1.What are the symptoms of a heart rhythm problem?

Most patients experience a rapid heartbeat or pulse. Sometimes, this is described as a chest fluttering. Other patients report shortness of breath or chest discomfort. Heart rhythm problems may be associated with light headedness, dizziness, or feeling like you are going to pass out. In some instances, patients either do not have any symptoms at all, or have nonspecific problems such as fatigue or decreased energy levels.

2. What are the triggers of heart rhythm problems?

Heart rhythm problems may occur at any time without an obvious trigger. There may be long periods of normal heart rhythm between episodes of abnormal heart rhythm. Some patients associate an increased frequency of their heart rhythm problem with lack of sleep, caffeine or alcohol intake, decongestants, stress, and illnesses unrelated to the heart.

3. Will my heart rhythm problem go away on its own?

Unfortunately, most heart rhythm problems do not resolve spontaneously. Heart rhythm problems are often treated with medications, but once the medication is discontinued, the heart rhythm problem tends to recur. On occasion, a heart rhythm problem has a known, reversible cause and does not return if the primary problem is adequately treated.

4. Is my heart rhythm problem dangerous or life-threatening?

While some heart rhythm problems are associated with an increased risk of stroke or death, many other heart rhythm problems are not. As there are many types of heart rhythm problems, Dr. Liu will need to address this question with you on an individual basis.

5. Will I need any tests performed in the office to determine whether I am a candidate for a procedure to cure my heart rhythm problem?

Yes. If you have not had your heart rhythm problem diagnosed on an electrocardiogram (EKG) previously (e.g. during a visit to the emergency room), you may be given an event monitor to wear at home (depending on the frequency of your symptoms). You will also likely require additional tests such as an echocardiogram (an ultrasound of the heart) to look at the structure of the heart. You may require a stress test to look for blockages in your heart arteries before your procedure.

6. What is a heart rhythm ablation procedure?

Heart rhythm ablation is a minimally-invasive procedure which can permanently cure abnormal heart rhythms. Dr. Liu will thread catheters (essentially small electrical wires) through the veins in your legs up to your heart. With these catheters in position, she will first diagnose the specific type of rhythm problem you are experiencing (this diagnostic part is the EP study) and then, while you are still sedated, treat the abnormal rhythm circuit in your heart. This treatment, known as an ablation, is most often performed with electrical current ( either radiofrequency energy or a pulse field energy). Either form of ablation eliminates the electrical activity of a small, focused area of heart tissue, permanently eliminating the abnormal heart rhythm circuit.

7. What is an electrophysiology study?

An electrophysiology study (also called an EP study or EPS) is the first portion of the ablation procedure. This is the diagnostic part of the procedure where Dr. Liu gains a better understanding of the mechanism of your specific abnormal heart rhythm circuit. In the vast majority of cases, she will make your heart go into your abnormal rhythm while you are sedated for the procedure. This is accomplished by pacing the heart from different locations with the catheters. Sometimes, an adrenaline-like medication is given to provoke your abnormal heart rhythm.

8. What if Dr. Liu cannot induce the rhythm problem during my procedure? Can she still cure me?

Yes, in many cases she may still able to cure your rhythm problem, even if she is unable to reproduce your abnormal heart rhythm problem during your EP study. Often, but not always, she is able to acquire the necessary information about your abnormal heart circuit from other data acquired at the time of your procedure.

9. Are there alternatives if I don’t want to undergo a procedure?

Yes. Dr. Liu will discuss alternatives, such as medications (if appropriate), at the time of your office visit.

10. How likely am I to be cured of my heart rhythm problem?

Dr. Liu will address this question with you on an individual basis. The success of the procedure varies with the type of rhythm problem treated. Many rhythm problems (such as the common forms of supraventricular tachycardia) are successfully eliminated in greater than 90-95% of patients. Patients with other rhythm disturbances (for example, atrial fibrillation) may experience lower success rates, but ablation is still the most effective treatment option for atrial fibrillation.

11. Are there risks to the procedure?

Yes, there are risks related to the ablation procedure. However, the potential long-term benefits outweigh the risks, otherwise Dr. Liu would not recommend this procedure for you. At the time of your office visit, Dr. Liu will discuss the potential complications and answer all questions you may have. The risks of the procedure vary depending on the type of rhythm problem you may have. Overall risk is low.

12. When do I have to start fasting and stop eating/drinking?

We recommend that you do not eat or drink (including coffee) after midnight on the night before your procedure. You may, however, have a small sip of water with your routine medications (please see next question below).

13. Do I need to stop my Coumadin (warfarin), Pradaxa, Xarelto, Eliquis, Plavix (clopidogrel) or aspirin prior to the procedure?

NO for ablation procedure and Watchman procedure. Hold pradaxa, xarelto and eliquis for 2 days prior to device implant.

14. What about my diabetes medication? Do I need to stop these medications?

Most diabetes medications (including insulin) should not be taken on the day of the procedure. Every patient is different, however, and Dr. Liu will provide you specific instructions. Your blood sugar will be checked at the hospital.

15. Do I need to stop my heart rhythm medications?

Patients undergoing most ablation procedures (with the notable exception of ablation of atrial fibrillation) will typically be asked to stop their heart rhythm medications five days prior to the procedure. This includes beta-blockers (e.g. Lopressor, Toprol, metoprolol, Coreg, carvedilol, atenolol, etc.), calcium channel blockers (e.g. verapamil and diltiazem), and antiarrhythmic drugs such as Betapace (sotalol), Tambocor (flecainide), Rythmol (propafenone), amiodarone, Tikosyn (dofetilide) and Multaq (dronedarone).

16. Will I need pre-procedure blood work or a chest x-ray?

Pre-procedure laboratory testing and ECG will be performed.  Depending on the start time of your procedure and the specific hospital, this lab work may be performed on the same day as your procedure or a few days before it. Typically, no chest x-ray is required prior to the procedure.

17. Do I need to bring anything with me to the hospital?

You should prepare an overnight bag to take to the hospital (e.g. toothbrush, slippers, personal items, personal music player, etc.). Even if we expect that you can be discharged the day of your procedure, it is best to be prepared. Please also bring a list of your medications with correct dosages.

18. Will I be asleep for the procedure?

Every patient receives some degree of sedation for every procedure. The degree of sedation depends on the individual patient and the procedure. Less complicated procedures may only require moderate sedation – a technical term that means the patient is in a drowsy state but is able to breathe on their own. More complex procedures may require deep sedation or even general anesthesia. If you are to undergo a more complex procedure, you will meet the anesthesiologist at the hospital before your procedure begins. The anesthesiologist will make certain you are comfortable before and asleep during the procedure.

19. How long is the procedure?

The procedure usually takes between 2 to 4 hours (longer for some procedures), depending on the type of rhythm that needs to be treated. Dr. Liu will spend as much time with you as is necessary.

20. Am I in pain after the procedure?

After the procedure, some patients request pain medication. This will be available for you as needed. Most patients are quite comfortable, however, and do not require pain medication while in the hospital or upon returning home.

21. How long will I be in the hospital?

This depends on the patient, the procedure and the sedation they received (see question 18). Patients who undergo less complex procedures that require only moderate sedation can typically be released home a few hours after their procedure. Patients undergoing more complex procedures, or who receive deep sedation or general anesthesia, usually spend one night in the hospital and are discharged home early the next morning. In no case will a patient be sent home before they are ready or before they feel safe to be discharged.

22. When will I start to feel better?

The results of the ablation procedure are often immediate. Sometimes it takes 2-3 months to see the full effects. This is very dependent on the type of rhythm problem treated. This will be discussed with you during your office visit.

23. If I stay overnight, what can I expect on the morning of my hospital discharge?

Blood work may be taken. You will be examined by Dr. Liu, who may again review with you the results of your procedure (sometimes the anesthesia received during the procedure makes it difficult to remember the initial review of your procedure).

24. Will I have any physical restrictions after the procedure?

You will need to lay flat for approximately four hours after the catheters are removed from your leg veins. You will then be able to walk around.  We do not recommend exercise or lifting for the first 7 days as you are healing. You will receive more specific, printed instructions after the procedure.

25. Do you have to take any stitches out?

There are no stitches or staples used except for Watchman and leadless pacemaker procedures. This is a minimally-invasive procedure. There are usually 4 or 5 small cuts from needle insertion (millimeters in length) where the catheters entered the leg veins. These should heal completely in 1-2 weeks.

26. How much time do I need to take off from work after the procedure?

The amount of time off will depend on the type of work you do. Individuals who perform manual labor (i.e. not office based) will require additional time off from work (up to 2 weeks) to recover. We will be happy to complete any paperwork related to a short-term leave of absence from work.

27. When should I call the doctor’s office?

Please notify us if you develop swelling, bleeding, or increased tenderness where the catheters had been placed in your leg veins. Please also make us aware of any chest pain or breathing difficulties. We are happy to address any of your additional questions.

28. When do I need to be seen by the doctor after procedure?

You will be seen by Dr. Liu approximately 1-2 weeks after your procedure.  

29. Will I be able to take fewer medications after the procedure?

After a successful ablation procedure, your heart rhythm medications are often no longer necessary and can be discontinued. If you are taking blood thinning medications (e.g. eliquis or xarelto) for atrial fibrillation, the decision as to whether or not to continue is individualized based on their risk factors calculation. Dr. Liu will discuss her expectations with you at your initial visit.

30.My friend had an ablation procedure and the information his/her doctor provided is different from what Dr. Liu told me. Why is that?

There are many different types of heart rhythm problems. The type of ablation procedure (with its inherent risks and benefits) is different for each rhythm problem. You may need to obtain more specific information from your friend in order to permit comparison.