Frequently Asked Questions

General

If there is an acute emergency the best thing to do is immediately contact 911. If you think you may be having a heart attack also immediately call 911. When the paramedics arrive or you are seen in the emergency room you should then notify them who your cardiologist is so they can directly notify our physicians.

Yes. We have physicians available 24 hours a day for acute care needs. There is also a physician always available from our group to perform an emergency procedure for an acute heart attack. Please let the paramedics or emergency room staff know who your cardiologist is so they can notify the physician on call.

Yes. We have physicians available every weekend and holiday to care for all of your inpatient needs. This may not be your primary cardiologist, however he has informed the on call physician about your current in-hospital stay and out patient records are always available if needed.

Yes. After every visit a letter is dictated and sent to your primary care physician. We are also in frequent telephone contact with them as well. Our physicians also work closely in the hospital setting with your primary care physician if you are hospitalized. If you do not have a primary care physician you cardiologist can recommend one for you. If you switch primary physicians please notify our staff so we can arrange to have further evaluations sent correctly.

Nearly all of your non-invasive heart tests will be completed in our offices. Our front office staff will help make all the arrangements for you and supply you with confirmation as well as any direction that may be necessary. All invasive procedures are completed at the Gwinnett Medical Center.

We offer a complete blood lab in our office. If we are not able to accommodate a specific lab test for you our front office staff will be happy to arrange testing for you.

If you need a refill of you heart medicines please contact our medical assistants or log on to your account at the Relay Health website. They will then notify your physician who can authorize refills for you. When you see your physician in the office it is always best to bring your medications with you. Our medical assistants will then update your chart and notify the doctor if medications will need to be reordered.

No. While we work closely with many primary care physicians in the community you do not need a referral to have an evaluation with our physicians.

Please see our list of approved insurance carriers. We currently offer care for Medicare and PPO insurance. If you have any questions, do not hesitate to contact our business department and they will be happy to assist you.

If this is the case please contact our business department. They can often assist you with a payment program fitted to your needs.

Unfortunately, this can be rather confusing for a patient. Certainly when one complains of chest pain but tickly on the left side of the chest When's immediate concern is whether this is coming from the heart or not. We are all aware of the typical description of hot chest pain. This is a pressure a band like sensation across the chest which may be associated with radiation of the pain to the neck or the left arm. There are also associated symptoms of shortness of breath, cold clammy sweat and nausea which could occur along with the symptoms. However, unfortunately for patients and doctors, the heart does not always abide by the textbook explanation. Heart chest pain can mimic indigestion in that it could be burning in sensation. It does not necessarily have to be left sided. It can be located behind the breastbone or even on the right side of the chest. In addition it could be stabbing in nature. Heart pain coming from a lack of blood to the heart doesn't typically last seconds in time. The heart is a muscle and works on supplied and demand. Usually chest discomfort originating from the heart, will first occur when one is exerting oneself.

There are different characteristics and precipitating factors that we as physicians ask the patients when trying to determine whether the chest pain is truly due to a lack of blood to the heart or not. There are multiple other causes of chest pain. With respect to the heart, one can also experience chest pain secondary to inflammation of the outer sac of the heart, called pericarditis. This pain is typically worse when one lies down and better on sitting up. The most common cause is a viral syndrome. Therefore, it is usually preceded by a fever or cold or flu like symptoms.

Chest discomfort after eating or lying in bed, typically is due to indigestion or heartburn. This is more a burning sensation that occurs behind the breastbone and may radiate up to the jaw. Gallbladder pain may also occur after eating, particularly a fatty meal. This pain is usually more right sided and may radiate to the shoulder blade. It is commonly associated with nausea. Chest pain immediately below the breastbone or to the left side of the upper abdomen that is resolved with eating is usually due to inflammation of the stomach or possibly an ulcer, Chest pain that is worse when one takes a deep breath or cough's is usually due to a lung cause of the pain. This could be due to inflammation of the outer sac of the lung. This condition is called pleurisy. This is most commonly caused by a viral infection. Finally, one could experience any type of superficial pain of the chest wall, either due to muscle, bone or nerve injury. In the case of females, the breasts can definitely produce chest pain in the location of the heart.

An EKG is a snapshot of the electric patterns in your heart that make it beat. It is a routine test in any cardiac evaluation. You can expect to have one during an initial evaluation and any time there is a change in symptoms. It is also used to monitor effects of certain medications. The test is administered by a medical assistant or nurse in the office. It allows us to look at for irregularities in the electrical rhythm of your heart as well as give us clues to structural abnormalities of the heart.

Heart failure is when heart is not able to pump efficiently to circulate oxygen rich blood to different organs of the body. Simply heart is not able to keep up with its workload.

" Shortness of breath " Easy fatigability " Coughing especially lying down " Swelling in the ankles " Weight gain " Loss of appetite " Heart beating fast " Exercise intolerance

Some of the common causes are: " Heart muscle weakness( Cardiomyopathy) " Stiffness of the heart " Valvular abnormalities like leaky valves or stenosis of the valves " Problems with the electrical system of the heart (Arrhythmias ) " Arterial blockages and heart attacks " High blood pressure problems " Congenital heart defects " Infections " Obesity " Nutritional deficiencies

" Treatment depends on the cause and symptoms " Lifestyle changes help to decrease the signs and symptoms as well as some times to reverse the causes of heart failure " Medications like Ace inhibitors, beta blockers, angiotensin receptor blockers, diuretics or water pills, antiarrhythmic medications. " Implantation of devices like pacemakers, defibrillators in severe cases artificial heart(LVAD) may be an option " In severe and refractory cases heart transplant can be considered for selected patients

" Taking medications regularly as prescribed. " Checking weight on the regular basis and watch for any unusual weight gain of more than 2 pounds in 24 hours. " Let physician know if there is any increase in shortness of breath, lower extremity edema, or significant weight gain " Follow low salt diet " Controlling blood pressure, blood sugars and treating underlying like sleep apnea

" Dietary changes like following low salt diet. " Not to smoke, abuse alcohol and being physically active " Treating underlying conditions like high blood pressure, diabetes, sleep apnea, arrhythmias. " Controlling stress as it may increase blood pressure, increase his risk of heart attack

" Highly variable depends on the etiology, risk factor modification, lifestyle changes and compliance with the medications " Without treatment or if underlying conditions are not correctable heart failure can become progressively worse and eventually fatal condition. Please discuss with your health care provider for specific treatment options.

In various heart diseases, there can be an increased risk of sudden cardiac arrest. A cardiac arrest typically is due to an electrical storm in the ventricles, the main pumping chambers of the heart. When this occurs, the heart essentially stops beating and if left uninterrupted results in almost immediate death. An implantable defibrillator (or ICD) can protect you.

Implantation is very similar to pacemaker implantation. The ICD is typically implanted beneath the skin through a small incision below the collar bone. A lead is then threaded through a vein to the heart where it touches the lining of the heart. This lead allows the defibrillator to sense the heartbeat. If an electrical storm in the heart is detected, the defibrillator can charge up and shock the heart to reset it. It's almost like having a paramedic on standby. The procedure is done with sedation and local anesthetic. Depending on the situation, you may be able to go home the same day or may need to stay overnight.

There is usually only minimal pain after implantation and perhaps some mild swelling at the site. You will be given some pain medication to be used if needed. You will typically wear a sling for a few days. you should avoid lifting over 10 lb and keep the elbow below shoulder level for 3 weeks. Avoid extremely vigorous activity like a full golf swing for a couple of months more. You will typically be seen in the office within the next couple of weeks, but in the end, ICDs are followed usually in our device clinic between once and twice a year. Home monitoring is also available to augment office checks.

Pacemakers are used to prevent a slow heartbeat. A slow heartbeat is caused either by the natural pacemaker of your heart, the sinus node, firing to slowly, or because those electrical impulses don't make it reliably from the upper chambers, the atria, to the lower chambers, the ventricles.

A pacemaker is typically implanted beneath the skin through a small incision below the collar bone. Pacemaker leads are then threaded through a vein to the heart where they touch the lining of the heart. These wires allow the pacemaker to sense the heartbeat and stimulate the heart to beat if it is too slow. The procedure is done with sedation and local anesthetic. Depending on the situation, you may be able to go home the same day or may need to stay overnight.

There is usually only minimal pain after implantation and perhaps some mild swelling at the site. You will be given some pain medication to be used if needed. You will typically wear a sling for a few days. you should avoid lifting over 10 lb and keep the elbow below shoulder level for 3 weeks. Avoid extremely vigorous activity like a full golf swing for a couple of months more. You will typically be seen in the office within the next couple of weeks, but in the end, pacemakers are followed usually in our device clinic between once and twice a year. Home monitoring is also available to augment office checks.

The main pumping chamber of the heart is the left ventricle. But the effectiveness of that pump is compromised if the sides of the left ventricle don't squeeze at exactly the same time. This lack of synchronization not only affects the output of the heart, but can actually lead to progressive weakening and enlargement of the heart. When that lack of synchronization is because of a delay of the electrical signal directing the heartbeat, it can be corrected by a special pacemaker, known as a biventricular pacemaker. This is also referred to as cardiac resynchronization therapy. This pacing technique can be applied to both pacemakers and implantable defibrillators.

At the time of either pacemaker or defibrillator implantation, an extra “third wire” also known as a left ventricular lead is placed. This is threaded to the heart the same way as other pacemaker or defibrillator leads, except it is then further threaded from the right atrium into another vein that leads to the surface of the left ventricle. It's a little more tricky to get that third wire in place, but is achievable in about 95% of cases. Otherwise, the rest of the procedures the same as standard pacemaker or defibrillator implantation. Please see descriptions of those procedures.

Please see defibrillator or pacemaker implantation for details. However, unique to biventricular pacing, the left ventricular lead passes very close to a nerve that runs along surface of the heart from the spine all the way down to the diaphragm. This is called the phrenic nerve. If it is stimulated by the left ventricular leave, it can cause a twitch of the left side of the diaphragm with every heartbeat. This is not dangerous, but can be quite aggravating. It can usually be corrected by reprogramming the pacemaker or defibrillator in the office. It is because of the potential for phrenic nerve stimulation that we frequently watch people overnight.

" Heart disease is the leading cause of death in United States, responsible for 1 and 4 female deaths " Same number of women and men die of heart disease each ear " Two thirds of women who die suddenly of heart disease have no previous symptoms. " About 6% of white women, 8% of African-American women, 6% of Mexican American women have coronary artery disease

More women present with atypical symptoms, than men. Some women have no symptoms with heart disease. Common Heart attack symptoms in women can be pressure in the chest, shortness of breath, jaw pain, throat pain, pain in the upper abdomen or back. Pain can be sharp, dull, burning or indigestion like. These episodes can occur during rest or during physical activity or can be triggered by mental stress.

Hypertension. High cholesterol. Smoking. Diabetes. Excessive alcohol use. Physical inactivity. Overweight and obesity. Poor diet.

Women develop heart disease 10 years later than men. Microvascular disease, disease of small arteries in the heart is more common in women. Mitral valve prolapse is more common in women. Broken heart syndrome or Stress induced cardiomyopathy where extreme emotional stress can lead to heart muscle failure is more common in women. Palpitations are more common in women. Risk factor modification, lifestyle changes, medical treatment, surgical procedures can help women to lower the risk of heart disease mortality and improve symptoms like in men. So, early prevention, diagnosis and treatment are important to improve survival.

CARDIAC CATHETERIZATION

Yes. All of our physicians have staff privileges at the Gwinnett Medical Center. Depending on your diagnosis you may see one of the other partners in conjunction with your primary cardiologist.

We recommend letting the physician at this facility know who your primary cardiologist is. That physician will then notify us regarding your current illness. If necessary we can make arrangements to have you then transferred to continue your care?

If there is an urgent need that does not require evaluation in a hospital setting we can often make accommodations for you. Please call our front office to assist you with an appointment. You will then be seen by either our physician assistant or the physician who is available that day in our office. However, if you think there is an emergency it is best to call 911 and our staff will see you urgently in the emergency room.

A cardiac catheterization is a minimally invasive procedure in which your doctor will insert a tube into the large artery in your groin or the small artery in your wrist in order to take pictures of the arteries of the heart, measure pressures in the heart and lungs and sometimes take a picture of the pumping chamber of the heart.

Your doctor could order a cardiac catheterization for a number of reasons. 1) To determine whether there are blockages in the arteries that feed the heart 2) To measure the pressures in the heart and the lungs 3) To measure pressure differences across the valves of the heart

The procedure is performed in the hospital in a specialized room with an x-ray camera and sterile instruments.

The procedure is performed with conscious sedation. This means that you will get medications to help relax you and to help with pain. In addition, local anesthetic will be administered to the area of access, either the groin or the wrist. Many people don't remember much of the procedure afterward because of the sedation that is administered.

For patients undergoing cardiac catheterization electively, the risk of complications is low. The most common complications include bleeding or discomfort at the site of access, either in the groin or the wrist. Rarely these bleeding complications require a blood transfusion or surgery to fix the artery. Less common, though more dangerous, complications can occur, including stroke, heart attack or even death. You should talk to your doctor about these risks.

The great majority of procedures are done to determine whether there are significant blockages in the arteries that feed your heart. If your doctor finds a severe blockage, he or she may open that blockage with a balloon and stent, which is a small tube of metal inserted to keep the artery open. If your doctor finds several severe blockages, he or she may suggest you have coronary bypass surgery.

Most patients spend a couple of hours in the recovery unit following a cardiac catheterization. If your procedure was done via the large artery in the groin, your doctor may have inserted a device or stitch to seal the hole that was made. If this is the case, he will lay flat for a couple of hours. If the tube was left in the groin and had to be pulled, he will lay flat for 4 hours or so following the procedure. You should drive or lift heavy objects for a few days following the procedure. If your procedure was done via the small artery in the wrist, he or she will have a band over the artery in the wrist hold pressure on the artery. In the days following the procedure, you may feel some discomfort at the access site. There will also possibly be some bruising in the groin or over the wrist. If you feel a lump form, you should call your doctor's office to let them know. If there is significant bleeding, you should hold pressure and call your doctor's office or 911.

STRESS TESTS

Nuclear stress tests are ordered to look for blocked heart arteries

You need to arrive fasting and wearing comfortable clothes. Part of the heart is behind the stomach. Food in the stomach will result in poor images and possibly giving an inaccurate result. You should avoid any liquids except a minimal amount of water.

Yes you should take your regularly scheduled meds the day of the test. There are 2 EXCEPTIONS: 1. Because you are fasting you need to AVOID taking your diabetic meds. However you should bring your diabetic meds to the test. There will be a time during the test when you are able to eat and you will need the diabetic medicine at that point. 2. If you are doing a treadmill stress test we need to increase your heart rate for an accurate test. You should hold your beta-blocker (metoprolol, atenolol, coreg) the evening before and the morning of the test.

In a stress test the doctor compares symptoms, your ecg, and images of your heart both at rest and after exercising. The heart can be exercised via treadmill or if unable to use a treadmill using chemical to simulate exercise. You should expect to to be present for 2-3 hours. You will need to lay flat, preferrably with your arms above your head, for a set of resting images and a second set of images after stress.

Within a day or 2 after completing the test you should be contacted with your results. If you are not, please call for your results.

An EKG is a snapshot of the electric patterns in your heart that make it beat. It is a routine test in any cardiac evaluation. You can expect to have one during an initial evaluation and any time there is a change in symptoms. It is also used to monitor effects of certain medications. The test is administered by a medical assistant or nurse in the office. It allows us to look at for irregularities in the electrical rhythm of your heart as well as give us clues to structural abnormalities of the heart.

There are several types of stress tests that we perform. Some involve getting on a treadmill, while others involve medicine put into a vein. During the stress test, we look at your heart different techniques, including ECGs, ultrasound, or nuclear images.

Different types of stress tests last different amounts of time and can vary from 30 minutes to over 3 hours.

Please wear comfortable clothes and shoes that you are able to walk and run in.

HEART STRUCTURE TESTS

In adult cardiology, structural heart disease usually pertains to disorders of the valves of the heart or to holes in the heart that should have closed either during gestation or shortly after birth.

The most common forms of structural heart disease seen in adults in the United States are disorders of the aortic and mitral valves. Less commonly treated structural heart disorders include patent foramen ovale is and atrial septal defects.

The aortic valve is valve between the pumping chamber of the heart and the aorta, which is the main blood vessel that brings blood to the entire body. The function of the aortic valve is to keep blood from flowing back into the heart as the pumping chamber of the heart relaxes.

The most common aortic valve disorder his aortic stenosis, in which the leaflets of the aortic valve become calcified over time and don't allow the aortic valve to open appropriately. Less common, though just as important, his aortic regurgitation, in which the valve is leaky and allows blood to flow backward from the aorta back into the heart.

The most common symptoms of aortic stenosis are chest pain with exertion, shortness of breath with exertion, dizziness or passing out, particularly during or immediately after exertion, and fatigue.

Most of the time, aortic stenosis is either diagnosed because the patient has symptoms as noted above or your doctor hears a heart murmur. In these cases, your cardiologist we'll likely order an ultrasound of the heart called an echocardiogram.

There are no medications known to slow the progression of aortic stenosis. If you are diagnosed with aortic stenosis in a mild form, your cardiologist will follow the progression of aortic stenosis with regular ultrasounds of the heart. Once symptoms of aortic stenosis are present and/or the aortic stenosis is clearly severe on ultrasound, there are two main forms of treatment: 1) Aortic valve surgery. Up until 15 years ago, this was the only treatment available for patients with aortic stenosis. This usually involves open heart surgery, in which the chest is opened, the patient is put on cardiopulmonary bypass, the diseased aortic valve is removed, and a new aortic valve is sewn into place. Most patient spent 4-6 days recovering in the hospital following surgical valve replacement. 2) Transcatheter aortic valve replacement. In the last 15 years, there has been rapid advancement in technology that now allows us to implant a new aortic valve without open heart surgery. This is most commonly done via the large artery in the groin. Many patients go home the next day, and most go home within 2 days.

Because transcatheter aortic valve replacement is a relatively new technique, and because the very long-term outcomes of this form of valve replacement are somewhat unknown, surgical aortic valve replacement remains the standard of care for patients at low risk for surgery based on things like age and other medical conditions the patient might have. Patients who are intermediate or high risk for surgery are candidates for transcatheter aortic valve replacement.

Because transcatheter aortic valve replacement is still a somewhat new technique, a cardiac surgeon is always present during placement of the valve. In most centers, the procedure is performed by one interventional cardiologist and one cardiac surgeon.

Talk to your treating cardiologist and/or cardiac surgeon about whether you are a candidate for transcatheter aortic valve replacement. Currently, patients who are at low risk for surgery should undergo surgical aortic valve replacement. However, there are currently ongoing clinical trials to evaluate whether low risk patients should be offered transcatheter aortic valve replacement as well.

The mitral valve is the valve located between the pumping chamber of the heart and the left atrium, which is the chamber of the heart that collects blood from the lungs and holds it until the pumping chamber is ready to accept it. The mitral valve is important because it keeps blood from being forced back into the lungs when the pumping chamber of the heart pumps.

The most commonly seen mitral valve disorder in the United States is mitral regurgitation, in which the valve is leaky and allows blood to flow backward into the lungs when the main pumping chamber pumps. Mitral stenosis, in which the valve is narrowed, is becoming increasingly rare in the United States.

Most people with severe mitral regurgitation complain of shortness of breath, palpitations or a fluttering feeling in the chest due to an arrhythmia or fatigue.

Many times, mitral regurgitation is diagnosed because of symptoms noted above or because your doctor hears a heart murmur. Your cardiologist will likely order an ultrasound of the heart cold and echocardiogram which can definitively diagnose mitral regurgitation.

As with aortic stenosis, there are no medications that can slow the progression of mitral regurgitation. If mitral regurgitation is found in its mild or moderate form, your cardiologist will perform routine echocardiograms to evaluate for its progression, particularly if you have worsening symptoms. If you develop severe mitral regurgitation, a mainstay of treatment is open heart surgery. In many cases, the valve can be repaired, but in some cases it needs to be replaced. He should discuss which option is best with your cardiac surgeon. Also, in some cases, the surgery can be performed with minimally invasive techniques. There are emerging nonsurgical options for mitral regurgitation, including the MitraClip In this procedure, which is spared only for those who are not candidates for cardiac surgery, a clip is placed in the center of the valve to reduce the amount of regurgitation. This is done through the large vein in the groin.

A PFO is present in everyone at the time of birth. When you are a fetus, there is no need for blood to be sent to the lungs because you get all of your oxygen from her mother's blood. There is a flap between two chambers of the heart that allows blood to be diverted as it returns to the heart so that I can be sent back out to the body. At the time of birth, the pressures in the heart change rapidly, and this flap normally closes and scars over. In about 20% of people, however, the flap remains open. This is called a patent foramen ovale.

In the vast majority of people, PFOs are not dangerous and are usually detected when someone undergoes an ultrasound of the heart for another reason. However, in a very small subset of people with a PFO, a blood clot that forms in your leg can cross over this flap and cause a stroke. In people in whom a stroke is thought to have occurred because of a PFO, closure of the PFO is currently recommended.

Nearly everyone with a PFO is asymptomatic. As noted above, a small subset of people with PFO can develop strokes. Howell my doctor diagnose a PFO? PFOs are diagnosed with an ultrasound of the heart called an echocardiogram. Many patients will also undergo a second ultrasound of the heart to more closely evaluate the area of the PFO called a transesophageal echocardiogram. This is done under sedation in the hospital.

PFO closure should only really be performed in people who have a stroke thought to be related to the PFO in whom an extensive search for other causes of stroke has not revealed any other potential source of the stroke.

PFO closure is performed in the hospital. He devices implanted via the large vein in the groin while in ultrasound camera in the other large vein in the groin provides guidance. Most people go home the same day, and the procedure is usually very well tolerated. It is done under sedation. Patients will need to be on aspirin and a second blood thinner for at least a month and then on aspirin indefinitely.

As opposed to PFOs, ASDs are quite rare. These are never normal and occur due to problems with the development of the heart in which the wall between the atria of the heart does not fully form.

Most people with an ASD are asymptomatic until later in life. Sometimes, patients will develop shortness of breath.

ASDs are usually seen by echocardiogram. If you are diagnosed with an ASD, your cardiologist will most likely order a transesophageal echocardiogram. This is done in the hospital under sedation and gives a much better view of the ASD and the wall between the atria.

Not every ASD needs to undergo closure. If the ASD is quite small, most people can be followed with routine echocardiograms to evaluate for worsening problems with the heart. If it appears as though the right side of the heart is being affected by the flow of blood through the ASD, patients should have their ASD closed.

ASD closure is performed either severe open heart surgery or through the large vein in the groin. Many patients can be treated without having open heart surgery, but the approach depends largely on the shape and size of the ASD as well as its location in the wall between the atria. You should talk to your cardiologist about whether surgery or procedure is right for you.

CATHETER ABLATION

Technically, ablation refers to destruction of tissue. When we do cardiac ablation, we are selectively targeting short circuits or sources of abnormal electrical impulses that cause rapid heart beats. An ablation procedure can be relatively simple or complex. An ablation is done in the electrophysiology or EP lab. Depending on the procedure, you may receive simple sedation or general anesthesia. Catheters are advanced through a vein in the leg to the heart. The ablation itself is accomplished by either burning or freezing small areas of heart tissue with one of these catheters. Some ablation procedures are done strictly as an outpatient and you go home the same day, whereas other oblations require that you stay overnight. Risks of the procedure are low in general, but depend on what area of the heart is being ablated.

Cardiac ablations target only abnormal heart tissue. There is no significant impact on heart function.

Atrial fibrillation or AFib usually is triggered by very rapid electrical impulses coming from the pulmonary veins. These are veins coming from the lungs that drain into the left atrium. There is heart muscle type cells in those veins with different properties than the rest of the heart that allow such rapid electrical activity. When we ablate atrial fibrillation, we either burn or freeze around the openings of those pulmonary veins to make a firewall that keeps those impulses from irritating the heart. In many situations, that is all that is required. However, in more advanced atrial fibrillation, there may be ablation required in other areas. AFib ablation is usually done with general anesthesia. Simple pulmonary vein isolation typically takes about two hours, but can go on significantly longer if additional ablation is required.

In general, you can expect an 85% reduction in atrial fibrillation. This may be a complete elimination or just a reduction in the amount of atrial fibrillation. Recurrences can be due to triggers coming from outside the pulmonary veins or may be due to reconnection of the pulmonary vein muscle fibers to the left atrium. This can require a repeat ablation procedure depending on the severity of recurrence.

Major complications are rare, but can be serious. The most concerning are stroke, atrial esophageal fistula and death. Strokes are usually caused by blood clots in the heart, and therefore we prescribe anticoagulants around the time of ablation. A risk peculiar to atrial fibrillation ablation is damage to the esophagus, which passes directly behind the left atrium. In rare cases, a hole can form between the atrium and the esophagus which can be lethal. We therefore monitor the esophageal temperature during ablation and prescribe acid blockers afterwards to protect the esophagus.

Expect to stay overnight. You will be at bed rest for three hours after the ablation. You can be up and around after that, but avoid heavy exertion for one week. While we do the ablation to prevent atrial fibrillation, the actual ablation itself causes irritation and in the first week in particular it is not uncommon to have recurrences of irregular heartbeat or even atrial fibrillation. Depending on our risk assessment, we may or may not therefore prescribe an antiarrhythmic drug. It is common to have mild chest discomfort for the first 2 or 3 days. We frequently prescribe an anti-inflammatory medication such as prednisone to prevent this. We also treat with antacid therapy for 1 month to protect the esophagus. It is common to have some bruising at the puncture sites. Usually it is fairly local, but it can extend a good way down to the knee on occasion. That in and of itself is not alarming. Progressive pain or swelling at the puncture sites is more concerning as it could represent continued bleeding. Late onset of chest pain or pain on swallowing requires immediate attention to prevent atrial esophageal fistula.

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