar tissue cannot transmit electrical impulses,
after ablation, the heartbeat will only follow the normal electrical
pathway. The ablation causes a very small scar or blemish within the
heart and will not interfere with the normal conduction or normal
function of the heart.
The radiofrequency catheter is a thin,
flexible wire that can be externally steered to pace, monitor and
locate the site of the arrhythmia. The catheter is placed in the heart
using x-ray guidance and sometimes using sound waves (ultrasound
catheter imaging). The ablation catheter can also record the
temperature where the catheter tip touches the heart wall when
ablating or destroying the abnormal heart rhythm.
Internal
Cardioversion
Internal cardioversion for conversion of atrial
fibrillation and atrial flutter to a normal sinus rhythm was developed
in 1991. Internal cardioversion is low energy electrical
shock (1 to 10 joules) delivered internally in the heart through two
catheters inserted in a vein in the groin and a small electrode pad
applied to the chest. This procedure is performed in the
Electrophysiology lab by our Electrophysiologist.
During the
internal cardioversion, the patient is given short acting sedatives to
make them sleepy. Currently, atrial flutter is successfully "cured"
by radiofrequency catheter ablation; but treatment to restore atrial
fibrillation to sinus rhythm has been the traditional use of
medications and external cardioversion. External cardioversion is
deliverance of high energy shocks of 50 to 300 joules through two
defibrillator pads attached to the chest. In some cases, external
cardioversion has failed because the electrical current has to first
travel through muscle and skeletal structures of the chest before
reaching the heart. Internal cardioversion has been performed when
medications and external cardioversion have failed to restore a
patient's rhythm back to a normal sinus rhythm.
With internal
cardioversion, the success rate of converting a patient from atrial
fibrillation to normal sinus rhythm has been 95%. The shorter time a
patient is in atrial fibrillation, the easier it is to cardiovert a
patient back to a normal rhythm, but we have found that even patients
with long-standing history of chronic atrial fibrillation can be
successfully converted to a normal rhythm through internal
cardioversion.
Implantable
Cardioverter-Defibrillator
For people who have had life-threatening rapid
heart rhythms, an implantable cardioverter-defibrillator (ICD)
delivers an electric shock to the heart when necessary. Like
pacemakers, only larger, ICDs are usually implanted beneath the skin
below the collarbone.
