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Medic-All Catheter Ablation of Atrial Fibrillation, Taipei VGH 〉 Catheter Ablation of Atrial Fibrillation

Catheter Ablation of Atrial Fibrillation

Catheter Ablation of Atrial Fibrillation

1.VGH is a well-known leading medical center for arrhythmia treatment in the world, specializing in atrial fibrillation and ventricular tachycardia ablation. 2.We developed “the Taipei approach” which has been recognized as gold standard.

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Overview
Besides the medical treatment, the catheter ablation provided an ultimate approach for optimal arrhythmia control in patients with complex arrhythmia. Our team is famous for the catheter intervention for several kinds of arrhythmia, including Atrial Fibrillation(AF), Atrial Tachycardia(AT), Paroxysmal Supraventricular Tachycardia(PSVT), Ventricular Tachycardia(VT), Brugada syndrome and Arrhythmogenic Right Ventricular Dysplasia(ARVD), etc.

In general, a complete treatment plan will provide to every patient. While the procedure, the diagnostic and ablation catheter will be introduced from the major vessels and placed in the critical position inside the heart. Delicate electrical stimulation and comprehensive diagnostic test will be done before intervention. This center is equipped with various kinds of novel mapping tools, including precise 3D mapping systems, cryo-ablation equipment, MediGuide technology, high density mapping catheters and novel software for rotor and similarity analysis. The ablation strategy will individualize based on the disease entity to achieve an optimal outcome.

Features
The team members have performed over 3,000 cases of atrial fibrillation ablation with 84.3% successful rate and only 2.59% complication up to date, which is outstanding among the reported data from most of the domestic or international medical centers. The team discovered numerous novel electrophysiologic mechanisms and techniques for atrial fibrillation, and one of the pivotal centers that started catheter intervention for atrial fibrillation, which is one of standard treatment nowadays.

More than 26 well-known medical centers invite this team leader, Professor Chen, to be visiting professor. The team attracts over three hundred international physicians, technicians and nurses in 19 countries from 72 medical centers to learn the skills and techniques of AF ablation. All these centers had good cooperation with our team, and we also provide instructions and advices to several hospitals to establish a new EP lab.

Service Procedure
Base on the treatment guidelines created by Professor Chen’s group and other well-known medical centers. (Heart Rhythm. 2007;4:816-861; Hear t Rhythm. 2012;9:632-696)
 
Pre Procedure
  1. No need to temporary suspension of the anticoagulation drugs, such as warfarin, and other new generation of anticoagulants, or adjust the concentration of the drugs before the procedure.
  2. Recommend to temporary suspension of the antiarrhythmic drugs for at least 5 half-lives before the procedure. But if the symptoms of the arrhythmia are still significant and need to control by drugs. Then continued using the drugs.
  3. To confirm the structure of the atrium and pulmonary vein and to develop the ablation plan, all patients must undergo 24-hours electrocardiogram, chest echocardiogram, left atrium and pulmonary vein CT scan, transesophageal echocardiogram.
  • Left atrial thrombus is the absolute contraindication for AF ablation. Transesophageal echocardiogram need to be performed not over three days before the procedures.
  1. Patient should remain fasting at least 6 hours before the procedure.
  2. Explain the whole treatment plan to patient and obtain patient’s consent for medical procedure.
 
During Procedure
  1. Heparin should be administered prior to or immediately following trans-septal puncture during AF ablation procedures and adjusted to achieve and maintain an ACT of 300 to 400 seconds.
  2. Performance of AF ablation in a patient systemically anticoagulated with warfarin does not alter the need for intravenous heparin to maintain a therapeutic ACT during the procedure.
  3. Administration of protamine following ablation to reverse heparin should be considered.

Post Procedure
  1. Immediate nurse care after the procedure, including drawing back the catheter, stanching bleeding, treating anticoagulants and evaluating the use of antiarrhythmic drugs after the procedure.
  2. The blood pressure and the heart rhythm should be monitored when the patient reaches to CCU.
  3. If the physician needs to withdraw the catheter in the artery, the Activated Clotting Time should be less than 180 seconds. Then apply pressure to stop bleeding and measure the hemoglobin and the concentration of sodium and potassium ion.
  4. After the procedure, patients may occasionally have a vagal response. The patient can be treated with IV injection or atropine medication. And we also use the echocardiogram to confirm whether the patient has pericardial effusion combine with hypotension.
  5. Treatment of anticoagulants:
  • Continue treatment of anticoagulants or aspirin+licodin for at least three months.
  • Discontinuation of systemic anticoagulation therapy post ablation is not recommended in patients who are at high risk of stroke as estimated by currently recommended schemes CHADS2 or CHA2DS2VASc.
  1. Treatment of antiarrhythmic drugs:
  • Treatment of amiodarone using pump injection.
  • Loading dose: Add 300mg amiodarone in 250 ml D5W, then IV injection for 1 hour.
  • Maintenance dose: Add 900mg amiodarone in 250 D5W, then using pump injection. The flow rate of the pump is 16ml/hr  for the first 6 hours and 8ml/hr for the latter 18 hours.
  • Treatment of antiarrhythmic drugs as pre-procedure used (such as Propafenone, Flecainide or Sotalol), or treatment of amiodarone orally for two months. Then stop the treatment.
  1. Let the patient come back for first-time follow-up at outpatient department after two weeks. Then keep following up the patient at OPD every one month.
  • Arrangement of 24-hour ECG, cardiac event recorder, or wireless remote monitoring every three months.
  • Arrangement of chest echocardiogram and pulmonary vein CT scan in 3-6 months after the procedure.





Notification
Cardiac tamponade, stroke, femoral pseudoaneurysm, arteriovenous fistula, atrio-esophageal fistula.
Estimated Cost
(Prices listed below are for reference. Actual cost may be according to the real expense during the hospitalization.)
USD 5,000~30,000
More Information
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