Frequently Asked Questions FAQ
FAQ about Electrophysiology Studies and
1) Does the
procedure hurt? The discomfort is minimal. Lidocaine (similar to
what your dentist uses) is injected to numb up the skin
before catheters are inserted. Once lidocaine takes effect, there
should be no feeling in that area. Furthermore,
sedatives are given in the vein to achieve a level of light
anesthesia called "conscious sedation" where one is
lightly asleep but
remains arousable. Without sedation, the actual application
of radiofrequency energy can cause discomfort in the chest area,
but this can be alleviated with appropriate level of conscious
2) Would I be asleep?
Conscious sedation (a level of light anesthesia) is all that is
necessary for most of these procedures. Patients are
sleepy but arousable within this stage of anesthesia. General anesthesia is unnecessary
for these minimally invasive procedures, except in prolonged cases
such as atrial fibrillation ablation..
3) How long does it take? In general, a routine EP study takes about
30 to 45 minutes. Radiofrequency ablation takes about 1 and ½
hours to 3 hours, depending on the difficulty of the case. One must
also allow the preparation and recovery time (~2 hour) before and
after the procedure.
4) How is it done? Multiple
small-caliber catheters are inserted through
the skin into the veins and advanced into the heart where they
make recordings of the electrical activities within the heart.
The catheters can be used to stimulate the heart in order to
uncover any electrical problems such as fast or slow heartbeats.
5) What is radiofrequency ablation? Radiofrequency is a
of energy that, when delivered through the tip of a special catheter
placed inside the heart, results in laser-like precision destruction
of abnormal electrical tissues. These tissues are nerve
bundles that are responsible for you irregular heartbeats.
does the doctor know where to ablate? Before the procedure, your physician would
have done an examination of you and had tests that give a general
idea of the location of the culprit "extra nerve"
responsible for your arrhythmia. However,
only after "mapping" is performed
inside the heart can one determine exactly where it is and where
to perform ablation. In the process of mapping, the rapid heartbeat,
or arrhythmia, is frequently reproduced by your physician (a process
called "induction"). After ablation is performed and the nerve
destroyed, one must then repeat the entire testing process to ensure
that the culprit "extra nerve" indeed has been destroyed and that
the rapid heartbeat is no longer "inducible."
7) When do I go home? Patients undergoing electrophysiology
studies will go home on the same day after a few hours of observation.
Most patients undergoing ablation can also be discharged the
same day, with rare exception (see post-operative care section).
8) How long is recovery? After the procedure, only minor skin discomfort
is expected at the site of catheter insertion. Aside from this,
patient may feel groggy for a period of several hours. The recovery time is usually a few hours and patients can go home
the same afternoon. It is generally advisable that patient
not engage in strenuous activities for 48 hours after the
procedure. Normal activities such as walking is not only
acceptable, but encouraged, to facilitate recovery.
9) When can I get back to work?
This depends on the type of work one does. Most patients can return
to work within 24 to 48 hours (see post-operative care section)
except for those who do heavy manual work, in which case time to
return to work should be individualized.
10) Can I shower?
Yes, on the same day of the procedure. One simply needs to
change the band-aid when wet for the next few days.
11) Does my insurance cover this procedure?
Today, electrophysiology study and radiofrequency ablation are
commonly performed procedures that have become mainstream therapy
for many types of arrhythmias. Essentially every major
insurance company covers these procedures.
FAQ about Pacemakers and
Defibrillators (before surgery)
1) Who needs
a pacemaker? A pacemaker is required for patients with
slow heartbeat. (See sections on pacemaker and defibrillator). An
exception is when one has a very rapid heartbeat where ablation is
performed intentionally to slow down the heartbeat, in which case
a pacemaker is inserted
to keep the heart rate steady (as in atrial fibrillation).
2) Who needs a defibrillator? A defibrillator is needed when the
heartbeat is very fast and life threatening. It is implanted in
patients already with these arrhythmias, or in patients at high risk
for these arrhythmias (See sections on pacemaker and defibrillator).
3) Can I choose my own pacemaker/defibrillator? If you know of a
certain company or certain type of devices that you feel strongly
about, your physician can work with you in choosing the devices. Most often, however, your physician knows
best the specific device that works best in your particular situation.
4) How and where is the pacemaker/defibrillator implanted? One to
three catheters (i.e., electrical wires) are implanted into the heart
via the veins on the chest. A pocked under the skin is made
on the chest near the shoulder (most often on the left side) where
the pacemaker or defibrillator is implanted. The skin is then closed
with suture. When the pocket is healed, one can not see any
hardware externally (from the outside), only a slight bulge on the skin.
5) Does the procedure hurt? The discomfort is minimal. Lidocaine
(similar to what your dentist uses) is used to numb
up the skin before the pacemaker or defibrillation is inserted.
Once lidocaine takes effect, there should be no feeling in the surgical
area. Furthermore, light sedatives are given for conscious sedation
(a light stage of anesthesia). Full general anesthesia is not
but is at the discretion of your anesthesiologist.
6) Would I be asleep during surgery? Most often, conscious sedation
(a light stage of anesthesia) should suffice during most procedures.
But for the more complicated cases,
general anesthesia is used.
7) How long does the surgery take? In general, a pacemaker can take
20 to 45 minutes and defibrillator 30 to 60 minutes, depending on
the complexity of the case. One must also allow the preparation
and recovery time (~2 hour). Devices with Resynchronization therapy
(CRT) capabilities may take longer (1-2 hours)
because of the the additional work involved in implanting an extra wire.
8) Does my insurance cover this procedure?
Today, pacemakers and defibrillators are commonly performed
procedures that have become mainstream therapy for many types of
arrhythmias. Essentially every major insurance company covers
FAQ about Pacemakers and
Defibrillators (post-operative care)
1) When do
I go home after surgery? Most patients will be discharged the next
morning unless their specific medical conditions require additional
stay. Many patients who come in only for the change out of a previously
implanted pacemaker or defibrillator can go home the same day.
2) What are my restrictions after surgery? The main limitation applies
to the arm on the side of surgery. We generally advise that patients
not lift the arm above the shoulder or engage in strenuous activities
on that arm for several
months. Activities such as golfing, tennis, and
weight-lifting should be avoided. There have been cases where the
electrodes (wires) have been pulled outside the heart because of
patient engaging in such
activities too soon after surgery.
3) When can I get back to work?
This depends on the type of work
one is does. Except in the case where work involves strenuous
activities, most patients can return to work within 24 to 48 hours.
4) Can I shower after surgery?
Yes. A medical adhesive
is often applied to the skin to seal the incision and make it waterproof. This is the shining
layer on the incision, which will fall off by itself in about 2-4 weeks.
Without this adhesive, one must avoid shower for up to one week.
5) Can I lift my arm after surgery?
Yes, but not above the shoulder level for 2 to 3 months. This is a
precaution taken to avoid dislodgement (moving out of position) of the wires placed in the heart. Such
dislodgement will almost always require a second. Therefore, after surgery, activities involving
heavy swinging around the shoulder, such as tennis, golfing, swimming,
and weight lifting should be avoided for 3 to 6 months, to be safe.
Activities involving the other arm (away from the pacemaker and
defibrillator) need not be restricted.
6) Can I sleep on my side of the pacemaker? No problem.
7) Can I drive?
Generally yes, unless you have a history of fainting prior to
the surgery, in which case your physician must evaluate how your are doing after
surgery before allowing you to drive again.
FAQ about Pacemakers and
Defibrillators (long term follow-up)
1) What kind
of follow up do I need for my pacemaker/defibrillator?
Generally speaking, long term
follow up for pacemaker is twice a year and for defibrillators four
times a year. The exact frequency depends on the particular
situation and is at the discretion of your physician. Close
follow-up is important so your physician can monitor the
progress of your heart condition and detect malfunctions of the
devices before serious consequences occur. When the battery voltage
runs low, such follow up check can help determine when it is
necessary to replace the battery of the pacemaker or defibrillator.
These follow up visits can also give your physician the opportunity
to advise you on certain unexpected issues such manufacturer recall.
2) How long does the pacemaker/defibrillator battery last? Most
pacemakers will last 5 to 8 years. Most defibrillators will last
4 to 6 years. Change out of the battery is a relatively simple outpatient
3) Can you recharge the battery? No. This is a concept that had
been considered in the past, but currently no manufacturers make a
rechargeable pacemaker or defibrillator. The technology in this
field is evolving so fast that it often becomes outdate within a few
years. Therefore, it makes little sense to recharge the
battery just to save the old unit and the old technology. The entire system,
battery and hardware (except the wires which stay in place),
is updated in one setting during change-out surgery.
4) How do I know if my battery needs to be changed? You
usually do not
feel any symptoms, unless the battery is completely
depleted and your heart rate is too slow without the pacemaker
(i.e., "pacemaker dependent"). In certain units, an audible warning beep
can be heard when the battery is running low. Most often,
battery depletion is discovered during routine office visit and
evaluation of the pacemaker. The unit gives advanced warning
of 6 to 12 months before complete battery depletion so that you and
your physician may have ample time to schedule an elective
5) Can I have an MRI after pacemaker/defibrillator? No. Current
devices are not MRI compatible (although futures ones are in development).
Although in theory it is reasonably safe, rare but severe (sometimes
fatal) consequences have been reported when someone with a
pacemaker goes through an MRI. It is generally recommended
that alternative imaging modalities, such as CT scanning, be used.
6) Can I go through airport security with my pacemaker/defibrillator?
Yes. It is generally safe. However, one may prefer
hand-search instead of going through the metal detector because of
personal preference. Most importantly, one should
never have the security personnel place the metal detector wand
directly over the pacemaker or defibrillator.
7) Can I use a microwave oven with my pacemaker/defibrillator? No
problem. This is an old wife's tale that just refuses to go away.
Currently there are no contraindications (or warning label) for the use of a microwave
with any implanted devices.
8) Can I use a cell phone? Cell phones are generally safe. New generations
of devices have been cell-phone tested and cell-phone compatible
since the mid 1990s. As a general
rule, however, we advise that when a cell phone must be used that
it be held on the side opposite your pacemaker of defibrillator in
order to minimize any potential
and theoretical interference.
9) Does the pacemaker/defibrillator tick?
Can I hear my pacemaker/defibrillator?
Some patients are absolutely convinced that they hear their
pacemaker of defibrillator tick. This is not possible. Pacemakers make absolutely no sound whether it is
pacing or not pacing. Likewise, defibrillators do not make any sound
when pacing or shocking the heart. The defibrillator, however, has a
built-in warning system that will
emit a beeping sound once a day (usually programmed to occur in
the morning) if the over-night check-up performed during your sleep revealed
an abnormality. The defibrillator will also emit a beeping
sound when a magnet is applied.
10) Can I take Viagra? Is there any limitation on sex? Viagra is
not contraindicated in patients with a pacemaker or defibrillator,
per se. However, precautions
should be taken if you have severe heart conditions, in which case
you should discuss with your general cardiologist. Although pacemakers and defibrillators are compatible with
most activities of a normal life style, including sex, sometimes
the heartbeat can run too fast during sex so as to result in the
discharge of the defibrillator.
11) Do I need antibiotics for dental work? No. There is no specific
indication for antibiotics related to your devices. However,
many patients may need antibiotics for other heart conditions, such
as mitral valve prolapse.
12) Can a pacemaker/defibrillator be reused
or recycled? We get this question
quite frequently. There is currently no role for a used device
in this country. FDA allows only brand new devices to be implanted
in this country.
13) How do I know if I receive a shock
from my defibrillator? A defibrillator shock is
uncomfortable and will not be subtle. However, there have
been occasional patients who did receive shocks but did not remember
the event, especially if it occurred during sleep or if patient
passes out as the result of the event. If there is any doubt,
one should make an appointment to have the defibrillator evaluated
in the office. The device keeps all its memory of any
arrhythmias and the memory can be downloaded for your physician to