Atrial Flutter / CTI Ablation
- Electrophysiology
About this procedure
This guide provides information about an atrial flutter ablation procedure. It includes information about what is involved, how to prepare and what to expect during and after this procedure. Please use this in addition to information from your doctor and nurse.
An atrial flutter ablation (sometimes referred to as a CTI ablation – CavoTricuspid Isthmus) is performed in an electrophysiology (EP) suite at IntraCare in Epsom. Your cardiologist will be assisted by our team of nurses and other highly skilled personnel.
Both IntraCare and Allevia Hospital will be involved with your care for this procedure. Allevia Hospital are responsible for your admission, preparation and aftercare in the Cardiac Investigation Unit (CIU).
What is atrial flutter?
Atrial flutter is usually a very regular arrhythmia and may result in rapid heart rates. This heart rhythm disturbance is caused by an electrical short circuit in the top chamber of the heart (atria).
The most common form (typical atrial flutter or CTI flutter) is a single short circuit that conducts electrical impulses rapidly around the heart valve which lies between the right atrium and right ventricle (tricuspid valve). During atrial flutter, the atria do not contract properly, but rather flutter quickly resulting in blood being pumped less effectively.
Why do I need an atrial flutter ablation?
Atrial flutter affects the rate at which the heart beats. People with atrial flutter may experience symptoms such as palpitations, shortness of breath, light-headedness and fatigue. If these symptoms are impacting your quality of life, then a flutter ablation may help.
This arrhythmia can often be difficult to treat with medication and even when it is asymptomatic, may lead to heart muscle weakening or failure. There can also be a risk of blood clots forming in the atria as they are not contracting effectively.
Following this procedure, you may be able to stop taking some heart medications, as advised by your cardiologist. If your heart muscle has weakened from the flutter, it may also recover over time.
What is an atrial flutter ablation?
Radiofrequency ablation is where an electrode catheter is placed in the heart and radiofrequency energy is delivered to cauterise a small area of tissue.
An atrial flutter ablation is a procedure to create scar tissue within the right atrium (top chamber) of the heart. The ablation catheter is placed on the target area (cavo‑tricuspid isthmus or CTI) and radiofrequency energy is delivered into the tissue. This creates scar and causes a line of block across the abnormal electrical circuit that is causing the atrial flutter.
Before the procedure
Pre-procedure phone call
A nurse from IntraCare will call you 24–48 hours prior to your procedure to discuss the following information:
- Your admission time.
- When you should stop eating and drinking.
- Medication instructions.
- Allergies (including medications, contrast dye, dressings/plasters and food).
- Answer any further questions.
Anticoagulation (blood thinner)
You will be prescribed a blood thinning medication by your cardiologist prior to the procedure if you are not taking one already e.g. Dabigatran (Pradaxa), Rivaroxaban, Warfarin or Clexane. It is very important to NOT miss any doses of your blood thinner for 1 month prior to your atrial flutter ablation. Please contact IntraCare if you have any questions about this.
On the day (important anticoagulation instructions)
- If you are taking Pradaxa/Dabigatran, please take this as usual on the morning of your procedure.
- If you are taking Rivaroxaban, skip the morning dose on the morning of your procedure. If you normally take this at night, take your dose as usual the night before the procedure.
- If you are taking Warfarin, please continue to take this as usual. Our nurses will monitor your INR levels and advise any medication changes if necessary.
Other regular medications
Reminders for the day of your procedure
- If you are on regular medication, please bring this with you in its original packaging.
- Please leave all your jewellery and valuables at home. You are welcome to bring your mobile phone in with you.
- We recommend wearing loose-fitting clothing and shoes that are easy to slip on/off.
- You are encouraged to bring a friend or a family member as a support person before and after your procedure.
- This is commonly a day stay procedure, but please bring an overnight bag with you in case you are required to stay overnight.
- The planned procedure time is an estimate only and may vary. We will keep you informed of any unexpected delays on the day.
Informed consent
As with any procedure, there are potential risks involved. Your cardiologist and anaesthetist will explain the procedure, discuss possible risks and answer any questions you may have. Your whānau or support person are welcome to be part of this discussion. You will then be asked to sign the consent form. This will occur either at an earlier appointment, or on the day of your procedure.
Your procedure
An atrial flutter ablation (CTI) procedure is performed under general anaesthetic and usually takes 1–1.5 hours.
Preparation
Once you are in the EP suite, the staff will perform a safety check-in to confirm your name, date of birth and the procedure you are having. A small intravenous (IV) line will be inserted into a vein in your arm for medication to be injected.
We may need to remove hair with clippers at the access site for sterile preparation. Please avoid shaving the area yourself as this may cause minor abrasions to the skin, increasing the risk of infection.
Several adhesive patches, small and large will be placed on your back and chest for monitoring and 3D mapping if required. Other devices for monitoring blood pressure, heart rate and oxygen levels will be fitted to ensure your safety during the procedure. We will carefully position and tuck your arms at your sides to ensure that sterility and safety are maintained.
The procedure
Atrial flutter ablations are performed under general anaesthetic. Once you are asleep, an anti-septic solution will be applied to the groin area to clean the skin. Following this, two or three small, hollow tubes (sheaths) will be inserted into the vein at the top of the leg (groin). Using X-ray guidance and sometimes 3-dimensional mapping, electrode catheters are then advanced up into the right atrium of the heart via the sheaths in the vein. The ablation is then performed to create a line of block across the electrical circuit that is causing the atrial flutter.
A 30-minute wait time is observed after the ablation, to ensure the ablated tissue does not recover. Once the procedure is complete, the catheters and sheaths are removed from the vein.
After your procedure
You will be transferred from IntraCare to CIU, where the Allevia Hospital team will look after you during your recovery. The nurses will monitor your progress, and if appropriate, you will be discharged home after 4–6 hours. Prior to your discharge, the nurses will provide instructions on medication, procedure site care, and resuming your usual daily activities.
Recovery and discharge
- Following your procedure, it is important that you do not drive for 48 hours.
- Please ensure you have a family member or friend to drive you home from the hospital, as you may still be under the effects of anaesthesia or sedation.
- You will need to arrange someone to be at home with you on the day of your discharge and overnight to support you in your recovery.
- Due to the general anaesthetic, you may feel lethargic afterwards with reduced concentration. For this reason, for 24 hours after your procedure:
- Do not do any activity requiring strength, concentration, or full alertness.
- Do not make any legal decisions or sign legal documents.
- You may feel discomfort in the throat where the breathing tube was placed. This discomfort should improve over the next couple of days. You can take a lozenge to relieve the pain.
- Due to the nature of ablation, it is common to experience some chest discomfort for a few days.
- For a few weeks after your ablation, you may experience, occasional skipped heart beats or brief palpitations. These symptoms are common and will decrease with time.
Resuming activities
- You will be able to return to work within a week of having the procedure unless your job involves heavy lifting (>5kg).
- You can begin light exercise after 1 week.
Medication
- You will need to continue taking your blood thinning medication (anticoagulant) e.g. dabigatran/pradaxa or rivaroxaban for at least 1 month following your procedure. Your cardiologist will discuss this with you in more detail.
- Your cardiologist will discuss any medication changes with you, if necessary. If you have any questions regarding your medications after your procedure, please contact your cardiologist.
Follow up appointment
Femoral (groin) site care
It is normal to experience some bruising at the puncture site. During the first few days after your procedure:
- Do not do any heavy lifting (>5kg) or strenuous exercise.
- Try not to excessively cough, sneeze, or strain as this puts pressure on the puncture site which may cause it to bleed.
- Do not sit in a bath, hot tub or spa. This reduces the possibility of bleeding
or infection. - Do not cross your legs while sitting.
- You may resume walking if your puncture site is not painful.
- If applicable, remove the dressing on your groin once the skin has healed (approximately 3 days).
Haematoma
- If a large lump (haematoma) occurs, lie down, and get another person to press down firmly on the centre of the haematoma for approximately 10 minutes.
- If after releasing pressure, the haematoma reoccurs, keep applying the pressure and go to your local accident and emergency department.
Bleeding
- It is common for there to be a small amount of ooze. If this occurs, re-apply a sticking plaster and lightly press for a few minutes.
- If there is significant bleeding, you should lie flat, and another person will need to apply firm pressure for 10 minutes. If this does not stop the bleeding, you will need to call an ambulance.
Seek immediate medical attention (dial 111 for an ambulance) if there is excessive bleeding from the puncture site or if you are experiencing severe chest pain.
- If you have any concerns, please contact IntraCare:
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- Monday to Friday (6:30am – 6:00pm): 09 630 1961
- After-hours, weekends, and public holidays: 0274 820 763
In case of emergency, always call 111.