Procedures

Ablation for PVCs involves passing 2 or 3 catheters up the femoral vein and inferior vena cava to the heart if the PVC is coming from the right ventricle or passing a catheter up the femoral artery and aorta if the PVC is coming from the left ventricle. To see exactly where the catheter is in the heart an electro-anatomic mapping system uses a magnetic field across the chest to track the movement of the catheter to the nearest millimetre. This means if a patient is having a sufficient number of PVCs, then by moving the catheter around the heart the exact origin of the PVC can be zeroed in on for ablation. The potential risks from a PVC ablation depend on the region it is coming from, but in general the risk of a potentially serious complication such as bleeding around the heart, heart attack or stroke (PVCs from the left side of the heart only) is ?1% and the risk of bleeding or injury in the groin where the catheters are inserted is 1-2%.

You may need to stop taking medication that you have been prescribed for you abnormal heart rhythm and anti-coagulation medications will need to be stopped 24 hours prior to your procedure. However, this will be discussed with you prior to your admission. If this has not been discussed with you, or if you are unsure, please contact the Rhythm and Cardiac Specialists.

You will be required to fast for at least six hours before the procedure. You will be notified by the hospital the day before your procedure to confirm your admission and fasting times. The clinics nurse will contact you one week prior to your procedure to discuss medications and answer any questions you may have leading up to your procedure.

A PVC ablation might take between 1 and 4 hours and is usually performed with local anaesthesia and sedation because general anaesthesia can temporarily suppress the PVCs themselves (put the PVCs to sleep as well). If a patient is having a lot of PVCs at the time of the procedure, then it is generally faster and easier to zero in on its precise location. The long-term success rates for PVC ablation with a single procedure range between 50-90% and depends on the region of the heart it is coming from. It also depends on the frequency of the PVC on the day of the procedure.

You will be transferred to the Electrophysiology Laboratory (EP lab) from your ward. Usually before leaving your ward your groin will be shaved. The lab has a patient table, X-Ray tube, ECG monitors and other equipment. The staff in the lab will all be dressed in hospital theatre clothes and during the procedure will be wearing hats and masks. Many ECG monitoring electrodes will be attached to your chest area and patches to your chest and back. These patches may momentarily feel cool on your skin.

A nurse or doctor will insert an intravenous line usually into the back of your hand. This is needed as a reliable way to give you medications during the study without further injections. You will also be given further sedation if and as required. You will also have a blood-pressure cuff attached to your arm that will automatically inflate at various times throughout the procedure. The oxygen level of your blood will also be measured during the EP study and a small plastic device will be fitted on your finger for this purpose. Your groin area and possibly your neck will be washed with an antiseptic cleansing liquid and you will be covered with a sterile sheet.

The doctor will inject local anaesthetic into the groin area and this will sting momentarily. After that, you may feel pressure as the doctor inserts the catheters but you should not feel pain. The doctor will then insert a special catheter through the vein in your groin area. As this is all internal you will not feel any discomfort. This will pass via your veins up into your heart. The doctor controls its position with the aid of X-ray.

You may have some bruising and discomfort to the groin area and you should avoid strenuous physical activity for at least one week. You will be monitored in the coronary care unit after your procedure overnight, and discharged the following day after review from your Cardiologist.