St. David's HealthCare

St. David's HealthCare is one of the largest health systems in Texas and Austin's
third-largest private employer, with more than 60 sites throughout Central Texas,
including seven hospitals, four urgent care centers, four ambulatory surgery centers,
and two freestanding emergency departments, with a third set to open in Bastrop this summer.

St. David's HealthCare has a long history of serving the residents of Central Texas
with exceptional medical care. Our 7,500 employees touch over 858,000 lives each
year with a spirit of warmth, friendliness and personal pride.

Visit our main website at www.StDavids.com

St. David's Medical Center (512) 476-7111
St. David's North Austin (512) 901-1000
St. David's South Austin (512) 447-2211
St. David's Round Rock (512) 341-1000
St. David's Georgetown (512) 943-3000
St. David's Rehabilitation (512) 544-5100
Heart Hospital of Austin (512) 407-7000

What To Expect

The Texas Cardiac Arrhythmia Institute treats persons who have cardiac arrhythmia (irregular heartbeat), providing thousands of people each year with a restored quality of life.

A cardiac arrhythmia occurs when the heart's electrical system misfires, causing the heart to beat in an irregular and rapid pattern. When this occurs, the chambers of the heart do not adequately fill with blood. As a result, the heart is not pumping a sufficient volume of blood throughout the body. The most common cardiac arrhythmia is Atrial Fibrillation, which affects approximately 2.2 million people in the United States.

Symptoms include:

  • Palpitations: the heart feels like it is pounding or beating very rapidly
  • Fatigue
  • Lightheadedness or dizziness
  • An uncomfortable feeling in the chest
  • Shortness of breath (even at rest)

Diagnosis is made through electrocardiogram (ECG or EKG) or monitor devices, which record the heart's rhythm.

Treatment:

  • Medication and lifestyle changes
  • Electrical cardioversion
  • Catheter ablation

While medication, lifestyle changes and electrical cardioversion treat the symptoms, catheter ablation offers a cure. In this procedure, the electrophysiologist locates the precise area of the heart triggering the arrhythmia. Through a catheter, the electrophysiologist creates a lesion that blocks the pathway for an irregular heartbeat. Sophisticated technology and the skills of an experienced electrophysiologist come together to restore the patient to a normal, arrhythmia-free life.

Texas Cardiac Arrhythmia Institute treats cases at all levels of acuity - from the most simple cardiac arrhythmias to highly complex cases. A leading research and treatment center, TCAI is able to offer successful outcomes to many patients who had previously been told that their case is untreatable. The leading edge technology provides electrophysiologists with the tools needed to treat these complicated cases. The Electrophysiology Labs (EP Labs) contain the most sophisticated technology available. TCAI is one of the few centers in the world offering this level of treatment.

The Center for Arrhythmias and Atrial Fibrillation

512.544.AFIB (2342)

The Center for Arrhythmias and Atrial Fibrillation at TCAI provides ongoing education for persons experiencing cardiac arrhythmias. Those who have not yet been diagnosed may call the Center to speak with an experienced cardiac nurse. Persons who have been diagnosed and are considering treatment may also call to ask questions and arrange a consult with an electrophysiologist.

Individuals who suspect they have a cardiac arrhythmia, or who have recently been diagnosed, may call the Center for Arrhythmias and Atrial Fibrillation. Nurses will provide basic patient education, and may facilitate an appointment with an electrophysiologist affiliated with the Texas Cardiac Arrhythmia Institute.

Those who live outside Central Texas and who are considering traveling to Texas Cardiac Arrhythmia Institute will receive pre-appointment guidance. In some cases, the nurses will suggest questions that you may ask your local cardiologist before your appointment in Austin.

Scheduling an Appointment

A nurse will work with you to schedule an appointment for a consultation or procedure. You will be instructed on how to complete the new patient paperwork and send to our office along with insurance information. You will also be asked to complete a medical release form.

Planning Your Appointment

After reviewing your records, a nurse will let you know which tests must be performed prior to your appointment. You will need to have had a recent echocardiogram, which measures the chambers of your heart. If you have had a prior cardiac ablation, you will need to have had a CT Angiogram to evaluate your pulmonary veins.

Testing may be performed by your local physician or we can schedule tests at the Texas Cardiac Arrhythmia Institute.

Length of Appointments

If you schedule a consultation only and are from out of the area, we suggest you arrive in Austin the night before your appointment and plan to leave the day after your appointment. If you are coming in for a procedure, you will stay overnight in the hospital after the procedure and be released the following day. If you do not live in the area, you will be asked to stay in Austin for two days following your hospital discharge.

St. David's Medical Center has negotiated discount rates at area hotels. Click here for hotel suggestions.

Insurance

Please direct questions about insurance coverage to Michelle Fishel at 512.615.6239.

Ongoing Education

Patients at the Texas Cardiac Arrhythmia Institute benefit from ongoing guidance and support provided by nurses from the Center for Arrhythmias and Atrial Fibrillation. During your physician consult, a nurse will meet with you to provide education regarding your condition and the treatment recommended by the electrophysiologist. If you have a procedure, a nurse will visit with you in the hospital and will provide follow-up telephone guidance in the weeks and months after hospital discharge.

Catheter Ablation: Frequently Asked Questions

Prior to the Procedure

What medications may I take before an ablation?
Please do not discontinue any of your medications without talking to the doctor or nurse. They will let you know which medications you should stop taking and how far in advance of the procedure they need to be stopped. Generally you will be asked to stop your anti-arrhythmic medication three to five days prior to your procedure.

Are there special instructions regarding Coumadin?
You will remain on Coumadin before and after the procedure. To ensure that your INR (Coumadin level) stays within range, you will be asked to have the level checked weekly for the four weeks prior to your procedure. Our nurses will tell you how to send the INR readings to our office.

If your INR falls out of range during this time, your procedure can still be performed; however, you may need to have a procedure called a Transesophageal Echocardiogram (TEE) prior to ablation.

What can I eat before an ablation?
Eat a normal meal the evening before your procedure. DO NOT EAT anything after 12 o'clock (midnight) the night before your procedure. If you normally take medications in the morning, you may take them with a small amount of water.

What should I wear to the hospital?
Remove all makeup and nail polish before coming to the hospital, and wear comfortable clothing. You will change into a hospital gown before the procedure. Please leave all jewelry and valuables at home.

Where do I check in at the hospital and what time should I arrive?
Please arrive at St. David's Medical Center Day Recovery about three hours before your procedure time. Your family is welcome to accompany you to this area.

What happens after I check in?
A nurse will offer support and guidance as you prepare for ablation. An IV (intravenous line) will be started in your arm to deliver medications and fluids during the procedure. A medication will be given through your IV to make you feel drowsy.

Your neck, upper chest, arm, and groin will be cleansed with an antiseptic solution and catheter insertion sites will be shaved. Sterile drapes cover you from your neck to your feet.

Where will my family wait during the ablation?
When you are taken to the Electrophysiology Lab (EP Lab), your family will be shown to the waiting area, which is where the electrophysiologist will visit with them following the procedure. The ablation procedure usually lasts two to four hours, although it could last about five hours.

During the Procedure

Where is the ablation performed and will I be monitored?
The ablation will take place in a special room called an EP Lab (electrophysiology) lab. St. David's Medical Center has four state-of-the-art EP Labs.

During the ablation, you will be connected to several monitors that will continually assess your heart rhythm. You will also be given sedation so that you will be asleep and remain comfortable.

How does the doctor insert the catheters?
After you are asleep, the electrophysiologist will numb the catheter insertion sites by injecting a medication. He will insert several catheters into the large veins on both sides of your groin or your neck.

A transducer is inserted through one of the catheters so that intracardiac ultrasound can be performed during the procedure. The ultrasound allows the doctor to view the structures of the heart and evaluate pulmonary blood flow on an external monitor.

Catheters will be advanced to your hear via blood vessels. After the catheters are in place, the doctor views a monitor to assess your heart's conduction system. Energy is delivered (via catheters) to the area around the pulmonary veins and/or portions of the heart, forming a lesion that stops the abnormal impulses. Once the ablation is complete, the doctor uses a monitoring device to observe the electrical signals of the heart.

After the Procedure

What should I expect when the procedure is over?
The catheters will be removed and pressure applied to the site to prevent bleeding. No stitches are needed. A pressure dressing (bandage) will cover the catheter insertion sites. To prevent bleeding, you will need to rest in bed for six to eight hours after the procedure with your legs still.

When will I learn the results?
After the procedure, the doctor will discuss the results of the procedure with you and your family.

Will I stay overnight in the hospital?
After the ablation, you will stay overnight in the hospital. A device called a telemetry monitor will display your heart rhythm in the nursing station so that the nurses can observe your heart rate and rhythm.

How will I feel after the ablation?
You may feel tired and experience chest discomfort or slight shortness of breath for the first two to three days. Please let your doctor or nurse know if any of these symptoms become prolonged or severe.

Will I take medications following ablation?
For at least three to six months you will need to take the anticoagulant medication Coumadin (warfarin) to prevent blood clots. For the first four weeks after your procedure you will need to have your INR (Coumadin level) checked weekly. Please schedule these blood tests with your local doctor's office.

You also may need to take an antiarrhythmic medication to control abnormal heartbeats, which may occur for two months following the procedure. You will be given specific medication instructions prior to your discharge.

After Hospital Discharge

What happens after I leave St. David's Medical Center?
Prior to leaving the hospital, you will be able to get up and walk around so that you can start getting ready for discharge. Also, you will be able to shower and remove the dressing about 24 hours after the procedure.

For your safety, we ask that you have someone drive you home from the hospital. If you live more than two hours away or if you have traveled by airplane, we ask that you stay in a hotel overnight. During your ride home, either by car or plane, please stand up and stretch your legs a few minutes each hour. Plan to rest when you arrive home.

What activity can I do after my ablation?
You will be asked not to do any strenuous activity, pushing, pulling or heavy lifting over 10 pounds for the first five to seven days after the procedure. After that time, you may begin resuming normal activities. Please be aware that it may take you a few days to resume all your normal activities.

Will I have a normal heart rhythm?
You may experience skipped heartbeats, palpitations, or short episodes of atrial fibrillation during the first three months after the procedure. These symptoms are common due to inflammation (swelling) of the heart tissue. After your heart has healed, these abnormal heartbeats should subside.

In order to keep close track of your heart rhythm after you are discharged, you will be given an event monitor. The nurses will instruct you on its use before you leave the hospital. You will be asked to send a transmission of your heart rhythm once a week and more frequently if you have symptoms or think you are having an episode of atrial fibrillation.

What symptoms should I report after ablation?
The most common symptoms patients experience after the procedure are chest discomfort or tightness and fluid retention. These are not unexpected, but can be a bit frightening.

Chest discomfort is due to inflammation caused by the ablation and can be alleviated by an anti-inflammatory medication such as Motrin (ibuprofen). You may take ibuprofen for the first few days after the procedure even though you are on Coumadin. Be sure to tell the doctor monitoring your Coumadin levels that you have had to take an anti-inflammatory, and make sure you get your INR checked within one week of hospital discharge.

Fluid retention may be caused by the intravenous fluids given during your procedure, and may not occur until about 24 hours afterward. The symptoms of fluid retention are swelling of your lower extremities or in your abdomen, shortness of breath especially on exertion and when lying flat, and weight gain of three to five pounds within three days. It is recommended that you weigh yourself for the first three to four days after the procedure to keep track of any weight gain that may be due to fluid retention. In the hospital, you will be given medication (called a diuretic) intravenously along with potassium in order to assist in removing the extra fluid. You may be given a prescription for a diuretic and potassium to use at home if you develop fluid retention symptoms.

In addition to the above symptoms, please let us know if you experience a low grade temperature, redness, swelling or drainage at the procedure site, or any difficulty swallowing.

Will I be monitored after an ablation?
Prior to discharge, you will be instructed on the use of an event monitor, which will be sent to your home so that you can send us weekly transmissions of your heart rhythm. Additionally, you will be asked to send a transmission if you are experiencing symptoms such as palpitations or arrhythmias.

What follow-up testing will I need?
Our office will contact you to follow up approximately three months after your procedure. At that time, you will be scheduled to have a CT Angiogram (to evaluate your pulmonary veins), an echocardiogram, and a 7-day heart monitor. We will also schedule an appointment to see the doctor to review the test results and monitor transmissions.

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