Ablation
Ablation is a relatively non-invasive procedure that involves inserting catheters – narrow, flexible wires – into a blood vessel, often through a site in the groin or neck, and winding the wire up into the heart. The journey from entry point to heart muscle is navigated by images created by a fluoroscope, an x-ray-like machine that provides continuous, “live” images of the catheter and tissue.

Once the catheter reaches the heart, electrodes at the tip of the catheter gather data and a variety of electrical measurements are made. The data pinpoints the location of the faulty electrical site. During this “electrical mapping,” the cardiac arrhythmia specialist, an electrophysiologist, may sedate the patient and instigate some of the very arrhythmias that are the crux of the problem. The events are safe, given the range of experts and resources close at hand, and are necessary to ensure the precise location of the problematic tissue.

Once the damaged site is confirmed, energy is used to destroy a small amount of tissue, ending the disturbance of electrical flow through the heart and restoring a healthy heart rhythm. This energy may take the form of radiofrequency energy, which cauterizes the tissue, or intense cold, which freezes, or cryoablates the tissue. Other energy sources are being investigated.

Patients rarely report pain, more often describing what they feel as discomfort. Some watch much of the procedure on monitors and occasionally ask questions. After the procedure, a patient remains still for four to six hours to ensure the entry point incision begins to heal properly. Once mobile again, patients may feel stiff and achy from lying still for hours.

Balloon Angioplasty / Atherectomy (PTCA)
A Coronary Balloon Angioplasty (PTCA) is a minimally invasive procedure that is done to open a heart artery that has been narrowed by plaque. It also can be done to reduce the risk of a heart attack or to prevent further heart damage. This increases the amount of blood flow through your coronary arteries. The physician will determine if you need this procedure after reviewing the X-ray pictures from your cardiac catheterization.

A flexible tube (guiding catheter) is inserted into the artery through the sheath and guided towards the blocked area within the artery. The physician is able to view the procedure using the X-ray images on a monitor. There is a deflated balloon at the tip which is inflated to open up the blockage by compressing the plaque and stretching the artery open. It is then deflated and removed. Some patients will require stent placement to help keep the artery open. (See stent implantation)

This procedure can take 30 minutes to an hour. An overnight stay in the hospital is required.

Sometimes prior to a balloon angioplasty, an Atherectomy is done. The catheter for this procedure has a coarse burr near its tip. The physician uses this device to shave the plaque inside the artery into small bits. These bits are carried away in the bloodstream. A stent may also be placed after this procedure. An Atherectomy along with balloon angioplasty and stenting can take one to two hours to complete.
Incision care and discharge instructions should be given to you prior to leaving the hospital. Please ask the hospital staff and or physician if you have questions.

Coronary Catheterization or Coronary Angiogram
Cardiac Catheterization or Coronary Angiogram is a minimally invasive procedure that allows the physician to see the blood flow through your coronary arteries and the inside of your heart as it pumps. It also can help to determine if any of the blood vessels are blocked, if the heart valves are working properly, if the heart has been damaged by disease or if you were born with a heart defect.

Information will be given to you by the physician's office regarding the instructions to follow prior to the procedure. If you have any questions, please give our office a call.
The procedure is done in a special area of the hospital. A small intravenous (IV) catheter is inserted into your arm or hand so fluid and/or medication can be given as needed. Medication can be given to help you relax; however, you will need to be awake during the procedure. Electrodes will be placed on your arms and legs so the staff can monitor your heart rhythm. Numbing medication will be injected into the skin at the site where the catheter will be inserted. This will either be in your arm or groin (most common site). A small opening is made in the artery in this area and a small hollow tube (sheath) is placed into the blood vessel. A thin flexible tube (catheter) is then inserted and guided through until it reaches the heart. Once there, dye, which is visible to X-ray, is injected into the heart. Pictures are then taken and reviewed by the physician.

The catheterization can take about 20 minutes to an hour. There are several methods to close the puncture site in the artery; pressure and bed rest, stitches or a collagen plug. The physician will determine the method which is best for you.
Incision care and discharge instructions should be given to you prior to leaving the hospital. Please ask the hospital staff and/or physician if you have any questions.

Electrophysiology Study
This study is performed after giving local anesthesia and conscious sedation to keep the patient as comfortable as possible. The procedure involves inserting a catheter – a narrow, flexible tube – attached to electricity monitoring electrodes, into a blood vessel, often through a site in the groin or neck, and winding the catheter wire up into the heart. The journey from entry point to heart muscle is navigated by images created by a fluoroscope, an x-ray-like machine that provides continuous, “live” images of the catheter and heart muscle. Once the catheter reaches the heart, electrodes at its tip gather data and a variety of electrical measurements are made. These data pinpoint the location of the faulty electrical site. During this “electrical mapping,” the cardiac arrhythmia specialist, an electrophysiologist, may instigate, through pacing (the use of tiny electrical impulses), some of the very arrhythmias that are the crux of the problem. The events are safe, given the range of experts and resources close at hand and are necessary to ensure the precise location of the problematic tissue.

Once the damaged site or sites are confirmed, the specialist may administer different medications or electrical impulses to determine their ability to halt the arrhythmia and restore normal heart rhythm. Based on this data, as well as information garnered before the study, sometimes the specialist will proceed to place an implantable cardioverter device (ICD) or a pacemaker or will perform radiofrequency ablation. In any case, the information proves useful for diagnosis and treatment.

Throughout the procedure, the patient is sedated but awake and remains still. Patients rarely report pain, more often describing what they feel as discomfort. Some watch the procedure on monitors and occasionally ask questions. Others sleep. The procedure usually takes about two hours. The patient remains still for four to six hours afterward to ensure the entry point incision begins to heal properly. Once mobile again, patients may feel stiff and achy from lying still for hours.

Coronary Stent Implantation
The need for a coronary stent is determined by the physician after reviewing cardiac catheterization images. They are inserted after most balloon angioplasties. Stents are small, metal, spring-like devices about the size of a spring in an ink pen. Some patients think they look like a small chain link fence rolled into a tube. They are used to help prevent the coronary artery from narrowing again (restenosis). There are different sizes and types of stents. Drug eluting stents are coated in a medication to help reduce the amount of scar tissue that forms in the artery. The type of stent that is used will be determined by the physician.

During the procedure, the stent is mounted on a balloon-tipped catheter. The physician moves the catheter into the area of the blockage and inflates the balloon. This causes the stent to expand and press against the artery wall. The balloon is then deflated and withdrawn, leaving the stent in place to hold the artery open and allow blood flow through the artery. X-ray pictures are taken again to evaluate the improvement of blood flow.

The procedure can take approximately 60 to 90 minutes to complete if done with a balloon angioplasty. An overnight stay in the hospital will be required.
To reduce the risk of a blood clot from forming inside your stent, the physician may prescribe an anti-platelet medication for you take to make the platelets in the blood less sticky. Other medication changes may also be suggested by the physician. These medications are extremely important and should not be stopped or adjusted without consulting your cardiologist.

Incision care and discharge instructions will be given to you prior to leaving the hospital. Please ask the hospital staff or physician if you have any questions.