Patients with Ventricular Tachycardia (VT) know—this heart rhythm disorder is serious business. One of the most life-threatening arrhythmias, VT causes the bottom chambers of the heart—the ones primarily responsible for pumping blood to the vital organs and the brain—to beat too quickly. This can cause a wide array of debilitating symptoms, including palpitations, fainting, shortness of breath, and low blood pressure. In some cases, VT can lead to a weakening of the heart muscle and even in increase risk for sudden death.
Luckily for sufferers of this arrhythmia, the arsenal of treatment options for VT is continually growing. One such option is radiofrequency ablation (“ablation” for short), which can be done in a minimally invasive fashion from either inside or outside the heart muscle, depending on where the dysrhythmia is coming from. Here at St. David’s Medical Center, we are fortunate to have some of the most experienced electrophysiolgists and the most sophisticated equipment for performing this complex procedure. Because our staff is so experienced in handling this highly specialized cardiac ablation, we have developed a protocol for the procedure that focuses on the safety of the patient and the success of the procedure.
VT Ablation patients start out in our Cardiology Services Department, a pre-operative area. There, they sign all the paperwork that is needed, such as consents for the procedure. Intravenous (IV) access is started and labs are drawn and sent off. Due to the complexity of these cases, it is imperative that we are prepared for any emergency situation that may arise, so special blood coagulation lab work is drawn, and the patient’s blood type is determined. An EKG performed, the patient’s weight is taken, and the patient is seen by an anesthesiologist or nurse anesthetist before coming up into the Electrophysiology Lab.
Before the patient reaches the lab, nurses and technologists behind the scenes make sure that all the equipment needed for the case is setup in the rooms and working properly. Once this is determined and the patient is ready, they are brought into the room where a series of steps take place to prepare them for the procedure. After they get onto the narrow procedural table, the staff work together to ensure that all patches are placed correctly on the patient for accurate mapping and monitoring purposes. The anesthesiologist works on getting the patient comfortable and ensures that continuous blood pressure monitoring is in place. All complex VT ablation patients receive a urinary catheter. The patient is given a Propofol infusion during the insertion of the catheter for comfort purposes.
Both groins and the subxyphoid area (the area at the end of the breastbone) are prepped with a sterile solution. The physician places an arterial line in the right femoral artery for close monitoring of the patient’s blood pressure throughout the procedure. Medications that are administered during the procedure may include Isuprel, Phenylephrine, Epinephrine and IV caffeine. These are just some stimulants that can help to bring out any dysrhythmia during the procedure. Monitoring of the urine output is important as the patient receives continuous fluid administration during ablation. If the physician decides to perform epicardial ablation, there is further monitoring of any fluid that may be pulled off from the pericardial space. The ablation procedure can take anywhere from 3-8 hours, depending on the complexity of the case.
Once the procedure is completed, the patient is transferred to the Post Anesthesia Care Unit (PACU). The patient will remain in this area until they are cleared by the anesthesiologist to go to the nursing unit. The sheaths that were placed during the case are pulled in the PACU. If a pericardial drain is required to remain as a result of epicardial ablation, the patient is transferred to the ICU where closer monitoring is performed until it can be removed.
Post-VT ablation patients generally spend the night in the hospital and go home the next day if their procedure did not include any complications. The physician may decide to keep the patient longer if there are any other factors that may warrant continued monitoring and hospitalization. Discharge planning for these patients include: repeat ECHO the next day to rule out pericardial effusion, removal of epicardial drain if left in for excessive bleeding, and Ibuprofen for chest discomfort from epicardial access. Patients are instructed to avoid strenuous activity and lift no more than 10 pounds for 5 days, wear a 24 hour cardiac Holter monitor in 6 weeks along with a physician follow up, and to call the physician’s office if they experience any palpitations, light headedness, low blood pressure or shortness of breath.
Complex VT ablations present multiple challenges for everyone involved. I feel that at St David’s we have a tremendous representation of teamwork and communication from all the disciplines that come in contact with the patient. I attribute these valuable relationships to the continued successful outcomes that we provide these patients as they come through our lab.
–Tami Metz, RN