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Electrophysiological Examination and Intracardiac Ablation

Electrophysiological examination is an invasive procedure used to study heart arrhythmia (irregular heartbeat). 

Cardiac ablation is an invasive procedure used to treat certain kinds of heart arrhythmia. Energy is applied, which destroys the area responsible for or which is causing the arrhythmia.

Benefits of the operation

Electrophysical examination is performed when non-invasive diagnostic tests (echocardiogram stress test, Holter monitor, electrocardiogram) do not give the cardiologist enough medical information to be able to treat the arrhythmia. 

Cardiac ablation is an effective treatment for heart arrhythmias, such as atrial fibrillation, ventricular tachycardia, Wolf-Parkinson-White syndrome.

Medical-technical description

An electrophysical examination pinpoints the exact location of electrical signals (cardiac mapping) in the heart.  A cardiologist places several catheters directly on different parts of the heart that transport the electrical signal they receive. When this information has been processed, the cardiology specialist uses it to diagnose the type of arrhythmia, its origin and extent. 

Ablation uses catheters that are capable of transmitting energy from an external source to the heart. This energy, in the form of heat, causes controlled destruction of tissue measuring around 5mm in diameter and 2mm depth, stopping the transmission or generation of the electrical impulse in the selected area.

About the operation

Both procedures take place in the cath lab.  They take between one and five hours, depending on whether an electrophysiological study is performed alone or whether ablation is also required, and its complexity. The patient undergoes the entire procedure lying face up. Vital signs are read thoroughly and continuously throughout the entire process. 

A local anaesthetic is injected at the site of the puncture, through which several catheters are inserted in the vein and fed to the heart, simultaneously recording electrical activity at these points. These catheter insertion points are usually in the groin (artery and femoral artery) and forearm (basilic vein). Once mapping has taken place, ablation may start, if necessary.

Before the operation

  • When you are admitted you will have a blood test, an electrocardiogram and your vital signs will be recorded.
  • A line will be placed in the vein for delivering medication.
  • Your body hair will be shaved from the belly button to halfway down your thigh.
  • Do not take oral anticoagulants (such as Sintron or Warfarin). Your cardiologist will tell you when to stop taking them and what medicines you should take instead.
  • If you are taking medicine for your arrhythmia, your cardiologist will tell you if you should stop taking it and when.
  • You will have to understand and sign the informed consent form before the operation. This will be given to you by your cardiologist.
  • You must not eat or drink for six to eight hours before your operation.
  • Do not wear underwear or dentures. You must remove all metal objects (such as rings, bracelets, earrings, body piercings, etc.).

Post-operative care

  • You will not be able to eat or drink after the operation until it is safe to do so. The nursing staff will tell you when this is.
  • The nursing staff in the unit will watch your vital signs and the catheter insertion site regularly according to the protocol established for this purpose.
  • Once the procedures are complete, all the catheters will be removed and pressure will be applied to the insertion site until it stops bleeding. A bandage will then be applied which will be removed after 12 hours. During all this time, you will lie still on the bed without bending the affected leg.
  • Sometimes the catheter insertion site in the femoral artery is sealed with an appliance. Even so, the patient must rest in bed with the affected leg stretched out, for 12 hours.
  • When the compression bandage has been removed, you will be able to sit and walk about.
  • After you have been released you will be able to lead a normal life, although strenuous exercise and efforts are not recommended for the initial two days after release.
  • On release, you will be given a medical report with guidelines to follow at home.

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