Advice and questions – Clinicco Hospital

Frequently asked questions
Advice for the patients

Electrophysiology

What is electrophysiology?

Electrophysiologic studies are procedures used to identify types of arrhythmias by testing the electrical activity of the heart in order to discover the origin of a certain abnormal cardiac rhythm.

What is the purpose of an electrophysiologic study?

To determine the cause of an arrhythmia;
To determine the degree of efficiency of certain medication in treating arrhythmias;
To treat a certain condition by destroying the tissue inside the heart that is responsible for the abnormal electrical signals;
To establish if a pacemaker or a cardiac defibrillator can represent a solution for the identified type of arrhythmia;
To determine whether the patient presents with risks of sudden cardiac death due to cardiac arrest and if s/he does, to determine the degree of this risk.

How is it performed?

This type of procedure consists of introducing a catheter (a thin tube) through a blood vein, up to the inside of the heart. An electrode is used to send electrical signals to the heart and its activity is then monitored.

What recommendations do the patients receive after undergoing an electrophysiologic study?

The results of these tests help determine a correct diagnosis and, implicitly, an adequate treatment that can consist of medication, the implantation of a pacemaker, a cardiac defibrillator, ablation or surgery.

Implantable Cardioverter-Defibrillator

What is a cardiac defibrillator?

This device offers an effective protection against these dangerous heart rhythm irregularities, with very fast frequencies. The device avoids or stops, in time, fast ventricular arrhythmias and restores the normal heart rhythm. The possibility of implanting a defibrillator has saved the lives of thousands of people in the last few years.

The heart rhythm can either be too fast or too slow; the latter is called bradycardia. In this case, the heart has a frequency of less than 60 heartbeats per minute. In general, for healthy people, these frequencies do not have negative consequences (e.g. during sleep or in athletes, the cardiac frequency can go below 60 without any related issues). However, there are certain heart conditions that determine a very low heart rhythm that can have severe consequences on the patient. These conditions include the sick sinus syndrome and absolute bradycardia.

How does the implantable cardiac defibrillator work?

The electrical impulse generator is introduced under the skin (subcutaneously) in the area of the chest muscles. Usually, local anaesthesia is enough for this procedure. However, in some cases, general anaesthesia may be required.

The cardiac defibrillator is connected to the heart through electrodes. During the surgery, they are introduced through a vein inside the heart. The defibrillator is then tested and adjusted depending on the characteristics of each patient. Most of the patients can leave the hospital after two or three days.

What happens when the battery runs out?

The battery of an implantable defibrillator operates between 5 and 10 years. This depends on the type and on the frequency of electrical impulses generated by the device. The defibrillator has been designed to record and notify the user when the battery needs changing, with enough time in advance.

Taking into account the fact that the battery is an essential part of the defibrillator, during the procedure of changing it, the entire device will be replaced. In this case, the cardiologist makes an incision over the old scar and removes the old defibrillator. The electrodes are placed as well as possible and then they are checked. Next, the new device is connected, tested and inserted in the already existing pocket. The electrodes are replaced only under exceptional situations.

Pacemaker

What is a cardiac pacemaker?

The cardiac pacemaker can identify irregularities in the heart rhythm and send its own electrical impulses in order to make the heart beat normally and exactly once again. The cardiac pacemaker generates or creates an electrical impulse. It is made up of computer chips and a small battery, all in a sealed box, with a long period of operation.

The cardiac pacemaker is implanted surgically in the superior part of the chest or in the abdomen. The impulse that it generates is transferred through special wires called electrodes (conductors) that are usually placed inside the heart. The electrodes also help the impulse generator feel the heart rhythm. This is very important because the device must send the impulse at the exact, adequate moment.

Why the need for a cardiac pacemaker?

If you have a low or abnormal heart rhythm that causes fainting, dizziness, fatigue, difficul breathing (dyspnoea), palpitations or loss of consciousness, you might need a cardiac pacemaker. In many cases, a cardiac pacemaker can help the heart beat normally once again.

How does the cardiac pacemaker know when to generate the impulse?

The cardiac pacemaker can "feel" the heart's rhythm. Pacemakers can be "programmed" to generate impulses or to wait for the heart to beat on its own. Certain cardiac pacemakers can feel the patient's activity - e.g. when the patient is climbing up the stairs or when s/he is working out - thus they are able to increase or decrease the heart rhythm.

After implanting the pacemaker into the body, its settings can be changed. The physicians and the clinicians communicate with the pacemaker through a programming device (programmer). This is a computer with a device (baton) that transfers signals throughout the body to the cardiac pacemaker. The procedure is painless. The software also displays the information about the heart that the pacemaker was able to collect.

How do you feel the pulse?

The majority of people do not feel their pulse at all. The electrical impulse of a pacemaker is very small. If you feel the impulse, your physician or your clinician can change the settings in order for you to feel more comfortable.

What happens when the battery runs low?

Usually, the cardiac pacemaker operates between five and ten years. The operation period depends on the type of battery, on how often it sends impulses, on the patient's health status and on other factors.

The battery does not stop suddenly. It discharges gradually throughout several months. Usually the period is sufficient in order to be able to schedule a replacement. The physicians and the clinicians check the battery at every monitoring examination. When the battery level lowers, the cardiac pacemaker must be replaced and you will need to undergo another intervention.

Risks and benefits

Cardiac pacemakers do not represent a treatment for heart conditions. They do not treat the cause of low or irregular heart rhythms. However, since they can keep the heart pumping for years and years, pacemakers can improve very much the quality of life of the patients suffering from arrhythmia.

What are the benefits of a cardiac pacemaker?

The cardiac pacemaker improves the heart's capacity to pump regularly and in time. Some people are entirely dependent on pacemakers to make their hearts beat. For most of the patients, the symptoms of dizziness, vertigo and fainting disappear. Some patients feel that they have more energy. The cardiac pacemaker can also give the patient the feeling of "peace of mind", because they feel safer with the cardiac pacemaker keeping their heart operating.

What are the risks of a cardiac pacemaker?

A small number of patients develop complications as a result of the implantation of a cardiac pacemaker and of the electrodes present in their bodies. Such complications include infections, reactions to certain medicines used during surgery, blood loss or deterioration of a blood vein, of the heart wall or of other organs. Such complications can usually be corrected or healed. After surgery you might feel a slight discomfort or fatigue, but it passes quickly. Nevertheless, some patients continue to feel some discomfort in the area where the pacemaker was implanted.

Modern pacemakers have many safety characteristics. Sometimes, the pacemaker might not operate adequately because it is affected by external sources of electromagnetic energy. It is also possible for the top of the electrode to have changed inside the heart and thus, the impulse does no longer have any effect. Rarely, the device can get out of the chest "pocket".

And finally, please bear in mind that these devices are made by human beings. It is very important to monitor these devices regularly, during monitoring examinations, as often as the physician recommends it.

Please contact your physician if:

You experience fatigue, difficult breathing or your heart rhythm changes;
You notice that the wound is red, hot, swollen, more painful or it starts festering;
You notice that the symptoms you used to have before the implantation of the cardiac pacemaker reappear.

ADVICE REGARDING ELECTROPHYSIOLOGIC TESTS

How do we prepare for an electrophysiologic test?

The patient shall be informed with regard to all the medication that can be administered in the days preceding the investigation;
In certain cases, the physician can interrupt the administration of certain medication for three to five days before the investigation. For example, patients suffering from diabetes need to request information regarding the administration of the medication specific of their pathology;
Patients are not allowed to eat on the evening before the investigation;
If the patient does not comply with the medical indications regarding the preparation for this investigation, results may be inconclusive.

How is the test performed?

The electrophysiologic study lasts approximately 45 – 50 minutes. The patient undergoing the investigation receives local anaesthesia in the area of the puncture, usually at the level of the femur. Through this area we insert two catheters in a larger blood vein, which are then manoeuvred inside the heart. The catheters are similar to flexible, smooth cables, two millimetres in diameter. They are manipulated through radioscopy and they are used to constantly register the cardiac activity and the electrical stimulation, through a connection to an external stimulator. Moreover, in order to determine the diagnosis, we need to administer certain pharmacological substances during the procedure.

What are the risks?

The benefits of this procedure are superior to the risks and this is why we consider that the procedure should be performed. Puncturing the cutaneous tissue can lead to certain complications such as: the formation of a local haematoma that resorbs itself in time. Major complications are purely exceptional, 1 in 3,000 cases, and they involve haemorrhage that requires transfusions, pulmonary embolism or systemic embolism and cardiac perforation that requires cardiac tamponade. The medical personnel are prepared for any complications and they have all the necessary means to solve the problem.

Results obtained

Electrophysiologic studies are investigations used to determine types of arrhythmias by testing the electrical activity of the heart, in order to discover the place of origin of a certain abnormal cardiac rhythm. The electrophysiologic test can significantly diminish the risk of spontaneous arrhythmias and helps the medical personnel offer the most adequate treatment to the patients.

When does the patient sign the consent form?

The patient signs the consent form for this test before taking the test;
Before signing the consent form, patients should not hesitate to request additional information in relation thereof.

ADVICE after receiving a CARDIAC PACEMAKER implantation

What happens after I get back home?

In the first days or weeks after the surgery you need to recover. The wound will heal gradually. You will start feeling better. At first, you might be aware of the presence of the pacemaker, but in time, you won't even notice it anymore. Immediately after surgery you should:

Keep the wound clean and dry. If you notice that the wound is red, hot, swollen, more painful or it stars leaking, contact your physician immediately;
Follow the instruction regarding bathing, dressing and resuming activities;
Make only slow movements with the arm that is closer to the cardiac pacemaker. Avoid stretching, lifting weights and making sudden movements. As you heal, start increasing the use of the arm gradually;
Do not play with the pacemaker and do not move it underneath the skin. Try not to hit it or to crash into it;
Respect your physician appointments;
Keep the cardiac pacemaker identification card with you at all times;
If your health does not improve, contact your physician. Do not wait for the monitoring visits;

What happens during monitoring visits?

Monitoring visits usually take place at the physician's office or at the clinic. The examination is painless. After a short exam, the clinician or the physician attach the ECG electrodes to your chest. Then, s/he puts the baton on the chest and uses the programming device (the computer that communicated with the cardiac pacemaker) to display and print the information received about the heart and about the cardiac pacemaker. Using this information, the physician can check the pacemaker's settings. If certain changes need to be made, they can be made on the spot. The physician will also check the pacemaker's battery. Inform the physician or the clinician of any problems related to the cardiac pacemaker, the heart or to your general health status. This is also a good time to ask questions about the cardiac pacemaker.

When can I go back to the life I had before?

The recovery period is different for each person, but you should be able to get back to your normal life, with a few minor changes. The wound must be completely healed before resuming your daily normal activities. Talk to your physician about the moment you can go back to work, to driving the car, to doing physical exercises or to going on trips.

ADVICE after receiving a CARDIAC DEFIBRILLATOR implantation

After leaving the hospital you have to take a few months to get used to the situation. Talk to your family and friends about the defibrillator. Although this device cannot heal your disease, it can offer you a high level of safety. Initial doubts and fears can often be overcome through conversation. Most of the patients adapt quickly to the defibrillator. For them, this is their only chance at having an active life once again. In the majority of cases, the defibrillator can prevent the effect of certain potential tachycardias, thus the patients' quality of life improves significantly.

CHANGE OF HABITS

Immediately after surgery you have to pay attention to several things. You have to monitor the scar and to inform the physician if it becomes red, if it swells or if it festers. In the first few days you shouldn't move the shoulder that is closest to the implantation too much in order not to affect the healing process. Afterwards you can move freely, since the shoulder's mobility is not restricted. In the beginning, you also shouldn't lift heavy objects. After you have discussed it with your physician, strolls, sports and baths will no longer represent a problem. Your clothes shouldn't be too tight around the shoulder, in order to prevent irritation. Do not stretch your arms too much, as this can cause an unfavourable tension to the electrodes. After the scar is completely healed, nothing will stop you from resuming an active lifestyle. As long as your physician has no objections and as long as you feeling good, you can do whatever you want. With a defibrillator implantation most of the patients can improve their level of activity, since the defibrillator eliminates the fear of finding oneself helpless during an arrhythmic attack. The most important aspect of resuming your normal lifestyle is that you should feel better regardless of what you do.

WORK, PROFESSIONAL ACTIVITY AND HOUSE ACTIVITIES

You can start being active at work and at home, once again. It is true that you should avoid several activities, such as climbing scaffolds or ladders, welding or navigating alone, because during these activities a short moment of dizziness can put your and the others in jeopardy. You can do your daily shopping without any problem. Usually, the burglar-proof devices in shops do not represent a risk for the patients with defibrillator implants. However, just to be sure, you should pass quickly through these areas, without stopping. Other activities, such as using the computer or the house equipment are possible without any problems. Virtually, your defibrillator cannot be influenced by the vicinity of any usual electromagnetic fields. Nevertheless, a minimum distance of an arm's length should be kept from certain pieces of equipment. You can also resume your old means of entertainment. As a defibrillator carrier you can use household equipment without any problem, as long as they are adequately grounded and you do not try to repair them.

WHAT SHOULD I DO IN CASE OF EMERGENCY?

In case of tachycardia, the defibrillator will try to stop in a gentle manner, through anti-tachycardia stimulation. If this does not work, the defibrillator will apply an electric shock of cardioversion or defibrillation. In this case, you have to pay attention to the following things:

Find a place where you can relax, even lie down, if possible;
Ask someone to stay with you and to call for an ambulance in case the problem persists;
Call your physician if you are not feeling good after the defibrillator has acted;
If you feel good after the defibrillator has acted, there is no need to call the physician. If you consider that it is necessary, you can call your physician in order to let him/her know what has happened. The physician might ask things such as:
- What were you doing before the defibrillator acted?
- What did you feel (fear, nausea, palpitations, weakness etc.)?
- How are you feeling after the event?

Patients usually understand that this action is necessary and they accept it. After all, it is the rhythm irregularity that is dangerous, not the defibrillator. This is also valid for the fainting sensation that might occur. It is caused by the arrhythmia, not by the defibrillation. The defibrillator gives the sense of security in critical situations. Patients feel the shock of the defibrillator in various ways. The electrical impulse can be perceived as a strong and painful punch in the chest. The chest muscles and those of the superior part of the arm can contract in such a strong manner that you might be frightened. As long as this means that the defibrillator is working, you shouldn't be alarmed.

Advice and questions - Electrophysiology and implantable devices