ELECTROPHYSIOLOGY

PE 01075 (10/12) 1 of 3 To view or print: https://www.healthsystem.virginia.edu/docs/per/ To order: http://www.virginia.edu/uvaprint/

ATRIAL FLUTTER ABLATION

PRE-PROCEDURE/POST PROCEDURE INSTRUCTIONS Before the procedure: Your healthcare provider might ask you to have bloodwork done before the procedure to make sure your electrolytes and blood count are normal.

Medication Instructions:

If you are taking a blood thinner, your provider may ask you to stop it a few days before the procedure. We often do these studies without holding the blood thinner, so be sure to clarify what your provider wants you to do.

You may be asked to hold one or more of your other heart rate and rhythmcontrolling drugs for a few days before the procedure. We may want these drugs to

wash out of your system so that we can start the abnormal heart rhythm.

If you take blood sugar control (diabetes) medications, you may be asked to hold a dose or take a smaller dose before the procedure

Other Instructions:

You will be asked to have nothing to eat or drink (including water) for 6-8 hours before the procedure. You are usually allowed to take your other medications with a small sip of water on the morning of your procedure, but check with your doctor.

You will be prepared for the procedure by the nursing team. This may include shaving of the groin or chest, and placement of several electrode (EKG monitoring) patches on

your chest and back. An IV (intravenous line) will be placed in your hand or arm to deliver fluids, pain and sedation medications, or certain heart during the procedure medications.

During the procedure: You will be taken into the EP lab (electrophysiology procedure room) which looks like an operating room and has special monitors and equipment which will be used to help your physician look at your heart.

Your heart rate, blood pressure and sedation level will be monitored by a team of nurses

and technicians throughout the procedure.

The areas of the skin where catheters (soft, small flexible tubes) are to be inserted will be numbed. Typically these catheters are inserted into the femoral vein on the right side (in the crease between your thigh and lower abdomen). Sometimes, you may need to have

catheters placed in the femoral veins on both the right and left leg. The numbing medicine may sting at first but this will quickly pass. You may feel pressure but no pain as the

catheters are inserted. The catheters are passed or advanced into your heart while the physician uses the special x-ray (fluoroscopy) to monitor the catheters progress and position.

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During your procedure we may use soft bands (called positioning devices or medical immobilizers) to protect you from moving your arms or legs into the sterile field. These bands also keep your arms close to your sides and/or keep you from bending your knees or hips. Accidental movements may interfere with your procedure and could result in bleeding

or increased chance of infection.

Drawing courtesy of the Heart Rhythm Society. www.hrsonline.orq. August 2009

You will be sedated (twilight sleep) but easily awakened. The physician will look for the

abnormal electrical circuit that is involved in atrial flutter. The doctor does this using special monitoring equipment which shows the electrical activity within your heart. The

arrhythmia may start on its own, or the physician may need to start it by using adrenaline type medications (speeds up the heart rate) or rapid pacing from the end of the catheter. You may be awake enough to feel your heart rhythm change, but you shouldnt feel any discomfort.

Once the doctor has identified where the atrial flutter circuit is (typically circling around a section of tissue near the tricuspid valve in the right atrium), he will deliver radiofrequency energy down the catheter which causes heating at the tip of the catheter. This will burn or

scar the tissue in that tiny area. You usually do not feel this but let the nurse know if you feel pain or discomfort.

Once the burns have been placed, the doctor will try to restart the atrial flutter to make sure that he successfully broke the abnormal circuit. If the atrial flutter can be restarted, he

may need to place another burn.

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After the procedure: Once the procedure is done, the doctor will remove the catheters form the veins. One of the physicians or nurses will hold pressure over the area where the

catheter was inserted while the opening begins to form a clot. This usually takes 10-20 minutes. You will continue to be monitored during this time.

Once you are fully awake, the nurses will take you back to your room to recover. A heart rhythm monitor will be applied again in the room for continued monitoring. You will need to

lie flat in bed for a few hours to prevent bleeding or oozing from the catheter insertion sites. You will then be allowed to sit up and walk around. Many patients are able to go

home the same day as the procedure if it was short and there were no complications. However, if you live far away or have had problems, the physician may decide to keep you overnight. You should make your family aware of this possibility.

Special Instructions:

You will be instructed about which of your medications you are to resume and if there are any NEW medications you are to start. Make sure you have your entire list (including any medications that you stopped for the procedure) so that you can review

them at the time of discharge.

Most patients who were in atrial flutter at the time of the ablation will need to stay on

an anticoagulation(blood thinning) medication for at least 4 weeks after the procedure.

Do not do any pushing, pulling or lifting more than 10 lbs for 2 days after the

procedure. You should take it easy for 3 days after the procedure.

You may take a bath after 2 days. A shower is fine on the day after procedure.

You may feel tired for a few days after the procedure. Some patients feel aching muscles in their arms, legs and back because they were lying in the same position for several hours.

You may also notice bruising in the areas where the catheters were inserted. If the bruises get larger or you notice bleeding or oozing after you go home, you should call your doctor. If you notice pain, numbness or tingling in your leg on the side where the catheters were

placed, you should call your physician. Most of these issues resolve over time by themselves.

We typically see all patients one month or so after a procedure.