Some useful websites

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1 MonashHeart, Monash Health is committed to providing outstanding cardiac services for cardiac patients of all ages Some useful websites MonashHealth Every 10 minutes, an Australian dies from cardiovascular disease making it the biggest killer of all Australians MonashHeart treats more acute heart attack patients than anywhere else in Victoria MonashHeart Patient Information Ablation Each year MonashHeart treats over 5700 patients with acute heart problems, the most in Victoria MonashHeart operates one of the busiest cardiac CT scanners in the world MonashHeart is the only cardiac service in Victoria, South Australia and Tasmania to treat heart patients of all ages; from pre birth to our senior citizens Please use this space to write down any questions you may have: MonashHeart is an internationally and nationally recognised leader in cardiovascular research Nearly one in 100 children in Australia are born with a heart defect. Congenital heart disease accounts for 50% of childhood lethal malformations Fundraising Manager Monash Health Locked Bag 29 Clayton South 3169 A Guide For Patients

2 Introduction Your doctor has recommended you proceed to a cardiac ablation procedure. This booklet has been written to help you understand the need for an ablation, and what will happen when you have the procedure. If there is anything you do not understand please ask a member of the MonashHeart team. I support MonashHeart, Monash Health in providing leading care to cardiac patients of all ages. (Donations of $2 or more are tax deductible ABN ) I enclose a cheque/money order made payable to MonashHeart, Monash Health for: $... Please debit my credit/debit card for: $... VISA Mastercard AMEX Diners Card Nos: Expiry: / Cardholders Name:... Cardholders Signature:... Receipt sent to: You may feel sleepy after the procedure. Please make sure you have someone with you who can drive you home afterwards. You should not drive for 24 hours after the procedure as the effects of sedation may persist for many hours. If you have any further questions or concerns about your upcoming ablation procedure, please talk to your local doctor. On the day of the ablation the MonashHeart team will be more than happy to discuss all aspects of the procedure with you. Name:... Address: Postcode:... Phone: Is your donation a gift in memory? Yes No In memory of:... Acknowledgement should be sent to next of kin: Name:... Address:... I give MonashHeart the option of publishing my name in recognition of my support Here s how to make your gift: Call: 1300 MHEART Fax: Post: complete and return this coupon to: Fundraising, MonashHeart, Monash Health, Locked Bag 29, Clayton South 3169 Online: Thank you for supporting MonashHeart

3 What is an ablation? An ablation procedure is usually performed to treat a heart rhythm disturbance (arrhythmia). Arrhythmias often cause symptoms in patients such as palpitations (racing heart), dizzy spells or blackouts and patients may experience these in varying frequencies. There are a variety of rhythm disturbances that an ablation can treat. These include various forms of tachycardia (fast heart beat) such as: Supraventricular tachycardia (SVT) which include: AV nodal re-entry tachycardia (AVNRT) AV re-entry tachycardia (AVRT) Atrial tachycardia (AT) Atrial flutter or atrial fibrillation (AF) Ventricular tachycardia (VT) Rhythm disturbances often involve a portion of abnormal conducting heart tissue. An ablation procedure applies cooling or heating energy via a specialised catheter to a small area of abnormally functioning tissue, causing a small area of scar and rendering the area inactive. This is the means by which an abnormal rhythm can be abolished. The size or area of abnormal tissue can vary, although on the whole it is usually a few millimetres to centimetres long.

4 Why do I need an ablation? Not everyone with an arrhythmia (rhythm disturbance) requires an ablation procedure. Your cardiologist feels that you may benefit from an ablation procedure. Your individual reasons for the procedure should be discussed with your cardiologist or the electrophysiologist (cardiologist trained in rhythm disturbances) who will be performing your procedure. An ablation may be considered if an arrhythmia is not well controlled with lifestyle or medication measures, or if there is a poor tolerance of or desire to stop medications to treat the arrhythmia. A successful ablation may mean a cure from the arrhythmia and/or the elimination of the need for medications. The success rates of an ablation procedure vary depending on the particular arrhythmia. For example, success rates for supraventricular tachycardias (SVT s) are quoted around 90-95% following a single procedure. However, in a minority of patients, additional ablation procedures may be required in the future.

5 What are the risks of having an ablation? In recommending this procedure your cardiologist has balanced the benefits and risks of the procedure against the benefits and risks of not proceeding. Your cardiologist believes there is a net benefit of you having an ablation. The ablation is performed in a well-equipped cardiac catheterisation laboratory with a team of MonashHeart s specially trained health care professionals, including an electrophysiologist (cardiologist trained in rhythm disturbances), cardiac technologists and specialised nurses.

6 The procedure is generally very safe however, a few risks include: minor bruising at the puncture site (common, ie less than 5%) major bruising or swelling (uncommon) pain or discomfort in the chest may occur and is often brief and manageable. Additional pain relief (medication) can be given during the case headache is occasionally associated particularly with cryoablation (cooling) likened to eating a cold ice-cream clots in the leg (deep vein thrombosis (DVT)). Rarely part of this clot may break off and go to the lungs (very uncommon) clots to the brain (stroke). This can cause temporary or permanent disability. It is very uncommon and a risk in a minority of ablations that involve the left side of the heart. It is minimised by treating with blood thinning medication at the time of the procedure heart block. This may require a pacemaker (uncommon). Causing heart block can sometimes be intentional to treat some particular rhythm disturbances a hole in the heart or a valve. This may require surgery to correct (rare) A more detailed list of potential complications can be provided by your treating electrophysiologist. Overall, it can be stated that most complications can be remedied quickly and are rarely life threatening.

7 Preparation for your ablation On the day of your procedure, you will be visited by your electrophysiologist. You and your family will be provided support and advice about what to expect before, during and after your ablation. It is common to combine an electrophysiology study (EPS) with an ablation procedure. The electrophysiologist will explain the procedure and possible complications. You will then be asked to sign a consent form. If you are unsure of anything, ask the electrophysiologist before signing the form. The procedure is undertaken using x-rays, therefore if there is any risk of you being pregnant you must inform a member of the MonashHeart team. Some preparation will be needed before you have your ablation. This will be explained by the nurses caring for you. Before your ablation You must have nothing to eat or drink for at least six hours before your procedure Diabetic patients who are fasting should not take their morning insulin or morning diabetic tablets, but are to bring these medications in with them You will need to remove your clothing and put on a hospital gown You will be transferred to the cardiac catheterisation laboratory on a trolley or bed The procedure may require you to stop some medications. You will be advised by your electrophysiologist if there are medications that should be stopped. Your booking letter will confirm this. Other medications can be continued as normal and you may take these with a sip of water, unless you are instructed to do otherwise.

8 Specific advice for diabetics If you take diabetic medication: please withhold all diabetic medication the morning of your ablation bring your tablets and/or insulin with you on the day of your ablation you will be reviewed by a MonashHeart doctor on your admission who will decide on the timing and dosage of your medications If you need to clarify these instructions, please do not hesitate to contact MonashHeart. In the cardiac catheterisation laboratory The cardiac catheterisation laboratory, commonly called the cath lab, is a specialised x-ray room, where your ablation will be performed. The MonashHeart team involved in your procedure consists of an electrophysiologist, cardiac technologist and specialist nurses. As MonashHeart is part of a teaching hospital, it is not unusual for students, radiographers or other trainees to observe procedures. Your skin will be cleaned with an antiseptic solution and sterile drapes placed around the area of your body where the team will be working. There will be an x-ray camera above you and you will be connected to a heart monitor.

9 Local anaesthetic will be used to numb your skin around the areas where the catheters will be inserted. This will usually be one or both groin areas, and occasionally below the left collar-bone or the right side of the neck. Small cuts (less than 2mm) are made in the skin and small short tubings (sheaths) will be guided through the skin to an underlying vein. Specialised catheters (thin flexible insulated electrodes) are passed through the sheaths and via the veins to various positions in the heart. You will often have more than one sheath or catheter, commonly electrophysiology (EP) catheters and an ablation catheter. The x-ray machine will move above you as the electrophysiologist guides the catheters into place. These catheters are soft and flexible and designed to be gentle to the body. If you feel any pain, please inform the MonashHeart team who can give more local anaesthetic, sedation or pain relief. Prior to the study, or as a result of information gathered from the study, the electrophysiologist is able to determine the site of abnormal tissue responsible for the rhythm disturbance. An ablation catheter can then be directed towards this area and ablation performed. In most cases, the rhythm disturbance may be extinguished, or an adequate scar created in the abnormal tissue to make it inactive. The procedure usually takes about two hours although it can be longer. Sedation or pain relief can be given if you are uncomfortable during the procedure. When the procedure is finished, the catheters and sheaths will be removed and the doctor will apply firm pressure on your skin to ensure there is no bleeding. A clear plastic film (dressing) will be applied over the small entry cuts on the skin. This dressing is waterproof and can be removed the morning after the procedure. The electrophysiologist may tell you test results while in the cardiac cath lab or on your return to the immediate care centre (ICC) or ward.

10 On return to the Immediate Care Centre / Ward You will be instructed to rest in bed for two to four hours so the puncture sites in your groin do not bleed. You will have frequent observations of your pulse, blood pressure and checks made of your puncture sites by the nursing staff. Please let the nurses know if you need the toilet or feel any unusual warmth or dampness in your groin (this may indicate bleeding of the puncture site), or if you feel heart palpitations. A review appointment will be made with your cardiologist usually within six to eight weeks of your ablation and this will be provided to you on an appointment card prior to discharge.