Pre-Procedure / Post-Procedure Instructions |
||
|
AVJ Ablation / Pacemaker Implant Before the procedure: Your healthcare provider might ask you to have your blood work (INR) checked about a week or a few days before your procedure so that we can be sure that your blood is not too thin for the procedure. Medication instructions:
Also, you will be asked not to have anything to eat or drink (including water) for 6-8 hours before your procedure. You may be allowed to take your other medications that morning with a small sip of water, but talk to your doctor first. At the time of your procedure, you will be taken into the EP lab (electrophysiology procedure room). This looks like an operating room, and has special X-ray equipment, and monitors around the room which will be used to help the physicians look at your heart. An intravenous line (IV) will be started in your hand or arm. This will be used to give you sedatives, pain medicine, and heart medicines during the procedure. ECG patches and other monitoring equipment will be attached to you so that the staff can monitor your heart rate and blood pressure during the procedure. These areas on the groin, neck, shoulder or arm may be cleansed and shaved to prepare for the placement of the special procedure catheters or the pacemaker. During the procedure: AVJ Ablation The areas of the skin where the catheters will need to be inserted will be numbed. This may sting at first, but will quickly pass. The special soft, flexible catheters or tubes will be inserted through this numbed area. A very small incision will be made in your skin in order to let catheter be placed into the vein. You may feel pressure but you should not feel any pain. If you do, tell the nurse. The catheters are then passed or advanced into your heart while the physician uses the special x-ray (fluoroscopy) to monitor the catheter’s progress and position.
Using special x-ray (fluoroscopy) to monitor the catheter’s progress, the doctor places the catheter over the AV node (electrical connection between the top and bottom chambers of the heart). Radio-frequency energy (electrical current) is passed through the catheter to heat the tissue at the tip of the catheter (ablation). You may feel stinging or discomfort during some of these “burns”, usually less than a minute, but you should tell the doctor or nurse if you feel pain. This ablation creates a break in the electrical circuit of the heart and a barrier to stop the irregular impulses from getting to the ventricle. Pacemaker implantation
After the procedure: Once the procedure is done, the doctor will remove the catheters from the veins. One of the physicians or nurses will hold pressure over the area where the catheter was inserted while the opening forms a clot. This usually takes 10-20 minutes. You will continue to be monitored during this time. Please let the nurse know if you feel uncomfortable. Once you are fully awake, the nurses will take you back to your room. A heart rhythm monitor will be applied there so that we can continue to monitor your heart rhythm overnight. You will need to lay flat in bed for a few hours (the nurse will give you specific instructions) to prevent bleeding or oozing from the catheter insertion sites. You will be told not to raise your arm or move it very much during those first few hours. You will be need to stay in your hospital bed for 12 hours after the pacemaker is implanted to prevent the leads which were implanted in your heart from coming loose (dislodged). You may have an ice bag placed over your shoulder incision to prevent bruising. Specific information related to the ablation: You may be quite tired for a few days after the procedure. Some people feel aching muscles in their arms, legs or back because they were lying in the same position for several hours. You may notice bruising in the areas where the catheters were inserted. These bruises should resolve in a few weeks. If the bruises get larger, or you notice new bleeding or oozing after you go home, you should call your doctor. If you notice any pain, tingling or numbness in your leg on the side where the catheters were inserted you should call your doctor. Specific information related to the pacemaker : Right after the procedure, you may notice bruising around the pacemaker incision or over the chest, side or arm near the incision. This is normal and will fade over the next few weeks. Sometimes, especially if you take blood thinners, you are more prone to bruising. Call your doctor if you notice that the bruise is getting worse, or if there is a bulging area under the incision –like a golf ball—that wasn’t there before. Please know that even though a pacemaker is small, you can usually see it under the skin, but that is different from a bulging bruise. Call your doctor if you are unsure. You will also want to keep the incision dry for 3 days and watch the incision for signs of infection (redness, swelling, drainage). If you notice any signs of infection please call your doctor or the pacemaker nurse. You will be given specific instructions about your pacemaker and how to take care of it and yourself before you leave the hospital. These instructions will include information about returning to normal activity, how to take care of the incision, and what you need to know about living with a pacemaker. Most people are able to return to most of their normal activities by the third or fourth week after the pacemaker implant. You will be given an appointment to follow up with your doctor or the pacemaker clinic. They will evaluate (interrogate) your pacemaker and make programming changes as needed.
|
The doctor will make a small incision (about 2-3 inches long) in the skin just beneath the collarbone to make a pocket for the pacemaker. A thin flexible coated wire or “lead” will be passed down through a large vein that leads into the heart until it reaches the chamber of the heart that is to be paced.
