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Cath Lab Procedure

- Electrophysiology

Ablation for atrial flutter

These are procedures that take place in the catheter laboratory under local anaesthetic and sometimes with the addition of sedation administered into a vein. The procedure can be a day case procedure or sometimes requires an overnight stay. This procedure is performed if you have an issue with the electrical functioning of the heart.

The ablation procedure is slightly different depending on the underlying condition that is being treated.

Some examples of these procedures are described below.

This is a procedure takes place under local anaesthetic and sedation. You will be asked to lie on your back in the catheter laboratory (cath lab) room. You will receive an injection of local anaesthetic in your groin. A small tube (catheter) will be inserted into the vein of your groin which will be moved  into the right side of your heart guided by  x-ray.. The tube  has a sensor at the tip which is able to measure the electrical impulses of the heart (known as an  (EP) study).

Once your doctor has tested the electrical impulses of the heart during the EP study, they will usually proceed to the ablation part of the study. In most cases of atrial flutter, the electrical abnormality is arising from the right side of the heart near the tricuspid valve and it is possible to treat the rhythm problem relatively easily. Your doctor will inform you of their plans for ablation during the procedure.  During the ablation procedure the doctor will use a heat from the tip of the tube and apply it to the area of the heart where the atrial flutter is originating. For the few seconds the heat is applied you may experience slight discomfort but your doctor will talk you through exactly what is happening throughout the procedure. If you find the sensation more painful during the ablation procedure, your doctor can give you  sedation  via a drip in your arm to make you more comfortable.

Once the ablation has taken place the tube  will be removed from the heart and mild pressure will be applied to your groin where the keyhole procedure was performed.

If your atrial flutter is originating in the right side of your heart, then the procedure has around a 95% success rate. Sometimes after the electrophysiology study (EP study), it appears that the atrial flutter arrhythmia is originating from the left side of the heart. If this is the case then your doctor will inform you of this during the procedure. They may decide to go on to perform the procedure on the left side of the heart (this is a similar procedure to ablation for atrial fibrillation – see below) or decide to manage your case with tablets / considering bringing you back another day for the procedure.

Prior to the procedure you will usually be taking blood thinner medication (warfarin or NOAC/DOAC medication). This will usually be continued before and after the procedure but the bookings team will inform  you about this. If you are not sure what to do with your medication please contact the team by calling the telephone number on your appointment letter.

The procedure usually takes 1-2 hours and you will usually stay overnight on the Cardiology ward after the procedure.

Atrial flutter ablation, when performed on the right side of the heart, is considered a low-risk procedure with few complications. Common complications include bruising and bleeding in the groin where the tube was inserted. Rare complications include damage to the electrical conductions fibres of the heart requiring a pacemaker (1 in 200), damage to the blood vessels in the groin (1 in 200 to 1 in 1000), damage to the heart causing blood to accumulate around the heart (pericardial effusion, 1 in 500), stroke (1 in 1000) and death (1 in 10,000).

Main points:

1. A procedure usually performed as a day case under local anaesthetic and sedation.

2. Wires are passed to the heart from the leg, allowing your doctor to make an electrical map of the heart.

3. If an area of the heart responsible for a short-circuit is identified, this can be targeted with the aim of curing an arrhythmia.

You should always talk to your healthcare team about any procedure you're going to have and make sure it is right for you.


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