Catheter Ablation

The electrophysiology test is performed in patients suffering from cardiac arrhythmias or in order to diagnose serious clinical manifestations that may possibly be arrhythmia-related. The electrophysiology test is an invasive procedure which consists in introducing specially-prepared electrodes to the cardiovascular system in order to register normal and abnormal electrical signals created by the heart or resulting from electrical stimulation of the selected areas in the heart. This allows to explain how arrhythmia has been formed and sustained, estimate the risk for the patient, and to choose optimal treatment strategies. For some patients, this may mean a change in the lifestyle, the choice of appropriate antiarrhythmic agents (pharmaceuticals), implantation of a pacemaker or a cardioverter, and ablation.

Arrhythmia ablation is the removal of the focus of abnormality that is responsible for the formation or continuation of arrhythmia by using increased temperature of the tissues around the electrode (radio frequency electromagnetic waves), or by application of low temperature, which causes damage to cells in the selected areas of the heart through the development of ice crystals (cryoablation). Indications for the procedure are based on a detailed analysis of clinical symptoms (syncope, collapse, poor effort tolerance, and palpitations) combined with medical documentation confirming the presence of arrhythmia at the time of occurrence of the symptoms. This is why it is so important to keep all the ECG test results of the ECGs that have already been performed. In the case of arrhythmias that occur sporadically, the patient has to plan appropriate diagnostic tests. They are performed under the supervision of the doctor in charge, who may also refer the patient for a specialist consultation in order to make a better diagnosis. 

The consultation before the procedure is carried out in order to learn more about the aspects of the condition that require testing with the use of specialised medical equipment, and then a further treatment plan is prepared, which may include scheduling of a possible procedure.

Arrhythmia ablation consultation

Patient is prepared to the procedure with the intention of reducing the risk related to it. In order to do this, the patient is vaccinated against hepatitis B, is instructed on the lifestyle s/he should follow, pharmacological treatment is optimised, with a special focus on preventing blood clotting and arrhythmia. 

Admission to the Centre for the procedure is based on the referral issued by the doctor in charge, after having made an appointment. Prior to the procedure, the patient has to stop taking some medications, especially antiarrhythmic and anticoagulant drugs as specifically instructed by the doctor. The patient should have with her/him complete medical documentation, all hospital discharge summaries, ECG test results, up-to-date echocardiography test results, a list of medicines used, and the results of the recent tests including the blood type. Up-to-date proof of insurance confirmed in the past month is valid.

The procedure is performed after the patient has given informed, written consent for the procedure on an appropriate form. The procedure is performed on the patient who is on an empty stomach and with the access to the vein secured. The procedure is performed in the operating room. Under local anaesthetic, appropriate diagnostic and ablation electrodes are introduced in the groin area in order to reach the selected structures in the heart. An electrophysiological test is carried out; during the test an arrhythmia may be triggered. Then the ablation procedure is performed. 

When the radio frequency waves are applied, the temperature rises to about 60C, and the patient may experience pain, which s/he should report, in which case painkillers are administered and the procedure is continued. Sometimes there may be a need for a short-term intravenous anaesthesia, about which the patient is always informed, similarly to being informed about other important stages of the procedure. 

Heart arrhythmia - electrophysiological test

The period after the procedure starts at the moment when the medical equipment is disconnected and the patient is moved to the recovery room. During that time the patient is still monitored, blood pressure and the pulse are measured. The groin area is secured with an appropriate bandage. The patient is immobilised in bed for a few hours and should not bend her/his limbs. The patient may be visited. After vasoconstriction has been eliminated, the patient is mobilised and moved to the patient room. The blood pressure and pulse are still measured.

The patient is obliged to report any discomfort. On the day of discharge from hospital the patient receives a release note and the record containing information about the procedure s/he has undergone. A week-long period of convalescence, during which time the patient returns back to normal life.

The effectiveness of the procedure is higher than all the other methods, but it depends on the type of arrhythmia. It amounts from 60% in the case of atrial fibrillation to 100% in the case of ablation of the atrioventricular junction. In the case of ventricular arrhythmias the effectiveness varies between 70% to 90%, in nodal supraventricular tachycardia it amounts to around 95%, 95% in the case of atrial flutter, and over 90% in the case of Wolff–Parkinson–White syndrome (WPW). This means that the improvement in the quality of life and the reduction of the risk of sudden death can be expected in the majority of the patients. The patient has a chance to return to normal life and to continue her/his professional career without the need to continuously take many medications.

Atrial fibrillation ablation

Complications and possible problems result from the characteristic form of the treatment and concern a few per cent of patients. The most common complications are the complications in the area of access to the vascular bed. Bleeding, hematomas, pseudoaneurysms, arteriovenous  fistula, embolisms and thrombi may occur. The most severe complications (death, myocardial infarction (heart attack), damage to the valve apparatus, a pneumothorax, perforation of the heart chambers, and a stroke) occur with a frequency of less than 0.5%. Heart rhythm and cardiac conduction abnormalities that require the implantation of a pacemaker occur in about 1% of the procedures. The patient should also take into account sporadic instances of allergic and infection complications. 

Health checks are usually performed under the supervision of the doctor in charge. The date of the first appointment, after a week, is scheduled with each patient individually. After a month a control Holter examination is scheduled.

If there is such a need, the patient may also see a specialist at LUXMED Non-public Cardiology/ Cardiac Dysrhythmia Clinic (NZOZ LUXMED) or St. Joseph’s Interventional Cardiology Centre (Ośrodek Kardiologii Zabiegowej im. św. Józefa)