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Electrophysiologic Procedures

Electrophysiologic Procedures

Atrial Fibrillation Ablation

How many days will I be in the hospital?

It is usually a one to two night hospital stay.

How is the procedure done?

Under general anesthesia, catheters are introduced through both groins into the veins and then advanced into the heart. We then cross from the right side of the heart to the left side and by using electro-cautery we electrically isolate the pulmonary veins which drain into the left atrium. The pulmonary veins have sleeves of cardiac muscle that trigger the arrhythmia and are responsible for its initiation and perpetuation. Once isolated the arrhythmia is cured.

What level of sedation or anesthesia is used?

We perform all A Fib ablations under general anesthesia.

What is the success rate of this procedure?

The success rate of an A Fib ablation can be measured in multiple ways. The arrhythmia free rate at one year is in the order of 75-85%, which means that if one takes a 100 individuals with paroxysmal atrial fibrillation and perform an A Fib Ablation, 80 will be cured and in a normal rhythm a year later. Studies have also shown that symptoms further improve beyond the arrhythmia free rate.  So within the 20% of patients who remain experiencing arrhythmias, a significant number will become symptoms free.

What are the risks?

The procedure carries a 1-3% risk of complications, including bruising or groin hematomas as the most common ones. More serious complications such as stroke, damage to the heart, the esophagus or the diaphragmatic nerve occur in less than 0.5% of the procedures.

How soon after can I go back to work or to my usual activities?

We recommend that patients take it easy for at least 5 days but within two days you can go back to work refraining from heavy object lifting.

How should I be followed?

You should have a follow up visit with us at 3 months; we also recommend a follow up remote monitor check at 6 months and then another visit with remote monitoring at one year.

Device Implantation

How many days will I be in the hospital?

It is usually a one night hospital stay

How is the procedure done?

Under sedation and using abundant local anesthesia an incision is made under the collar bone where the device will be placed in the sub-cutaneous space. Then the axillary-subclavian vein is accessed and the lead or leads are attached to the heart.

What level of sedation or anesthesia is used?

Most procedures require the use of sedation and abundant local anesthesia, but on occasions general anesthesia is used for safety and comfort.

What are the risks?

The procedure carries a small risk of complications, including bleeding, infection, cardiac perforation, pneumothorax and a reaction to the contrast agent.

How soon after can I go back to work or to my usual activities?

We recommend that patients take it easy for at least one week but within two days you can go back to work refraining from heavy object lifting and avoiding damage to the skin.

How should I be followed?

You should have a follow up visit with us within two weeks after the device is implanted and then at 6 weeks for reprograming.

Premature Ventricular Contraction (PVC) Ablation

How many days will I be in the hospital?

It is usually a one to two night hospital stay.

How is the procedure done?

Under sedation, catheters are introduced through both groins into the veins and arteries and then advanced into the heart. We then map the origin of the arrhythmia and utilize electro-cautery to eliminate the source.

What level of sedation or anesthesia is used?

Most procedures require the use of sedation and abundant local anesthesia, but on occasions general anesthesia is used for safety and comfort.

What is the success rate of this procedure?

The success rate of a PVC ablation is in the order of 90-95% depending on the anatomical location of the source.

What are the risks?

The procedure carries a 1-3% risk of complications, including bruising or groin hematomas as the most common ones. More serious complications such as stroke or damage to the heart may occur in less than 0.5% of the procedures.

How soon after can I go back to work or to my usual activities?

We recommend that patients take it easy for at least 5 days but within two days you can go back to work refraining from heavy object lifting.

How should I be followed?

You should have a follow up visit with us at 1 month; we also recommend a follow up remote monitor check at 6 months.

Supraventricular Tachycardia (SVT) Ablation

How many days will I be in the hospital?

It is usually an outpatient procedure to a one night hospital stay

How is the procedure done?

Under sedation, catheters are introduced through both groins into the veins and then advanced into the heart. We then map the origin of the arrhythmia and perform multiple tests including the administration of adrenaline. Depending on the location of the source we may have to cross from the right atrium into the left atrium. Electro-cautery or freezing is then used.

What level of sedation or anesthesia is used?

Most procedures require the use of sedation and abundant local anesthesia, but on occasions general anesthesia is used for safety and comfort.

What is the success rate of this procedure?

The success rate of an SVT ablation is about 98%, with a 2% chance of the arrhythmia coming back.

What are the risks?

The procedure carries a 1-3% risk of complications, including bruising or groin hematomas as the most common ones. More serious complications such as stroke, damage to the heart or needing a pacemaker if the source is too close to the normal conduction system is about 1%.

How soon after can I go back to work or to my usual activities?

We recommend that patients take it easy for at least 5 days but within two days you can go back to work refraining from heavy object lifting.

How should I be followed?

You should have a follow up visit with us between 1-3 months.

Ventricular Tachycardia (VT) Ablation

How many days will I be in the hospital?

It is usually a one to three night hospital stay.

How is the procedure done?

Under sedation, catheters are introduced through both groins into the veins and arteries and then advanced into the heart. We then map the origin of the arrhythmia and by using electro-cautery we eliminate the source that sustains it. Ventricular tachycardia is most often sustained via channels of diseased cardiac muscle that survive within areas of scar. The goal of the procedure is to identify those channels and eliminate them.

What level of sedation or anesthesia is used?

Most procedures require the use of sedation and abundant local anesthesia, but on occasions general anesthesia is used for safety and comfort. Depending on the overall health of the patient an extra support is required to assure a stable blood pressure and good perfusion of every organ.

What is the success rate of this procedure?

The success rate of a VT ablation is in the order of 50-80% depending on the anatomical location of the source, how sick the patient is and the size of the scar. Depending on the circumstance, while still in the hospital, we often recommend a no-invasive test (NIPS) done through the internal defibrillator to assess the success of the procedure or the need to do more work on the scar.

What are the risks?

The procedure carries a 1-3% risk of complications, including bruising or groin hematomas as the most common ones. More serious complications such as stroke, damage to the heart or death may occur in about 1-2% of the procedures.

How soon after can I go back to work or to my usual activities?

We recommend that patients take it easy for at least 5 days but within two days you can go back to work refraining from heavy object lifting.

How should I be followed?

You should have a follow up visit with us at 1 month; we also recommend enrollment into a remote monitoring schedule for the internal defibrillator for better follow up there after.