Understanding Atrial Fibrillation · È UNDERSTANDING ATRIAL FIBRILLATION CARDIAC CATHETER ABLATION Cardiac ablation is a relatively non-invasive procedure that involves inserting

UnderstandingAtrial FibrillationDiagnosis, managementand follow-up

Cardiovascular Center

CONTENTS

! "#$%&'(#(

) *$+,#$- *$./0.0+ 123$.#'&

4 5/$. .' 6780-. 9+#'+ .' :';+ *$+,#$- 123$.#'&

<= 9+08$+#&% >'+ :';+ *$./0.0+ 123$.#'& 9+'-0,;+0

<! ?/0 *$./0.0+ 123$.#'& 9+'-0((

<) 5/$. .' 6780-. 1>.0+ :';+ *$+,#$- 123$.#'&

<4 @'33'A-B8 *$+0

C< *'&.$-. BD

UnderstandingAtrial Fibrillation

UNIVERSITY OF UTAH HEALTH CARE / CARDIOVASCULAR CENTER

* 4 * * 5 *

UNDERSTANDING ATRIAL FIBRILLATIONÈ

!e following information is intended to help you better understand the diagnosis and treatment for atrial "brillation. It is important to read through all of the information carefully and discuss any further questions you may have with your doctor.

DIAGNOSIS

5/$. #( 1.+#$3 @#2+#33$.#'&E Atrial !brillation (also called AF or A Fib) is a common heart rhythm dis-order caused by an electrical system problem in the upper chambers (atria) of the heart. Cells in the atria send out extra electrical signals. "ese extra signals make the atria beat very quickly and unevenly.

When this happens, the atria beat so fast and unevenly that they may quiver instead of contract. If the atria don’t contract, they don’t move enough blood into the bottom portion of the heart (ventricle).

Atrial !brillation is a serious condition since it a#ects the heart’s ability to

!ll with blood normally. However, with treatment and close monitoring, it can be controlled.

Atrial !brillation may occur from time-to-time, or may be constant. More than $ million people in the U.S. have A Fib, and about %&',''' new cases are diagnosed each year.

5/$. $+0 ./0 DFG8.'G( '> 1.+#$3 @#2+#33$.#'&ECommon symptoms include palpitations (a (uttering heartbeat), dizzi-ness, weakness or tiredness, chest pain or tightness, or shortness of breath.

5/$. -$;(0( 1.+#$3 @#2+#33$.#'&E Many times the cause of atrial !brillation is unknown but possible risk factors include:

heart


* 6 * * 7 *


5/$. "'0( $ "#$%&'(#( '> 1.+#$3 @#2+#33$.#'& H0$&E If you are diagnosed with A Fib, you could have an increased risk of:

Stroke

to force open the heart valves that pass blood from the atrium to the ventricle. Blood that isn’t kept moving can pool and form clots in the atria. "ese clots can move into other parts of the body and cause serious problems, such as a stroke.

Heart Failure or Heart Muscle Disease Atrial !brillation is associated with a decline in heart function and wors-ening of heart failure symptoms. Sometimes A Fib can damage the heart muscle and change the normal electrical signals to the heart.

?+0$.G0&. >'+ 1.+#$3 @#2+#33$.#'& Multiple treatments for atrial !brillation work together to prevent blood clots from forming, control heart rate and restore a normal heart rhythm. "e goal of treatment is to reduce the risk of stroke and heart failure as well as to improve the quality of life.

Treatment Includes: !"##$-%&'(('() *+$',-%'#(. Warfarin (Coumadin®) is com-mon. Taking Coumadin® thins your blood and prevents blood clots from forming.

.+-/% /-%+ *+$',-%'#(. Medications can work to either restore normal heart rhythm or control heart rate by reducing the number of electrical signals transmitted to the heart. "e heart is then able to pump more e)ciently.

0'1+2%3"+ *#$'1',-%'#(2.ca#eine, tobacco or alcohol can cause arrhythmias. Your physician may ask you to stop taking/using substances believed to be causing the problem.

4-/$'#5+/2'#(. "is procedure at-tempts to restore normal heart rhythm by sending a perfectly timed electri-cal shock to the heart, causing all the heart cells to contract at once. All electrical activity in the heart stops for a brief moment. When it resumes the normal heart rhythm is restored.

4-/$'-, 4-%&+%+/ 67"-%'#(.

(destroy) small areas of heart tissue that contain irregular electrical pathways. In this procedure, doctors direct a catheter, a thin tube, through blood vessels toward the heart and close to the area containing the abnormal pathway. Heat energy is then passed through it, heating the tip of the catheter and destroying the small area of tissue.


* 8 * * 9 *


CARDIACCATHETER ABLATION

Cardiac ablation is a relatively non-invasive procedure that involves inserting catheters into a blood vessel, o*en through a site in the groin or neck, and threading the wire up

to ablate (destroy) small areas of heart tissue that contain irregular electrical pathways.

In this procedure, the catheter is directed toward the heart and close to the area containing the abnormal pathway. Once the damaged site is con!rmed, energy is used to destroy a small amount of tissue, ending the disturbance of electrical (ow through the heart and restoring a healthy heart rhythm.

If you have been diagnosed with atrial !bril-lation and your physician has recommended a cardiac ablation procedure as treatment, there are several steps to the ablation process

any questions you may have about the pro-cedure with your physician.

WHAT TO EXPECT PRIOR TO YOUR CARDIAC ABLATION

I( ?0(.#&% 9+#'+ .' HF 123$.#'& J0K;#+0,ESome testing may be required prior to your ablation procedure. Your doctor will let you know which tests you will need, if any. Testing require-ments will vary for each patient.

Tests that may be needed include:

5/$. #( $ *$+,#$- H$%&0.#- J0('&$&-0 IG$%#&% (HJI)E

detailed images of your organs and tissues with the use of radio waves

your heart, especially in your le* upper chamber (atrium). It provides us with baseline images prior to the procedure, as well as ruling out post-

pulmonary vein anatomy and the percentage of scarring in the le* atrium.

9+#'+ .' HJI


* 10 * * 11 *


notify your ordering physician. You will need a %+-hour medication

notify your ordering physician.

";+#&% HJI

you as comfortable as possible by placing a cushion under your knees and providing a ball you can squeeze in your hand to alert the tech.

instructions on breathing during certain parts of the scan (breath in, breath out, and hold).

1>.0+ HJI

for your ablation.

If your ordering physician determines you are unable to have a cardiac

which is also a non-invasive, painless test.

5/$. #( $ ?+$&(0('8/$%0$3 6-/'-$+,#'%+$8/F (?66)E

a test that allows your doctor to record im-ages of your heart from inside your esopha-gus, or food pipe. "is test is done to look for blood clots in your heart and needs to be

-dure. If there is a clot found in your heart, your ablation procedure will be rescheduled. Allow one to two hours from your arrival to the time you can leave.

L0>'+0 :';+ ?66

and ask if it’s OK to take them before the test.

the test. "is includes water.

hiatal hernia, or problems swallowing. Also, let him or her know of any aller-gies to any medications or sedatives.

home a*er the exam.

";+#&% :';+ ?66

will change into a hospital gown, and then be taken to the testing room.


* 12 * * 13 *


anesthetic to numb it. You may be given a mild sedative through an

help you relax. You may also be given oxygen. "en you’ll be asked to lie on your le* side.

into your mouth. As you swallow, the tube is slowly guided into your esophagus. "e tube is lubricated to help it slide easily.

probe, but it shouldn’t hurt or interfere with your breathing. A nurse monitors your heart rate, blood pressure, and breathing. "e test usually takes

1>.0+ ./0 ?0(.

ablation procedure, you can eat and drink again when your throat is no longer numb.

to drive you home a*er the test is complete.

PREPARING FOR YOUR CATHETERABLATION PROCEDURE

5/$. "' I M00, .' "' ./0 M#%/. L0>'+0 $&, ./0 "$F '> HF 123$.#'& 9+'-0,;+0E

Ne Night Before

your ablation.

Ne Day Of

with a small sip of water.

to store them in.

5/$. "' I M00, .' L+#&% ./0 "$F '> HF 123$.#'&E

"e list should include the drug name, the dose and how o*en you take it.


* 14 * * 15 *


THE CATHETER ABLATION PROCESS

What can I expect the day of my procedure?

O0..#&% D.$+.0,

provide medications and (uids that you will need during the procedure.

be placed in your bladder to drain urine during the procedure and in recovery.

"e groin area and neck will be shaved as needed to place the catheters (narrow, (exible wires). We will also be placing multiple patches on your chest and back to monitor your heart rhythm.

From here, you will be moved into the procedure room and moved to an x-ray table. "e room will be cold but we will do everything possible to make you comfortable and place some warm blankets over you to keep you warm.

"e patches on your chest and back will be connected to a machine. We will also monitor your blood pressure and oxygen level.

To keep the catheter insertion sites sterile, your body will be covered with a sterile drape and another will rest on your head, allowing you to still see the nurse. Only the area where the catheters are inserted is exposed.

keep you comfortable. You will be sleepy but not unconscious.

?/0 9+'-0,;+0"e doctor will use several catheters to start your arrhythmia to create an electri-cal map of the heart. "is map helps the doctor identify what type of arrhythmia you have and where the problem is so they can locate and ablate, or destroy, the prob-lem cells. A*er ablating the problem cells with energy, the doctor tries to start your arrhythmia again. If a fast, irregular rhythm can’t be started, ablation was successful. If an irregular rhythm starts again, more abla-tion is needed.

I&(0+.#&% ./0 *$./0.0+("e skin where the catheters will be in-serted is numbed with a local anesthetic so you won’t feel pain, although you will feel pressure. A small needle is used to make punctures in your veins or artery. If at any time you feel pain in the groin area, let the

more numbing medicine.

Multiple catheters are then inserted through these puncture sites and guided to the heart with the help of x-ray monitors. Two catheters, the mapping catheter and ablation catheter, are placed in the right


* 16 * * 17 *


femoral vein. "e mapping catheter locates where the abnormal signals are coming from

system so we can identify the locations that need to be ablated. "e ablation catheter is used to deliver the radiofrequency energy to create lesions, disrupting the abnormal sig-nals. You may feel some discomfort during this part of the ablation.

One catheter, the intracardiac echo, is placed in the le* femoral vein and one catheter is placed in the neck. "e intracar-diac echocardiography is a special viewing device used to view the le* atrium using ultrasound during the procedure. "e total ablation procedure takes two to six hours.

not to move or take deep breaths while the doctor is ablating. "is is important to en-sure we are ablating the appropriate areas.

1>.0+ :';+ 9+'-0,;+0When the procedure is !nished, all the catheters will be withdrawn and pressure will be applied to the insertion sites. You will need to remain still for four to six hours to ensure that the bleeding has stopped and the incisions are healing properly.

A*er your procedure, you will be admitted to the hospital overnight. You will need to stay in the hospital for at least $+ hours a*er the procedure for observation.

Your doctor may give you a prescription before you leave the hospital. You may !ll prescriptions at your regular pharmacy or the hospital pharmacy. If you would like to !ll your prescriptions at the hospital, please remember to have your insurance card(s) with you as well as some form of payment.

123$.#'& J#(P(Although the risks of catheter ablation are fairly low, it is important to discuss the possibilities with your doctor before the procedure.

Such risks include esophageal !stula, perforation, bleeding, stroke, pulmonary vein narrowing, groin complications and pneumothorax.

procedure will help us monitor and evaluate in(ammation (swelling) and can rule out esophageal !stula.


* 18 * * 19 *


WHAT TO EXPECT AFTER YOURCARDIAC ABLATION

5/$. 1+0 *'GG'& DFG8.'G( 1>.0+ 123$.#'&E"e ablated tissue takes approximately six to eight weeks to heal and ar-

unusual to require anti-arrhythmic medications or other treatment. You may experience the following symptoms:

5/0& D/';3, I *'&.$-. HF "'-.'+EContact your doctor if you experience any of the following:

insertion site.

5#33 I Q$R0 1&F 1-.#R#.F J0(.+#-.#'&( 1>.0+ HF 123$.#'&EActivity Guidelines:

(A gallon of milk is about %' pounds).

FOLLOW-UP CARE

A*er your procedure, your doctor needs to see you in three months, six months and one year for follow-up appointments.

5/$. *$& I 6780-. $. HF ?/+00-H'&./ 188'#&.G0&.EBefore this appointment, you will need to

Preventive Cardiology will set up these appointments for you before you are dis-charged from the hospital.

holter monitor.

5/$. *$& I 6780-. $. HF D#7-H'&./ $&, S&0 :0$+ 188'#&.G0&.(E


* 20 * * 21 *


5/$. #( $& 6#%/.-"$F Q'3.0+ H'&#.'+E At your three month, six month and one year follow up appointments, you will be given an eight-day holter monitor. "is will monitor episodes of atrial !brillation a*er the heart tissue has healed. It will continuously record for eight days and must be worn at all times except when showering.

A*er returning the monitor, your results will be ready in about two to

your doctor may decide to stop your Coumadin®.

5/$. #( $& 6R0&. H'&#.'+EBefore you leave the hospital, you will be given a cardiac event monitor

this monitor for &' days to monitor your heart while you are healing. It is designed to monitor and record any abnormal heart rhythms and has a button you can push to manually record your heart rhythm if you feel anything unusual. You will then send these recordings via phone to the monitor company who will put the recordings onto a secure website for your doctor to monitor. If your doctor sees any abnormal reports he will contact you. You will have three responsibilities while wearing an event monitor:

every other day. Keep the monitor on at all times except when you

company, if you need more stickers. "eir phone number is

You may also need to push the button to manually record your heart

rhythm if your monitor has not recorded automatically.

+. Transmit all recordings by phone (you must use a land line, cell

at least two to three times per week, even if your monitor has not recorded automatically.

"e monitor will be explained to you in detail before you leave the hospi-tal. At the end of &' days, you will mail your monitor back to the distribu-tion center (an envelope will be provided for you).

CONTACT US:

Cardiovascular Center University of Utah Hospital

O0..#&% .' ./0 Q'(8#.$3

From the Salt Lake International Airport: Take eastbound I-,' to the &'' South exit. "e exit will put you on eastbound &'' South. Follow

Turn right and proceed east on %'' South for two miles. When you reach

University of Utah Hospital.


* 22 * * 23 *


From I-<T northbound: Take the &'' South exit and go east. Follow &''

right and proceed east on %'' South for two miles. When you reach the

-sity of Utah Hospital. From I-<T southbound:

Turn le* and proceed northbound to %'' South. Turn right and proceed east on %'' South for two miles. When you reach the University of Utah

For maps, visit: http://healthcare.utah.edu/hospital

Notes


* 24 *

Cardiovascular Center30 N. 1900 E., Room 4A100Salt Lake City, Utah 84132(801) 587-5888

healthcare.utah.edu/cardiovascular

Documents

Understanding Atrial Fibrillation · È UNDERSTANDING ATRIAL FIBRILLATION CARDIAC CATHETER ABLATION Cardiac ablation is a relatively non-invasive procedure that involves inserting