Department Of Medicine

You will be instructed to stop taking certain medications several days before the study to assure more accurate results; also, blood thinners such as coumadin are usually stopped 4 days beforehand. If you are taking a blood thinner, please make sure your doctor knows about this.

Be sure to mention allergic reactions you have experienced from any medications to the doctor or nurse, but also remember that a side-effect (like nausea) and an allergy are not necessarily the same thing.

Sometime prior to your procedure, your doctor will review your medical history and examine you. He or she will also explain the purpose of the procedure, its potential benefits and possible risks. Because an EP study is "invasive," requiring the insertion of catheters into the body, it involves some risk. The risk is small, however, and the study is relatively safe. Most patients who undergo EP studies do not experience complications, but you should discuss your particular risk factors with your doctor, as well as any questions, concerns or feelings you have.

You and your family will be scheduled to meet with our Electrophysiology Arrhythmia Nurse Coordinator, Marilynn Namekawa Wong, R.N., a day or two before your procedure in the Clinic, 350 Parnassus Avenue, Suite 300. Marilynn will instruct you on your arrhythmia, electrophysiology study, catheter ablation procedure, and to answer any questions that you may have. Also, preadmission tests, such as lab work and a 12 lead EKG, will be performed if not obtained before your procedure date. Your preadmission lab work will be drawn in the Clinical laboratory, first floor of the Ambulatory Care Center. For patients coming from a long distance that cannot meet with Marilynn, she will consult with you by phone and have your preadmission tests performed by your personal physician's office. You will enter the hospital either as an inpatient or an outpatient.

**DO	Take your medicines as usual, unless our office tells you otherwise. Please inform our office if you are on coumadin or medications for your heart rhythm.
**DO	Bring your medicines to the hospital.
**DO	Bring any medical records or lab results that your personal physician asks you to take to the doctors who will be performing your electrophysiology study. Make sure your referring doctor has sent copies of any cardiac studies you might have had, and EKG’s of your arrhythmia (if available) to us at UCSF.
**DO	Pack a small bag with personal toiletries if you like for your hospital admission.
**DO	Eat a regular supper the evening before your electrophysiology study.
**DO	Arrive at Moffitt Hospital: 505 Parnassus Avenue at 7:15 a.m. (usual admission time, unless instructed differently) and go to the Admitting Office, room 140 M on the main floor of Moffitt Hospital. Public parking is available across the street from the hospital. It is very important that you arrive on time at the Admitting Office. From the Admitting Office, you will be directed to one of the three locations listed below: 10 Long Hospital, to the nurse's station or 13th floor Moffitt, room 1351, to the Electrophysiology Laboratory. or 12th floor Moffitt, room 1230, to the Cardiac Cath Laboratory.
**DO NOT	Eat or drink anything after 12:00 midnight, the night before your test. Also, do not drink any water unless you need to take your regular morning pills on the day of the procedure, but take your pills with only a sip of water enough to swallow them. You may brush your teeth and rinse your mouth the morning of the procedure.
**DO NOT	Bring large sums of money or valuables to the hospital unless family or friends coming with you will hold them during the electrophysiology study.

3. How many Electrophysiology Studies and Catheter Ablation procedures have you done?
Our four Electrophysiologists perform over 400 catheter ablation procedures and 900 total procedures annually; this high volume ensures efficiency and expertise in the treatment of arrhythmias. We receive referrals from all parts of the world because of our expertise and state-of-the-art technology.

4. Will the procedure hurt?
You may feel minor discomforts during the Electrophysiology Study and Catheter Ablation Procedure from lying flat on our X-Ray table, or from the injection of the numbing medicine where catheters will be placed, or intermittently feel your heart racing when the doctors try to induce your abnormal heart rhythm. But through most of the procedure, you should be sound asleep. To minimize any discomforts during the procedure, you will be given short acting sedatives to make you calm and sleepy throughout the procedure.

5. Is the electrophysiology study and catheter ablation procedure safe?
Yes, the electrophysiology study and catheter ablation procedure are relatively safe. With any procedure, there are potential risks. The risks will be fully covered by our physicians before you have your electrophysiology study and catheter ablation procedure. The electrophysiology study and catheter ablation procedure are performed safely on children and adults, with the youngest at 3 months old and the oldest at 97 years old.

6. How long is the procedure?
During the Electrophysiology Study and Radiofrequency Catheter Ablation Procedure, you will be in our EP lab for 3 to 6 hours. Please let your family and friends know the length of the procedure time so that they do not worry.

7. Why does a catheter need to go in my neck?
There are two large vessels that enter the right side of the heart where the catheters are placed. The catheter placed at the neck site will enter from the top of the heart and that from the groin will enter the bottom. By allowing the catheters to enter the heart from two directions, it allows your doctor to maneuver the catheters in different directions to locate where your abnormal rhythm is coming from and to ablate it.
Once the catheters are removed from the neck and groin site, you will have a very tiny hole, looking very much like a "bug bite". The site should not leave a scar and there are no sutures to be removed.

8. How long will I need to stay in the hospital?
For the Electrophysiology Study and Catheter Ablation procedure, you will be able to go home the same day or the next day, around 9:30 to 10:30 A.M.

9. When can I resume my normal activities?
You can resume your normal daily activities (walking, bathing, showering, etc.) upon discharge from hospital unless instructed differently. The only restriction is straining or lifting heavy objects more than 10 pounds for a few days so that the incision site can heal.

10. When can I go back to work?
Unless your job requires you to lift heavy objects, you can return to work in a day or two.

11. Will I come back here for follow-up?
Upon discharge from the hospital, you will receive specific follow-up instructions by our Electrophysiology team. Our physicians will write a detailed letter, describing your hospital stay and treatment, to your personal physician. We suggest that you see your personal physician in 2 to 4 weeks.

The EP study is performed in the electrophysiology laboratory of the hospital, where you will be placed on an x-ray table. A camera and television screens will be close by, as will heart monitors and various instruments. You will be connected to monitors with electrodes and gelatin patches. A blood pressure cuff will be put onto your upper arm so that we may monitor your blood pressure frequently.

A nurse will shave and cleanse the area where the catheters will be inserted (the groin and/or neck) to protect against infection. The area will be cleansed with an orange-brown, sticky antiseptic. Sterile sheets will he draped over your body. It is important you find a comfortable position so that once the study begins, you will not touch the sterile working area.

During the study you may be given some sedative medications by intravenous infusion to make you sleepy. This will serve to reduce your anxiety and relieve your discomfort. In addition, a local anesthetic will be given with a tiny needle to numb the area where the catheters are placed. You'll feel a pinprick and possibly a stinging sensation from the anesthetic for just a few seconds.

Medications are sometimes used to stimulate your arrhythmia, so you may feel your heart racing or pounding. This may make you anxious, but you needn't be alarmed. The doctors want to induce the abnormal rhythm causing your problem, so that they can treat the arrhythmia. If you have any uncomfortable symptoms -- chest pain, dizziness, shortness of breath, nausea or pain -- tell your nurse or doctor.

The EP study should not cause you any pain. It is important that you stay calm and relaxed, and not move your arms or legs in the sterile working area. If you feel any discomfort, let your doctors or nurses know, so they can help you get comfortable.

In the controlled condition of the EP laboratory, induced arrhythmias are handled by well-trained personnel with state-of-the-art equipment. And, perhaps most importantly, the doctor uses the information gathered from the induced arrhythmia to prevent future occurrences.

Before discharge, your doctor or arrhythmia nurse coordinator will instruct you about restrictions to normal activities, medications and follow-up care.

Don't worry if you see a bruise or small lump under the skin at the insertion site; it will disappear within three to four weeks.

Depending on the type and severity of your arrhythmia, and the results of various tests including the EP study, there are several treatment options. You and your doctor will decide which one is right for you.

Certain anti-arrhythmic drugs change the electrical signals in the heart and help prevent abnormal sites from starting irregular or rapid heart rhythms.

To make sure the medication is working properly after two or more days in the hospital, you may be brought back to the EP laboratory for a follow-up study. Our goal is to find the drug that works best for you.

All artificial pacemakers work on 'demand' and are used to treat slow heart rhythms. They are a small sized device that is implanted beneath the skin below the collarbone and connected to a pacing wire(s) positioned inside the heart via a vein; this delivers a small electrical impulse to stimulate the heart to beat when it is going too slow .

A technique pioneered at UCSF, radiofrequency catheter ablation destroys or disrupts parts of the electrical pathways causing the arrhythmias, providing relief for patients who may not have responded well to medications, or for whatever reason would rather not or cannot take medications. This technique has a high percentage of successfully "curing" many types of arrhythmias.
Radiofrequency catheters are positioned close to the abnormal electrical pathway and high frequency current is passed through them. The tip of the catheter - about the size of a pencil eraser - ablates (destroys) the site of the abnormal pathway using radio waves. Since scar tissue cannot transmit electrical impulses, after ablation, the heartbeat will only follow the normal electrical pathway. The ablation causes a very small scar or blemish within the heart and will not interfere with the normal conduction or normal function of the heart.
The radiofrequency catheter is a thin, flexible wire that can be externally steered to pace, monitor and locate the site of the arrhythmia. The catheter is placed in the heart using x-ray guidance and sometimes using sound waves (ultrasound catheter imaging). The ablation catheter can also record the temperature where the catheter tip touches the heart wall when ablating or destroying the abnormal heart rhythm.

Internal cardioversion for conversion of atrial fibrillation and atrial flutter to a normal sinus rhythm was developed here at UCSF in 1991. Internal cardioversion is low energy electrical shock (1 to 10 joules) delivered internally in the heart through two catheters inserted in a vein in the groin and a small electrode pad applied to the chest. This procedure is performed in the Electrophysiology lab by our Electrophysiologist.
During the internal cardioversion, the patient is given short acting sedatives to make them sleepy. Currently, atrial flutter is successfully "cured" by radiofrequency catheter ablation; but treatment to restore atrial fibrillation to sinus rhythm has been the traditional use of medications and external cardioversion. External cardioversion is deliverance of high energy shocks of 50 to 300 joules through two defibrillator pads attached to the chest. In some cases, external cardioversion has failed because the electrical current has to first travel through muscle and skeletal structures of the chest before reaching the heart. Internal cardioversion has been performed when medications and external cardioversion have failed to restore a patient's rhythm back to a normal sinus rhythm.
With internal cardioversion, UCSF's success rate of converting a patient from atrial fibrillation to normal sinus rhythm has been 95%. The shorter time a patient is in atrial fibrillation, the easier it is to cardiovert a patient back to a normal rhythm, but we have found that even patients with long-standing history of chronic atrial fibrillation can be successfully converted to a normal rhythm through internal cardioversion. With internal cardioversion, our electrophysiology team was successful in converting a patient, who had been in chronic atrial fibrillation for 8 years, back to a normal rhythm.

This is a device for people who are prone to life-threatening rapid heart rhythms. It is slightly larger than a pacemaker and usually implanted beneath the skin below the collarbone. It is connected to defibrillation/pacing wire(s) positioned inside the heart via a vein. It has the capability to deliver an electric shock to the heart when it determines the heart rate is too fast, it is also capable of pacing the heart to stop it from going too slow.

Make sure you follow your doctor's instructions to receive the most benefit from your treatment.

Follow-up visits as prescribed by your physician are essential. We will work closely with your primary physician, providing you with optimal medical care. We at UCSF are committed to providing you with the most technically-advanced and personalized care. We work hard to be responsive to your needs -from teaching to safe, effective diagnosis and treatment. We strive to give you all the advantages of a prestigious university hospital. And, we are dedicated to excellence. If you have questions, you may contact us by calling (415) 476-9194 to talk with one of our experienced nurse educators.

Text by Marilynn Namekawa Wong, R.N., B.S.N., Electrophysiology Arrhythmia Nurse Coordinator