Arrhythmia Associates LLP

FAQs

Frequently Asked Questions (FAQ)

How do I become a patient of Arrhythmia Associates?

Please call our main Fairfax office at 703.849.0770 to obtain information about making a consultation appointment with us. We will help you determine if your insurance program requires a specific referral.

What are the scheduled office hours for your office?

Generally, we see patients Monday through Friday from 8am until 5pm and we encourage you to call us during these hours if you have questions about your medical care. Any questions or inquiries will be given to one of our nurses who will then refer the issue to one of our physicians. You should expect a response from our office within no more than 1 hour. After 5pm, one of our physicians is on-call until the following morning at 8am. We are always available to discuss your care. Of course, your complete chart is available to us during office hours and this allows a more complete conversation so routine matters are best addressed at this time.

I take warfarin/(Coumadin). How do I adjust my medication dose?

Warfarin/ Coumadin dosing requires scheduled laboratory testing by adjusting your Coumadin dose based on the INR level. If your Coumadin is managed in our clinic, the laboratory values will be faxed to our office later that day. You should expect us to call you that afternoon with the results of your laboratory testing as well as directions to adjust your Coumadin dosing. If you do not receive a phone call from our office by 5pm, you are instructed to call us the following morning after the start of office hours at 8am. While we are available 24 hours a day for medical emergencies, the on-call physician will not have access to your laboratory values and we will not be able to direct your care at that time. Simply call our office the following morning and we will provide all necessary recommendations.

My prescription for arrhythmia medication ran out. What should I do?

During scheduled office hours, please call our office and the message will be relayed to our nurses and doctors and we will work with you to refill your medications. Once again, we encourage you to call us during scheduled office hours rather than contacting the on-call physician to provide the best care for these routine matters. If you realize that your prescription has run out after office hours, in general you can call us the following morning and we would be happy to assist you. See Prescription Refills.

When should I remove the bandages after my pacemaker/ICD implantation or pacemaker generator change?

In the setting of a new pacemaker/ICD implantation, we will remove the large dressing bandage covering the incision site. The steri-strips covering the incision itself will now be exposed and these will fall off on their own in the next two weeks. You should not remove these strips. If they are still present at the time of your two week office visit, we will take them off at that time. We will ask you to keep the area of your incision site dry. Generally, patients are advised to perform "sponge baths" rather than taking daily showers or baths until the post-operative office visit.

What does a pacemaker/ICD "recall" mean? What should I do about it?

Pacemaker and ICD's are mechanical devices and are composed thousands of working parts. Like all mechanical devices, pacemakers and ICD's have the potential for malfunction. Recently, a rare number of these devices have been identified to have technical concerns and these technical problems have prompted the regulatory agencies such as the FDA to issue warning recommendations. Some of these recommendations are called "advisory's" to alert physicians about potential problems. The most severe of the FDA warnings are referred to as "recalls" in which physicians are requested to carefully screen all patients with suspect devices and apply any necessary changes. Several comments are warranted. First, the incidences of device malfunction in the worst scenario have proven to be very, very uncommon (occurring in the range of 1/10,000). Second, almost every patient who has an implantable device that is under recall can be successfully managed with straightforward programming changes. Rarely, patients may require their pacemaker/ICD to be removed and a new device implanted.

Third, the steps necessary to deal with any recall does not come close to the tremendous benefit provided to patients who have pacemaker/ICD's implanted. The benefits from ICD implantation, for example, are tremendous. Across nearly every clinical trial, a powerful mortality benefit is shown for those patients who are eligible for and who receive ICD implantation.

My pacemaker/ICD incision hurts. How do I know if it is infected?

It is normal for a new surgical incision to feel sore for several days after surgery. Generally, medications such as Motrin are sufficient to treat any mild pain. If the pain is severe, your physician may prescribe more powerful pain medications such as Percocet for several days. If you continue to have pain from your incision site that is not getting better after 3-4 days, we ask you to call our office to discuss it.

Aside from pain from the incision site, we also ask you to notify us if you experience any fever or if you notice that the incision site is red, warm, and/or tender. While incision site infection is quite rare, we would like to be very "proactive" in this area to avoid future problems.

My pacemaker/ICD is beeping. What does that mean?

Some devices are programmed to notify the patient if there is a change in the device or the leads that attach to the implantable device. The most common reason for beeping from your implantable device might be when the battery life is depleting and is approaching an elective replacement indication or ERI. If you notice beeping from the device, please call our office to discuss it.

I recently had an ablation procedure and I feel more palpitation. Is this normal?

After successful ablation (see catheter ablation), it is very common to feel symptoms of palpitation. Skipped beats are common following ablation and should lessen with time, but if sustained arrhythmia reoccurs, call our office. Many patients have told us that for several weeks after the procedure that they feel as if the "arrhythmia is about to happen but doesn't". You may feel a few extra beats but the sensation should be fleeting and lasting only several seconds. This is a very normal finding and actually suggests that the arrhythmia circuit has been eliminated. The ablation procedure itself can irritate the inner lining of the heart and can cause mild inflammation there. This inflammation itself can initiate extra heart beats called atrial premature contractions (see APC's) or ventricular premature contractions (see VPC's). This inflammation will resolve in 1-2 weeks after the ablation procedure and the symptoms should also resolve. If symptoms continue, please call our office.

You should also call our office if you experience symptoms of dizziness, chest pain, or shortness of breath.

Is a diagnostic electrophysiology study and ablation Safe?

Since EPS is an invasive procedure, there is some risk. The risk is small, however and the procedure is exceedingly safe and considered preferable to the use of long term medications for the treatment of cardiac arrhythmias.

Some patients experience bleeding from the insertion sites which is minimal and this may result in some local skin discoloration as a small amount of blood collects under the skin. If the collection is big enough, you may notice a small lump under the skin. This is safe and will disappear in a matter of days to weeks. Serious complications, however, are rare and include damage to blood vessels or to the heart itself. Very rarely, a patient may require a permanent heart pacemaker due to damage to normal nerves in the heart. Equally rare is infection and the formation of blood clots. Death has been reported as a result of ablation but this is an exceeding infrequent occurrence.

What activity limitations are there after ablation?

Limit activities immediately following the EPS and/or ablation. By 24 hours afterward, you may perform normal activities but do not lift anything heavier than 25 pounds for two days. After that time, you may perform any activity except for vigorous exercise such as jogging or weight lifting for which you should wait at least one week following ablation. You may shower the day after the procedure.

What medicines should I take after the ablation procedure is completed?

The drugs you may have taken for control of your arrhythmia generally will no longer be needed. If you are not allergic to plain Tylenol, you make take two tablets every four to six hours for pain. Patients not allergic to aspirin should take one aspirin each day for one month. Before your discharge from the hospital, your doctor will give you detailed instructions about your medication requirements as well as office follow-up.