Heart Procedures

Patient Education from Capital Cardiology Associates

Heart Procedures

This page discusses the surgical and non-surgical heart procedures performed by the physicians at Capital Cardiology Associates.

Angioplasty

Your doctor has recommended that you have an angioplasty because you have coronary artery disease, also called atherosclerosis. The purpose of cardiac angioplasty is to open arteries that have become partially blocked by a build-up of plaque (a combination of cholesterol and other fats, calcium, and other elements in blood). When plaque accumulates, the opening in the arteries becomes more narrow and less blood, and therefore less oxygen, reaches the heart. This can cause chest pain (angina) or even a heart attack (myocardial infarction).

Angioplasty is a treatment, not a cure. After your procedure, it is important to reduce your any risk factors you may have for coronary artery disease by following your doctor’s instructions and by participating in a cardiac rehabilitation program if ordered by your doctor.

Testing Instructions

DO NOT EAT OR DRINK AFTER MIDNIGHT THE DAY OF THE PROCEDURE UNTIL THE PROCEDURE IS COMPLETED.

Take all medications as prescribed with a small sip of water unless directed otherwise by your doctor.

Be sure to tell your doctor if:
• You have an allergy to seafood, x-ray dye or iodine
• You know or suspect that you are pregnant
• You are taking blood thinners
• You have a history of bleeding problems
• You are diabetic

Prior to your procedure, blood tests, x-rays and an electrocardiogram (ECG) will be ordered by your doctor. Family members will be taken to a waiting room where your doctor will speak with them after your procedure.

Possible Complications

Complications of an angioplasty are rare, but may include: bleeding that results from a puncture of a large blood vessel; blood clots in a catheterized blood vessel; collapse or tear in a blood vessel; and restenosis, or excess scar tissue in an artery that may cause more blockage. The doctors and nursing staff are highly skilled and are prepared to act immediately in the event of any complication.

Complications from angioplasty occur infrequently but may include:
• Sudden closure of the artery
• You may require emergency bypass surgery
• Heart attack
• Death. The risk of death is higher when more than one artery is involved.

What to expect following surgery

You will be transferred to the recovery room or to the Coronary Care unit where you will be closely monitored by the nursing staff. You will remain in bed with the head of the bed slightly raised until your doctor determines that it’s okay for you to get up. You will usually start walking within 12 to 24 hours after the procedure. Your doctor will decide when you will be able to drink liquids and eat solid food.

It is not uncommon to have swelling, bruising and a small lump where the catheter was inserted. The leg below the catheter insertion site will be monitored to check for bleeding. Movement of your leg will be restricted for several hours. When the sheaths are taken out, the nurses may apply pressure to reduce swelling and prevent bleeding. Please tell your nurse if you experience any pain or discomfort. Your doctor will decide, based on your concerns, whether you will be discharged to your home or transferred to another unit in the hospital. Discharge usually takes place within 24 hours of the procedure. Exercise and driving may usually resume after 1 to 2 days with permission from your doctor.

What to do and expect once you go home

• Avoid heavy activity for 1 to 2 days, including pushing or pulling heavy objects or lifting more than 10 pounds.
• Stop exercising before you become tired or short of breath. If you experience chest pain during exercise, stop immediately, call your doctor and follow all instructions given. If you cannot reach your doctor and are still in pain, call 911.
• Avoid rubbing the lump at the catheter insertion site.
• Avoid driving for two days after the procedure.
• Keep all follow-up appointments with your doctor.
• You may return to your normal sexual activity after your groin heals. Don’t smoke. Angioplasty will not remain successful if you smoke.

Plan a diet that is healthy, tastes good and is low in fat and cholesterol. Too much weight is hard on your heart and blood vessels. If you need to lose weight, ask your doctor for help. Learn to manage stress. Discuss any emotional problems you may have with your doctor or nurse.

Returning to work

The type of work you do determines how quickly you will be able to return to work. Your doctor will discuss this with you to see what’s best for you.

Call your doctor if
• Your arm or leg becomes numb or painful, or if there is redness or a yellow discharge.
• You have pain or numbness below the catheter insertion site (leg, toes, arm, fingers).
• The catheter insertion site swells or bleeds. If this happens, lie down immediately on a firm surface and have someone apply pressure to the catheter insertion site for 10 minutes by pressing the heels of both hands over the lump and pushing down. If the swelling and/or bleeding does not stop, call your doctor or go to the emergency room while continuing to hold pressure on the site. Seek emergency medical care immediately if you have chest pain like the pain before or during your angioplasty.

Medications

You may be placed on medications following your angioplasty to prevent blood clots from forming. Report all side effects from medications to your doctor. DO NOT stop taking any medicine unless directed by your doctor.

This information should not be considered specific medical advice and is not meant to replace professional medical services. Please speak to your physician regarding symptoms, diagnosis, treatment, and any other pertinent questions regarding pacemakers.

Atrial Fibrillation Ablation

Atrial fibrillation is the most common irregular heart rhythm in the United States. Atrial fibrillation is an abnormal heart rhythm originating in the atria (top chambers of the heart). Instead of the impulse traveling in an orderly fashion through the heart, impulses begin and spread throughout the atria in a rapid and disorganized manner causing an irregular heartbeat.

During pulmonary vein isolation, the physician inserts catheters from both groin veins into the upper left atrium chamber of the heart. The patient is asleep under conscious sedation. A special machine delivers radio frequency energy through the catheters to the area where the pulmonary veins enter the left atrium. This energy delivered by the tip of the ablation catheter produces a circular scar that blocks any impulses firing from within the pulmonary veins, thereby “disconnecting” the pathway of the abnormal rhythm and preventing atrial fibrillation. In some cases, pulmonary vein isolation also may be performed in other parts of the heart such as the superior vena cava.

Medications, Ablation and other treatments for atrial fibrillation

The goals of treatment for atrial fibrillation include (1) regaining a normal heart rhythm (called “normal sinus rhythm”); (2) controlling the heart rate; and (3) preventing blood clots and strokes. Initially medications are used to treat atrial fibrillation. The medications may include:
• Rhythm control medications (antiarrhythmic drugs) to try to maintain normal sinus rhythm
• Rate control medications (to slow the heart rate)
• Coumadin (warfarin – an anticoagulant or blood thinner) and/or aspirin to prevent blood clots and stroke

Other treatments for atrial fibrillation, such as catheter ablation or pulmonary vein isolation, are appropriate for patients who:
• Have a history of chronic or paroxysmal atrial fibrillation
• Have continued symptoms of atrial fibrillation, despite treatment with medications
• Can not tolerate antiarrhythmic drugs, or have had complications from these drugs
• Wish to discontinue medications altogether used for the treatment of atrial fibrillation and are considered a good candidate for ablation after an evaluation by a physician.

Are there any risks?

All procedures have risks, but the catheter ablation procedure is generally very safe. Special precautions are taken to decrease these risks. Your doctor will discuss the risks of the procedure with you.

How successful is catheter ablation in treating atrial fibrillation?

Success rates for catheter ablation of atrial fibrillation are defined as restoring a patient’s normal sinus rhythm while not being dependent on medications to control the heart rhythm. Pulmonary vein isolation has a roughly 80 percent success rate with the first ablation. For those who have returned for further ablation, the success rate has been about 90 percent. Some patients remain on medications after the ablation but still feel better. Some types of atrial fibrillation (paroxysmal, or people who who go in and out of atrial fibrillation) are more successfully ablated than others (chronic, or people who are constantly in atrial fibrillation).

Before pulmonary vein isolation, what tests may be performed?

In all patients, spiral computed tomography (CT) test will be performed before the procedure; in some patients, a transesophageal echocardiogram (TEE) may be performed before the procedure. If you take coumadin, the results of your INR test (a blood test to evaluate blood clotting) must be within a suitable range before the procedure can be performed. You will be given instructions regarding all of this.

Should I take my medications before the procedure?

Your physician may ask you to stop taking certain medications. Do not discontinue any of your medications without first talking to your physician. Bring your prescription medications with you to the hospital, but follow the directions about taking them as given to you by your physician. If you have diabetes, ask the nurse how you should adjust your diabetes medications and/or insulin.

Can I eat before the procedure?
Eat a normal meal the evening before your procedure. However, DO NOT eat, drink, or chew anything after 12 midnight before your procedure. This includes gum, mints, water, etc. If you must take medications, only take them with a small sip of water.

What happens when I arrive?
Before the procedure begins, a nurse will help you get ready. You will lie on a bed and the nurse will start an IV (intravenous line) in a vein in your arm. The IV is used to deliver medications and fluids during the procedure.

A medication will be given through your IV to make you feel drowsy. Your neck, upper chest, arm and groin will be cleansed with an antiseptic solution. The catheter insertion site(s) will be shaved. Sterile drapes will be placed to cover you from your neck to your feet.

Where is the catheter ablation procedure performed?

The procedure takes place in a special room called the EP (ElectroPhysiology) lab.

Will I be monitored?

The nurse will connect you to several monitors that will check your heart rhythm and your body’s responses to any arrhythmias during the procedure. The nurse will constantly assess you during the procedure. The following are the monitors that will be used during the procedure:
• Defibrillator/pacemaker/cardioverter: Attached to one sticky patch placed on the center of your back and one on your chest. This allows the physician and nurse to pace your heart rate if it is too slow, or deliver energy to your heart if the rate is too fast.
• Electrocardiogram or EKG: Attached to several sticky electrode patches placed on your chest, as well as inside your heart. Provides a picture on the monitors of the electrical impulses traveling through the heart.
• Blood pressure monitor: Connected to a blood pressure cuff on your arm. Checks your blood pressure throughout the ablation.
• Mapping system: State-of-the-art technology that helps your physician locate the exact area of your arrhythmia.
• Ablation machine: Attached to another sticky patch on your back.
• Oximeter monitor: Attached to a small clip placed on your finger. Checks the oxygen level of your blood.
• Fluoroscopy: A large X-ray machine will be positioned above you to help the physicians see the catheters on an X-ray screen during the procedure.
• Intracardiac ultrasound, performed by a catheter transducer inserted into the heart: used throughout the procedure to view the structures of the heart and the catheter when it is in contact with the heart lining.

How does the physician insert the catheters into the blood vessels around my heart?

After you become drowsy, the physician will numb the catheter insertion site by injecting a medication. The doctor will insert several catheters into large veins in both sides of your groin.

A transducer is inserted through one of the catheters so intracardiac ultrasound can be performed during the procedure. The ultrasound allows the physician to view the structures of the heart and evaluate pulmonary blood flow on an external monitor.

The catheters will be advanced through the blood vessels to your right atrium. A needle is then used to place the catheters through the septum into the left atrium.

After the catheters are in place, radiofrequency energy is delivered through the catheters to the area around the pulmonary vein openings to stop (“ablate”) the abnormal impulses that cause atrial fibrillation.

Once the ablation is complete, the electrophysiologist uses monitoring devices to observe the electrical signals in the heart.

How will I feel during the procedure?

You will fall asleep during the procedure due to the medication given to make you relax. You will feel an initial burning sensation when the physician injects medication in the catheter insertion site.

You may feel some discomfort or a burning sensation in your chest when the energy is applied through the catheter. It is important to remain quiet, keep very still and avoid taking deep breaths. If you are feeling pain, ask your physician or nurse to give you more medication. Our goal is to have all patients deeply asleep so they feel no pain and have no recollection of the procedure.

How long does the procedure last?

The procedure may last from 3 to 5 hours.

After pulmonary vein isolation, what should I expect?

The doctor will remove the catheters and apply pressure to the insertion site to prevent bleeding. No stitches are needed. A pressure dressing (bandage) will cover the insertion sites.

You will need to stay in bed for 6 to 8 hours after the procedure. You’ll need to keep your legs still during this time to prevent bleeding.

When will I find out the results?

After the procedure, the physician will discuss the results of the procedure with you and your family.

How will I feel after the procedure?

You may feel fatigue or chest discomfort during the first 48 hours after the procedure. Please tell your physician or nurse if any of these symptoms are prolonged or severe.

Will I have to stay in the hospital?

Yes. You will be admitted to the hospital and stay overnight after the procedure.

In your hospital room, you will be placed on a special monitor, called a telemetry monitor. Telemetry consists of a small box connected by wires to your chest with sticky electrode patches. The box displays your heart rhythm on several monitors in the nursing unit so the nurses will be able to observe your heart rate and rhythm.
Will I be taking new medications?
For at least one to three months after the procedure, you will need to take an anticoagulant (blood thinning) medication, such as Coumadin (warfarin), to prevent blood clots. You must have frequent blood tests,(called an INR/Protime) to evaluate the dosage of Coumadin. Your physician will tell you how often to have this test.

You may also need to take an antiarrhythmic medication to control abnormal heartbeats for two months after the procedure.

You will receive the necessary prescriptions and medication instructions from your physician. Ask your physician if you can continue taking your previous medications.

In some cases, your physician may recommend cardioversion to control abnormal heartbeats.

Will I be able to drive myself home?

No, for your safety, a responsible adult must drive you home.

When can I return to my normal activities

Your doctor will tell you when you can resume your normal activities, including driving. Usually you can return to your normal activities within 48 hours after the procedure. For one week after the procedure, do not lift anything that weighs more than 10 pounds if possible, just to avoid putting strain on the catheter insertion sites in the groins.

What symptoms should I expect?

You may experience skipped heartbeats or short episodes of atrial fibrillation during the first two months after the procedure. These symptoms are common due to inflammation (swelling) of the heart tissue and are treated with medications. After your heart has healed, these abnormal heartbeats should subside.

What symptoms should I report?

Please call Capital Cardiology Associates and ask to speak with a nurse if you have:
• A temperature of more than 101 degrees Fahrenheit or 38.4 degrees Celsius (a possible sign of infection).
• Redness, swelling or drainage at the procedure site (call right away).
• Significant atrial fibrillation symptoms.
• Significant chest pain
• Difficulty or pain swallowing

Follow-up visit

A follow-up visit will be scheduled at three to four weeks after the procedure. You will be asked to get a blood draw for coumadin dosing (called an INR test) the first week after leaving the hospital.

This information is provided for education purposes only and is not intended to replace the medical advice or informed consent discussion of your physician. While we strive to keep our website current, medical practices sometimes change quickly. Please consult your physician for advice about a specific medical condition or procedure.

Electrophysiology Study

Your doctor has recommended that you have an electrophysiology (EP) study because you have cardiac arrhythmia. The purpose of the test is to cause your heart to produce the arrhythmia in the controlled environment of the Electrophysiology Lab so that your cardiologist can locate and diagnose the cause of your arrhythmia.

Once the test has been completed and a diagnosis has been made, your doctor may recommend specific treatment options: medication, surgery, an implantable cardioverter defibrillator (ICD), and a pacemaker or catheter ablation.

Pre-testing instructions

Do not eat or drink after midnight the day of the procedure and until the procedure is completed.

Take all medications as prescribed with a small sip of water unless directed otherwise by your doctor. Be sure to tell your doctor if:
• You have an allergy to seafood, x-ray dye or iodine.
• You know or suspect that you are pregnant.
• You are taking blood thinners.
• You have a history of bleeding problems.
• You are diabetic.

Prior to your procedure, your doctor will order blood tests, x-rays and an electrocardiogram (ECG). Family members will be taken to a waiting room where the doctor will speak with them after your procedure. You should make arrangements to have someone drive you home after the procedure.

The electrophysiology procedure

You will be awake during the entire EP study, you should try to remain quiet and still throughout the procedure. You will wear a hospital gown, and you may wear your glasses, hearing aid and dentures. This is a sterile procedure. To limit the chance of infection and to maintain a sterile field, you will be covered with sterile cloths from neck to feet. To limit movement and to be sure your hands do not enter the sterile field, your wrists may be strapped to the examination table.

At the start of the procedure, a nurse will give you a sedative to help you relax. If you don’t already have an intravenous needle (IV), one will be started. A bladder catheter may also be started. Your blood pressure and electrocardiogram (ECG) will be monitored throughout the procedure.

The procedure begins by administration of an anesthetic in the groin area. You may feel a slight “stinging” sensation during the injection. During the procedure, the doctor will insert two plastic tubes, called sheaths, into a vein and an artery in the groin. Then, a thin, flexible tube (catheter) is carefully guided into your heart. The doctor will follow the progress of the catheter through the veins while watching the procedure on an x-ray. Since blood vessels do not have nerves, you should experience no pain while the catheter is threaded into your heart.

Once the catheters are in place, the doctor will use them to artificially stimulate or start your arrhythmia. You may be kept in this state for a length of time. The doctor may also start and stop the arrhythmia by using drugs to control it. Because the doctor will start your arrhythmia, you will experience the same feelings you do when the arrhythmia occurs naturally. Your doctor can stop the arrhythmia immediately if necessary. If it is necessary to stop the arrhythmia by applying a shock to the heart, you will receive medication to make you comfortable. You will be unable to feel the shock that is administered.

How long does the EP study take?

The procedure usually takes 1-3 hours. It is unusual to experience any pain during the procedure. Report any pain or discomfort to your doctor immediately.

Catheter Ablation

If catheter ablation is recommended, the procedure will probably be performed immediately while you are in the EP lab. Catheter ablation uses high-frequency sound waves to eliminate the tissue that is responsible for causing the abnormal heart rhythm. Following the ablation, these cells will cease to function, thus eliminating the cause for the abnormal heart rhythm. The catheter ablation procedure may be applied a number of times during the same procedure. Catheter ablation takes 2-6 hours.

After the procedure, catheters will be withdrawn and pressure will be applied to the catheter insertion sites.

Complications

Complications following catheter ablations are rare, but complications do occur and may include: injury to or bleeding in a blood vessel, blood clots developing inside the heart or blood vessels that hold the catheters, stroke, bleeding in the sack surrounding the heart or implanting of a permanent pacemaker. To reduce the risk of blood clots or stroke, blood-thinning medication may be given during the procedure. The doctors and nursing staff are highly skilled and are prepared to act immediately in the event of any complication.

What to expect following the EP study

After the EP study, you will be transferred to the recovery room or to the Coronary Care Unit where you will be closely monitored by the nursing staff. The catheters will be removed from your groin. There will be no stitches. A sterile dressing will be placed on the wound. This can be removed the next day. It is important to keep your leg as still as possible to help the catheter insertion site heal. Your doctor will decide when you will be able to eat and drink after the test. You will remain in bed for 4-6 hours, with the head of the bed either flat or slightly raised to allow the insertion site to heal.

Your blood pressure, heart rate, breathing and catheter insertion site will be closely monitored by your nurse. The IV will remain in place for 2-3 hours and the nurse may place a small weight on the catheter insertion site to apply pressure to prevent bleeding. It is not uncommon to have swelling, bruising and a small lump at the catheter insertion site. The nurse will help you use the bedpan or urinal if you need it. Please tell your nurse if you experience any pain or discomfort including warmth, wetness, and numbness or tingling.

If you have had a catheter ablation, you will spend the night in the hospital so that your heart rhythm can be monitored. Your doctor will determine what medications you will receive and when you will be able to drink liquids and eat solid food.

Homegoing instructions

Avoid heavy activity for 7 days, including pushing or pulling heavy objects or lifting more than 10 pounds.
Stop exercising before you become tired or short of breath. If you experience chest pain during exercise, stop immediately.
Call your doctor and follow all instructions given. If you cannot reach your doctor and are still in pain, call 911.
Keep all follow-up appointments with your doctor.
You may return to your normal sexual activity after your groin heals.
Don’t smoke.
Plan a diet that is healthy, tastes good and is low in fat and cholesterol. Too much weight is hard on your heart and blood vessels. If you need to lose weight, ask your doctor for help.
Learn to manage stress. Discuss any emotional problems you may have with your doctor or nurse.
Avoid rubbing the lump where the catheter was inserted.
When you can return to work depends on the kind of work you do. Your doctor will discuss with you when you can return to work and when you can start driving again.
Call your doctor if:
• Your arm or leg becomes numb or painful, or if there is redness or a yellow discharge.
• You have pain or numbness below the catheter insertion site (leg, toes, arm, and fingers).
• The catheter insertion site swells or bleeds. If this happens, lie down immediately on a firm surface and have someone apply pressure to the catheter insertion site for 10 minutes by pressing the heels of both hands over the lump and pushing down. If the swelling and/or bleeding does not stop, call your doctor or go to the emergency room while continuing to hold pressure on the site.

Medications

You may be placed on medications following your EP study to prevent blood clots from forming. Report all side effects from medications to your doctor. Do not stop taking any medicine unless directed by your doctor.

Additional Reading

Read our brochure on Angiography

Read our brochure on Arrhythmias

Read our brochure on Catheter Ablation

Read our brochure on Pacemaker Implants