What is the choice of arrhythmia treatment? The type of treatment you have depends on the type of arrhythmia you have, the severity of your symptoms, and the results of various tests, including electrophysiological findings. Your doctor will decide if your arrhythmia needs treatment and, if so, which treatment is best. Medications Anti-arrhythmic drugs work by changing electrical signals within the heart. They can stop a fast or irregular heart rhythm that originates in an abnormal part of the heart. If medications are applied to treat an arrhythmia, it is important to make sure that they work effectively. Therefore, after 2 or more days of taking the medication, you may need to undergo an electrocardiographic follow-up examination with the aim of selecting the most effective medication for the arrhythmia you are suffering from. Artificial pacemaker An artificial pacemaker is a device that can be implanted in the body to pace the heart to treat slow arrhythmias. The pacemaker is often implanted under the skin in the chest under the collarbone, where it senses the body’s heart rhythm and responds accordingly. If it senses that the heart is beating too slowly or has been paused for a long time, it sends a weak electrical signal to stimulate the heart to contract and pump blood. Implantable cardioverter-defibrillator (ICD) An implantable cardioverter-defibrillator is a device that can be implanted in the body to deliver electrical stimulation to the heart, and is most commonly used to treat life-threatening tachyarrhythmias. Cardioverter-defibrillators are larger than artificial pacemakers and are usually buried under the skin in the chest. The device continuously monitors the heart’s rhythm, and if it senses an abnormally fast rhythm, it releases one or more electrical shock signals to stimulate the heart and restore it to a normal rhythm. Catheter radiofrequency ablation Catheter radiofrequency ablation, as we described earlier, is a non-surgical treatment that destroys the abnormal bypass of the heart that triggers the arrhythmia. It is often used to treat tachyarrhythmias. Catheter radiofrequency ablation can be performed for most tachyarrhythmias, including paroxysmal supraventricular tachycardia, pre-excitation syndrome, atrial tachycardia, atrial flutter, atrial fibrillation, ventricular premature, and ventricular tachycardia. Catheter radiofrequency ablation is an interventional technique that is different from surgical procedures and is characterized by less trauma, faster recovery, higher success rate and fewer complications. Preparation for electrophysiological examination and radiofrequency ablation Electrophysiological examination and radiofrequency ablation usually require hospitalization. Before undergoing electrophysiological examination and radiofrequency ablation, some routine laboratory tests, including electrocardiogram and blood tests, are required. (Blood tests may be performed 1 to 2 days before the electrophysiology exam.) Your electrophysiologist will take your medical history as well as perform a detailed physical examination (which may be done a few days before the electrophysiology exam). The doctor will explain the entire procedure, the purpose, benefits and possible risks of the test. It is a good idea to ask your doctor your questions at this time and, more importantly, to let your doctor know how you feel or are concerned about the test. The nurse will prepare and disinfect the skin at the site where the catheter is inserted into the body. The most common site used is the groin area, but sometimes the arm or neck is also used. Skin preparation and disinfection makes insertion easier and also prevents infection. In addition, the provider will insert a small intravenous needle into a vein in your arm to create an open line so that medication can be given directly into the vein if necessary. If you feel nervous, your doctor will help you relax with a sedative. Precautions before electrophysiological examination and radiofrequency ablation Ask about dietary considerations. You will usually be instructed not to eat or drink for 6 to 8 hours prior to your exam. However, you may take a few sips of water while taking the necessary medications. Schedule a time for a family member or friend to drive you to the hospital. Be sure to stay in contact with your doctor a few days before the test. You may be asked to stop taking certain medications 2 to 3 days before the test, as it is important to get accurate test results. Bring a list of the names of all medications you are currently taking with you to the hospital, as it is very important that your doctor knows the exact names and dosages of the medications you are taking. Inform your doctor of your history of allergies to any medications. Electrophysiological Examination and Radiofrequency Ablation Procedure Electrophysiological examinations and radiofrequency ablation are performed in a specially equipped room that we call the catheterization room, or electrophysiological examination room. On the day of the exam, a nurse will wheel you into the catheterization room on a mobile surgical bed and then move you to the X-ray bed. There is a large camera above the bed and several TV screens next to it. The catheterization room is also equipped with a heart monitor and other instruments. The catheterization room is usually staffed with electrophysiologists, assistants, nurses and technologists. On the X-ray bed, medical staff will connect various monitoring devices to your body and cover your body with a sterile sheet, and medical staff will wear sterile gowns and gloves. First, the skin at the site of catheter insertion (groin, arm, shoulder or neck) is thoroughly cleaned and disinfected, and local anesthetic is injected subcutaneously for local anesthesia. Then, a blood vessel (often a vein) is punctured with a puncture needle and the electrophysiology catheter is inserted through this vessel. The electrode catheters used for electrophysiological examinations are long, bendable conduits that transmit electrical impulse signals into and out of the heart. One or more catheters are inserted into the body and are guided to the heart and ultimately placed into the heart through the monitoring of a television screen. How are electrophysiological examinations and radiofrequency ablation performed? In general, the electrophysiological examination consists of two main components: Recording of electrical signals: The electrode catheter senses the electrical activity in different parts of the heart and detects the conduction rate of electrical impulses. Pacing the heart: The electrode catheter delivers weak electrical stimulation to pace the heart in order to induce certain arrhythmias, allowing the physician to observe these abnormal heart rhythms under artificially controlled conditions. The electrophysiological examination helps the physician find the exact site of abnormal electrical activity in the heart, a process known as “tagging”. Identifying the site and type of arrhythmia can help the physician choose the best treatment, and the exact site of the arrhythmia can be identified and radiofrequency ablation can be performed to eliminate the arrhythmia. When evaluating drug therapy by electrophysiological examination, once an arrhythmia has been successfully induced, the drug can be administered into the body through an open fluid circuit to test its effect on the arrhythmia. If the arrhythmia cannot be elicited after the drug is administered, it means that the drug prevents the occurrence of that abnormal heart rhythm. How you may feel during the electrophysiological examination and radiofrequency ablation You will be awake throughout the examination, but sometimes the doctor will sedate you to relieve your nervousness, so some patients may fall asleep unknowingly during the examination. However, you can rest assured that you will be monitored by the medical staff throughout the procedure. Electrophysiological examinations are generally painless, but you may feel some pressure at the insertion site during the insertion of the electrode catheter. Also, lying flat for long periods of time may cause you some discomfort. However, you will not feel anything as the catheter travels through your blood vessels. You will not feel these electrical impulses, but they will induce the arrhythmia that is causing your symptoms, causing you to feel the same symptoms as before, including dizziness, palpitations, chest pain, or shortness of breath, so please inform your doctor as soon as you experience these symptoms. Arrhythmias that are artificially induced during electrophysiological examinations often stop spontaneously. If the arrhythmia persists, especially if the abnormal rhythm is very fast, it may cause you to faint briefly. When this occurs, the staff will deliver an electric shock to your heart to restore it to a normal rhythm. Such an arrhythmia can be very dangerous and even life-threatening outside the cath lab. However, in the catheterization room, trained medical staff will control these arrhythmias with the help of advanced equipment and medications to ensure patient safety. Are electrophysiological testing and radiofrequency ablation safe? Electrophysiology and radiofrequency ablation require the insertion of a catheter into the body and are “invasive” tests. Therefore, there are some risks, but they are minimal and therefore relatively safe. In some patients, the catheter insertion site (groin or arm) may bleed and blood may stagnate under the skin, causing local swelling and/or ecchymosis. In rare cases, electrophysiology is associated with more serious complications, including cardiac or vascular injury, thrombosis, and infection. Patient death is much rarer. Although most electrophysiological examinations and radiofrequency ablation procedures do not have complications, you should be aware of the possibility of these risks. If you would like to know the risks that are particularly relevant to you, please consult with your physician. After the electrophysiological examination and radiofrequency ablation procedure, all catheters are removed and the doctor (nurse) will apply pressure to the catheter insertion site for a few minutes to prevent bleeding. Afterwards, you will be taken back to your room or to the monitoring room. The doctor will decide if you can eat and drink right away, depending on how you are doing after the exam. Once you are back in the room, you will need to lie flat for 4 to 8 hours, mainly to allow the puncture opening in the blood vessel to crust over and close. Remember not to curl up or raise the leg on the punctured side during this time. However, you may move your foot or wiggle your toes in order to relieve stiffness in your lower extremity. The nurse will check your pulse and blood pressure, as well as the site of the catheter puncture. The doctor who examined and treated you may inform you of the results of the electrophysiological examination and ablation treatment shortly after the procedure. Depending on the results of the tests and treatment, you may be discharged home after a few days of observation. At the time of discharge, please inform your family or friends to pick you up. What to do when you return home After returning home, you may do normal activities (including housework and physical exercise), but do not overexert yourself. Keep the dressing on the puncture site for about three days after surgery, and you can usually start bathing five days later. Petechiae or small bumps at the skin puncture site are common. They often subside three to four weeks after the examination. Notify your doctor if you feel pain or heat when you touch the puncture site with your hand, if the petechiae or swelling worsen, or if you have a fever of more than 37.8°C.