Heart Rhythm Procedures
Overview
Heart rhythm procedures are commonly referred to as Electrophysiology studies (EPS), catheter ablations or just ablations.
Heart rhythm procedures focus the investigation on the electrical activity of your heart, or simply, how and why your heart is pumping abnormally. The Doctor will try to replicate the abnormal rhythm, or arrhythmia you are experiencing, to see how they are best able to treat and minimise your symptoms or progression of disease. Your heart will be put through thorough testing via cardiac catheters, computers and advanced mapping technology.
The cardiac catheters are inserted into your heart via a vessel in your groin. Sometimes, we cannot replicate your arrhythmia, however if we do, a decision will be made whether you undergo an ablation. An ablation involves eradicating the abnormal electrical activity via heat or extreme cold, with the aim of returning your heart back to normal rhythm.
Why do I need to have a Heart Rhythm procedure?
The heart has four chambers, the upper two chambers (atria) and the lower chambers (ventricles). The atria and ventricles operate in coordinated fashion to pump blood to the lungs for oxygenation and then to the rest of the body to be used by organs or muscles. An electrical impulse in the atria initiates a heartbeat that creates a heartbeat.
Sometimes, the electrical impulses of the heart can become abnormal, irregular, sporadic or chaotic. This means your heart no longer pumps in a coordinated fashion, and your body becomes compromised. An ablation will aim to return your heart back to normal rhythm.
Prior to a heart rhythm procedure, it is likely you would have a 24-hour holter monitor, heart bug or an ECG to capture your abnormal rhythm. These tests give the Doctor clues to what abnormal heart rhythm you may be experiencing.
Types of Heart Rhythm Procedures
Diagnostic
Sometimes, a 24-hour holter monitor, heart bug or ECG do not capture the abnormal rhythm. A diagnostic procedure replicates what your heart would experience with high intensity exercise, caffeine or under stress, to challenge your electrical system and diagnose the type of arrhythmia you are experiencing. The Doctor will speed up your heart and test the electrical circuit of your heart via specific manoeuvres. You will be under sedation for this procedure. Sometimes your doctor will administer a medication during the procedure to help uncover the nature of your heart rhythm problem. This can make you feel like you’ve had a strong cup of coffee.
Supraventricular Tachycardia (SVT) ablation
Tachycardia refers to a fast heart rate and supraventricular means the atria, or above the ventricles. There are multiple types of SVT, therefore the Doctor will test and challenge your electrical system, which will enable a diagnosis to occur. SVT can originate from an abnormal electrical connection or channels, either within the atria or between the atria and the ventricles. These connections allow electrical activity to occur abnormally, in addition to the normal electrical circuit.
The extra channels can override the normal electrical system and allow the heart to pump too fast, which is often experienced by palpitations and shortness of breath.
The Doctor will gain access to your heart via a vessel in your groin and place numerous catheters (recording devices) into specific places within your heart. Thorough testing of your electrical system will now occur. If the tests confirm you have a type of SVT, your Doctor, through the use of technology and computers, will find where the SVT originates from and ablate (heat) the tissue to eradicate the “short” circuit, so the SVT can no longer be electrically activated. You will be under sedation for this procedure.
Atrial Flutter ablation
Atrial Flutter is most commonly observed in the right atria, although it can occur in the left atria. Atrial flutter is an abnormally fast rhythm that causes the atria to beat faster, often two to four times faster than the ventricles. A flutter can be visualised like a roundabout, where the car drives very fast around the roundabout without ever exiting. The Doctor will gain access to your heart via a vessel in your groin and place numerous catheters (recording devices) into specific places within your heart. Through the use of technology, computers and cardiac catheters, they will find where the flutter originates from and ablate (heat) the tissue to eradicate the “short” circuit, so the flutter can no longer be electrically activated. You will be under sedation for this procedure. Procedure times are 1-2 hours.
Atrial Fibrillation ablation (AF)
Atrial fibrillation (AF) can be described as a chaotic, irregular heart rhythm, where the atria are fibrillating or quivering, rather than pumping effectively. Therefore, the blood is not effectively being pumped out of the heart to the body. Stagnant blood can cause the formation of clots, which can travel to the brain or the heart and cause a stroke or heart attack.
AF can be experienced in many different ways. Sometimes it can come and go multiple times throughout the day, lasting a few minutes up to hours, other times it is permanently present. Often, patients will feel short of breath when they are in AF.
AF can be treated with medication or via catheter ablation. Catheter ablation procedure times can vary from 2 hours to 5 hours.
It is likely advanced technology and computer systems will be used for this procedure to create a 3D image of your heart in real time. The Doctor will either freeze or heat areas of the left atria muscle to electrically isolate the tissue, to make the heart muscle inert to chaotic electrical signals.
You may require multiple procedures to treat your AF, all of which require a general anaesthetic.
Ventricular Ectopic beats ablation
Ventricular Ectopic beats are abnormal beats that originate from the lower chambers; the ventricles. These abnormal beats can occur either occasionally (sporadic), or more frequently such as every second beat (bigeminy) or every third beat (trigeminy).
Caffeine, tobacco, stress and alcohol can increase the number of ectopic beats, with patients describing symptoms of pounding, fluttering and increased awareness of their heart beating.
Often, a 24-hour holter monitor device is requested to show how often you get the abnormal beats in comparison to normal beats (burden). If there is a large burden of abnormal beats, you may require an ablation. Your Doctor, through the use of technology and computers, will find where the ectopic beat originates from and ablate (heat) the tissue to eradicate the “short” circuit, so the ectopic can no longer be electrically activated. You will be under sedation for this procedure. Procedure times are 1-3 hours.
Risks associated with heart rhythm procedures
Heart rhythm procedures are safe and risks are low. There is a 1-6% risk of complications and these include:
- Bleeding or infection
- Blood vessel damage
- Blood clots; DVT or thrombosis
- Stroke
- Heart attack/ Myocardial Infarction (MI)
- Perforation
- Need for a pacemaker
- Neurovascular Injury
The most common risk is a small bruise in the groin. This is usually not serious and doesn’t get in the way of your recovery.
Prior to your heart rhythm procedure
- Fill in paperwork required for admission into Hospital
- You may have to stop taking certain medications prior to your procedure. Please speak to your Doctor to see if this is relevant for you. Some examples include aspirin, clopidogrel, apixaban, rivaroxaban, dabigatran and warfarin. Your doctor may also ask you to stop certain medicines that control your heart rhythm so that their effects don’t mask the diagnosis of your heart rhythm problem in the lab.
- Continue to take all other medications as normal. If you take medication for diabetes, ask your doctor before stopping or skipping these.
- Fast 12 hours prior to your procedure
- The Hospital administration team will contact you to confirm a time and date for your procedure and what time to come to the Hospital.
On the day of your heart rhythm procedure
- Remain fasting
- Arrive at the Hospital and go through to admissions
- You will meet Nurses, your Anaesthetist and see your Doctor before the procedure so you can ask and confirm any questions and sign the consent forms for the procedure to go ahead.
- The procedure will be performed in a specialist room called the Cardiac Cath Lab. You will be wheeled into this room and technicians and Nurses will set you up for the procedure, often placing
- Procedure time 1 hour – 6 hours, depending on the procedure type
- After procedure you will be transferred to recovery
Recovery and follow-up after your heart rhythm procedure
- You may have to stay one to two nights in hospital, sometimes there is a same day discharge
- Lie flat for 2-4 hours to allow healing of groin puncture and reduce bleeding
- You will be able to eat and drink once you are in recovery
- How long you take off work depends on the nature of your work. Talk to your doctor about this and ask for a medical certificate if you need one
- You may have brief driving restrictions. Speak to your doctor to see if there’s any need for this
- Follow up with your Doctor 6-8 weeks in their rooms following your procedure
