Assessment and treatment of Atrial Fibrillation

Assessment

In order to process your application, we require the following information. Your referring physician can send this information either via a secure online connection or by post:

• Patient’s name, address, town/city of residence and date of birth
• Patient’s medical history
• 24-hour ECG (Holter monitoring)
• CT scan of the patient’s thorax (showing the size of the atrium and pulmonary arteries)
• Lung function test
• Coronary artery examination
• An electrocardiogram (ECG)
• An ultrasound, to assess heart function and atrium size

The above scans may not be older than six months.

Once the above information has been collected, the patient’s case will be discussed during the weekly Multidisciplinary Arrhythmia meeting, and the final treatment plan drawn up. The case manager will then relay the plan back to your referring physician, who will discuss it with you.

  

 

Applying for the procedure

If you agree to the proposed treatment, the International Patient Office will send you a cost estimate and the medical file that you need in order to submit an application to your health insurer (often an E112 or S2 form). Forms can be requested from your health insurer. If the National Health Board is responsible, you will need to ask them for the relevant forms.

You and your referring physician will make the final decision regarding treatment at the Maastricht Heart+Vascular Center.

If you decide to go ahead with the treatment, you will inform your case manager (who will be in contact with your own doctor) and confirm your decision either by transferring the deposit amount, or forwarding your health insurer’s guarantee statement to the International Patient Office (heartandvascularcenter@mumc.nl).

Once the above has been received, your case manager will schedule your additional screening and your treatment. If desired, our hospitality officer at the International Patient Office can arrange travel, accommodation, visa or interpreting services for you. Simply tell your case manager what you would like. 

Pre-operative screening

Three days before your operation, a number of pre-operative tests will be carried out. You will have already received your appointment schedule by e-mail. They will be performed in outpatient setting. This means that you will NOT be admitted to the Maastricht Heart+Vascular Center. During these tests, you will stay at the accommodation of your choice and at your own expense, that you can either book yourself or have us book for you.

After registering at the outpatient reception, you will be collected by our case manager who will conduct your assessment interview. If you take blood thinners, you may need to stop taking them (in stages). Your case manager will discuss this with you. Afterwards you will see the surgeon, who will explain the possible complications to you and ask you to sign the informed consent form. More information on complications and informed consent is available here. You will also have an appointment with an anaesthetist, who will assess whether your condition is acceptable for you to undergo the operation. Lastly, several tests will be performed at the outpatient clinic, which may include an ECG, chest x-ray and blood tests. As soon as these results are in, the heart surgeon will assess whether the risk of surgery is acceptable. Your case manager will communicate your risk assessment to you, and the referring physician will receive a written copy from our heart surgeon. 

Admission and operation

You will be admitted to ward D4 one day before the operation. You will be interviewed by the attending physician, the nurse and the doctors who will be performing the hybrid ablation. All guidelines for taking medication and fasting will be explained to you once you are in the hospital.

On the day of the operation, the nursing team will take you to the operation complex and give you all the information you require. The multidisciplinary team, led by the cardiologist and heart surgeon, will take around 4-6 hours to perform the operation. You will spend the first night after the ablation in the Intensive Care Unit. If there are no complications, you will be transferred back to the ward the next day (the chest tubes are usually also removed at this point). The operation may result in some pain (e.g. in your chest), which will be managed by pain medication.

Medical and nursing care in the hospital ward is aimed at rehabilitation and reactivation. During your first few days there, you will certainly need maximum support in terms of physical care, dressing wounds and mobilisation (physiotherapy) aimed at a speedy recovery. 

Discharge and aftercare

You will usually be allowed to go home within 5-7 days. One to two days before you are discharged, it will become clear that you have sufficiently recovered to make the trip home. If you like, our hospitality officer can arrange for your return travel. The case manager will coordinate this request. When you are discharged, your medical and nursing team will issue you with a treatment report. It will also be sent to your referring physician, and agreements made with them regarding your aftercare and check-ups. These will take place in your local hospital, and will include the assessment of the weekly Holter readings that will take place 3, 6 and 12 months after the operation. Your own cardiologist will do this, and any abnormalities will be discussed by the MUMC+ hybrid ablation team.

You may experience more arrhythmia during the first three months after the operation. This does not mean the operation was not successful, and it will go away with time.

Two weeks after your discharge, we will be able to draw up a final account. This may differ from the initial quote, which only included an estimate of your stay in intensive care. Complications can lengthen this time, resulting in higher costs and differences on the final account. If your stay in ICU is shorter, then the account will of course be lower.

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