Electrophysiology (EP)

Your pre-admission appointment will take place approximately 1-2 weeks before your date of admission and will be carried out on video by a clinical nurse specialist (CNS). We will let you know by letter or email the date of your pre-admission video appointment and what you need to do access the appointment. 

During your appointment, the nurse will talk to you about your planned procedure, what to expect when you are admitted to the hospital, and address any questions or concerns you may have.

The nurse will also take details of your medical history, any current symptoms, allergies and current medication, and height and weight (in metres and kg). Please make sure you have an up to date prescription list with you for the appointment. The nurse will let you know about any medication you need to stop taking ahead of your procedure. 

Your video appointment

The video appointment will take 30-40 minutes. The letter or email you will have received will contain a link to a secure video platform on which your appointment will take place. 

Upon clicking the link, you will be taken through some simple steps to ensure your video and microphone are set up correctly. You will then be asked to enter your name, date of birth and telephone number. No information will be stored. You will then enter a virtual waiting area where one of our nurses will join you when they are ready.

If you do not have access to the internet, or are unable to access the video platform, do not worry, we will telephone you to carry out your pre-admission appointment. 

Please have a pen and paper with you to write down any important information. If you are a non-English speaker, please ensure you have someone with you who will be able to translate. 

We will endeavour to carry out your appointment at the exact time on your letter, but please bear with us if there are any delays. 

COVID-19

To limit the chance of admitting patients to hospital who have COVID-19 but display no signs or symptoms of the disease, we are testing all patients prior to their admission to check if they are carrying the virus. This is to ensure that we keep you as safe as possible and reduce the chance of spreading the virus to other patients and staff.

The risks of having COVID-19 around the time of the treatment depend on the type of treatment and your risk factors. Generally, cardiac procedures can carry much greater risk of complications and death if COVID-19 develops around the time they take place. 

COVID-19 restrictions remain in place for admission to hospital. During the pre-admission appointment the clinical nurse specialist will provide restrictions that you will be required to adhere and COVID-19 testing that you will undergo to prior to admission.

Blood tests

We may also arrange for you to have a blood test on the same day as your nasal and throat swab test. We will ask you to wait in your car after your nasal and throat swabs have been taken, and a member of the COVID-19 testing team will collect you to have your blood test taken.

Some patients will also need to have a test for MRSA (methicillin resistant staphylococcus aureus). This is a common organism carried harmlessly by many people. We will let you know during your video appointment if you need to be tested for MRSA, and if you do, we will arrange for this to be done at the same time as your blood tests. If testing for MRSA is required, this and the other tests will be carried out 72 hours prior to your admission to ensure we have enough time to get the results before you are admitted to hospital.

Catheter ablation is a minimally invasive keyhole procedure carried out in a cardiac catheter laboratory.

The first part of the procedure is to introduce three to five small (<3mm) plastic tubes (sheaths) through the skin into the veins at the top of the legs near the groin. Radiofrequency energy, which uses radio waves to produce heat, or cryoablation, which freezes small areas of heart tissue, is then used to destroy the heart tissue at the source of the erratic electrical signals which cause the fast or irregular heartbeat.

Further information about the procedure will have already been sent to you in the form of a procedure-related information sheet and consent form.

Medication before your ablation

Before your ablation some of your medication may need to be stopped. Personalised instructions on what to do with your medication in the lead up to the ablation procedure will be given to you by the arrhythmia nurse. If you have any concerns, please contact the arrhythmia nurse specialists on the number at the bottom of this page.

All patients who are undergoing ablation for atrial fibrillation (AF) or atrial tachycardia (AT) will be given a tablet called Lansoprazole, if you are not already taking this or a similar drug. This tablet reduces acid reflux and gastric complications after your procedure. This will be commenced during your admission.

Advice about warfarin

If you are taking warfarin you will be advised to continue to take this throughout your admission. Before admission you need to have your INR checked every week at your anti-coagulation clinic for at least four weeks prior to your admission. You will then have a final check on admission before your procedure. These checks will ensure that your INR is at the desired level before the ablation.

Please be aware that your procedure may need to be rescheduled for a later date if your INR has not been within the desired range during the four weeks prior to your procedure.

Advice about apixaban, rivaroxaban, dabigatran or edoxaban

If you are taking any of these drugs you should continue to take them unless instructed otherwise by the arrhythmia team.

Hospital admission

You will be admitted to hospital on the day of your procedure.

On the day of your admission, before leaving home, please phone Oak Ward to confirm your bed is available (telephone number: 01895 828648). If you are being admitted to Cherry Tree Ward (day case unit) you do not need to telephone; please arrive at the time given on your admission letter.

Eating and drinking before your procedure

You must not eat anything for six hours before your procedure. You can, however, drink clear fluids (water, orange squash, fruit juice (without bits), tea/coffee without milk) up until two hours before your procedure. 

What to bring with you

You should bring an overnight bag including a pair of pyjamas or a nightdress, dressing gown, non-slip footwear, toothpaste and other personal items. You should also bring any medication you are taking, in their original containers.

We will provide you with wash items such as towels and liquid soap. Please do not bring valuable items; however, you may bring a mobile phone. The ward cannot take responsibility for any damaged or lost possessions. 

Further information

Some procedures are performed under a general anaesthetic and some under a local anaesthetic. This will be discussed with you by your clinical team before your procedure. 

We may need to remove hair from your chest before the procedure, please do not do this yourself before you come to hospital. 

You will be allocated a bed on Oak Ward, Acorn Ward (ACCU), or Cherry Tree Ward. These are mixed sex wards; however you will be cared for in a single sex bay. When you arrive, please report to the ward reception, where you will be shown to your bed or to the day room until your bed is available. You will then be seen by a nurse and a doctor. If you need to have any medication before your procedure, this will be given to you by the nurse. You may have a cannula (a fine plastic tube), inserted into your arm/hand so that we can give you any medication required during the ablation.

Immediately after your procedure you will be on bed rest and attached to a heart monitor. You will be able to eat and drink as soon as you are fully awake. 

After your procedure, you may also have an echocardiogram (heart scan) and some blood tests. For patients who are required to stay in the hospital overnight, these will usually be done the next morning. You will also be reviewed by the doctor and/or arrhythmia nurse specialist.

Being discharged from hospital

Depending on your discharge assessment, you may be discharged from the hospital on the night of your procedure or the next day. You will be given a copy of your discharge summary, which will also be sent to your GP to inform them of your procedure. You may be asked to alter your medications, any changes will be discussed with you before are discharged, and your discharge summary will also inform your GP of these changes.  

If you go home the day after your procedure you may be asked to vacate your bed the following morning and take a seat in the dayroom. In most cases you will be ready to go home by approximately 1pm. 

Arranging transport

You will not be able to drive yourself home after your procedure, so please ensure someone can collect you from the hospital after you have been discharged. Post-operative advice on when you can resume driving will be discussed at your pre-admission appointment. In most cases, this is two days following the procedure. This is a legal requirement and DVLA rules.

Recovery

Most people recover quickly from their procedure, but it is not uncommon to experience symptoms such as tiredness, palpitation, bruising around the wound site and chest/neck/shoulder discomfort for up to a week. You should avoid heavy lifting and vigorous exercise for approximately a week after the ablation to allow the groin puncture site to heal. If you are employed, we strongly recommend that you take a week off work to fully recover.

Changes to your medication after an ablation

After your ablation your medications may be altered.  Any changes made will be discussed with you before you are discharged home and your discharge letter will also inform your GP of these changes.

It is very important not to miss any doses of your usual blood-thinning (anticoagulant) medication after your ablation to reduce the risk of suffering a stroke.

Even if you had a low risk of stroke before your ablation and were not taking anticoagulants, you will still need to take your anticoagulant for at least 2-3 months after your ablation, unless specifically advised otherwise.

If you have previously been using the “pill in the pocket” medication strategy to manage your symptoms, you may continue to do so, unless specifically advised against it by your doctor.

Most patients will remain under outpatient follow-up at Harefield Hospital for up to a year after their ablation. You will receive an appointment to be seen in clinic approximately three months after your ablation. In some cases follow-up appointments will be arranged at your local/referring hospital and/or via telephone. 

Please click here for procedure videos and e-consent forms.