Catheter Ablation: Atrial Fibrillation

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Class I
    • Symptomatic paroxysmal atrial fibrillation refractory to or intolerant of at least one Class I or III antiarrhythmic agent
  • Class IIa
    • Symptomatic paroxysmal atrial fibrillation before initiation of antiarrhythmic therapy or in cases in which the patient does not desire antiarrhythmic therapy
    • Symptomatic persistent atrial fibrillation refractory to or intolerant of at least one Class I or III antiarrhythmic
  • Class IIb
    • Symptomatic persistent or long-standing persistent atrial fibrillation before initiation of or in cases in which the patient does not desire antiarrhythmic therapy
    • Symptomatic long-standing persistent atrial fibrillation refractory to or intolerant of at least one Class I or III antiarrhythmic
CONTRAINDICATIONS
  • Inability to access the heart because of venous obstruction
  • Intracardiac clot, especially in the left atrium (LA)
  • Inability to receive appropriate anticoagulation therapy for at least 2 months after the procedure
  • Uncontrolled infection or other acute medical condition
EQUIPMENT
  • Sterile mask, gown, gloves
  • Sterile prep solution for access site
  • Sterile drapes
  • Sterile introducer sheaths, guidewires, and introducer needles
  • Lidocaine for local anesthesia
  • Syringes and small-gauge (25- or 30-gauge) needles for subcutaneous infiltration of local anesthetic
  • Ultrasound for vascular access (optional)
  • Intracardiac catheters and cables
  • Transesophageal echocardiography (optional)
  • Fluoroscopy system
  • Three-dimensional mapping system
  • Pacing stimulator
  • ECG and ECG recording system
  • Radiofrequency generator or cryoablation system
  • Crash cart with intubation equipment, resuscitation drugs, external defibrillator, and pacing equipment
  • Oxygen source and delivery system, if necessary (nasal cannula, mask, etc)
  • Equipment for starting a peripheral IV, if necessary:
    • IV catheter (20-gauge)
    • Alcohol or other sterile prep swab
    • Tape or transparent sterile dressing for securing IV
    • Heparin lock for IV
    • Gauze or bandage for IV site
  • Medications for sedation
  • Dressing for IV access site

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Patients should remain on bed rest for 2 to 6 hours to prevent bleeding at femoral access sites and should refrain from significant physical activity for 5 to 14 days afterward.
  • Patients should be cautioned to watch for swelling or bleeding at the femoral puncture site and to report these immediately to the staff.
  • If the patient does not have a therapeutic INR at the time of the procedure, unfractionated or low- molecular-weight heparin (0.5 to 1.0 mg/kg BID) is given as a bridge. Alternatively, a direct thrombin or factor Xa inhibitor may be used without bridging. Anticoagulation should be continued for at least 2 months after atrial fibrillation ablation and may be considered for longer-term use, depending on risk factors for stroke.
  • A recurrence of palpitations or other symptoms should prompt a repeat evaluation.
COMPLICATIONS
  • Risk of vascular injury or complications from vascular access is reported to be 0.5% to 2%.
    • Hematoma
    • Retroperitoneal bleeding
    • Arteriovenous fistula formation
    • Pseudoaneurysm formation
    • Pneumothorax or hemothorax (internal jugular or subclavian vein access)
    • Brachial plexus injury (subclavian vein access) or femoral nerve damage (femoral vein access)
  • Other complications:
    • Pericardial effusion or cardiac tamponade: 0.5% to 1.5%
    • Stroke or transient ischemic attack (TIA): 0.3% to 1%
    • Diaphragm paralysis: 0.2%
    • Mitral valve damage or catheter entrapment: <0.1%
    • Atrial esophageal fistula: <0.05%
    • Pulmonary vein stenosis: <1%
    • Gastroparesis: <1%
  • Death: <0.1%
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