Frequently Asked Questions (FAQs)

Dr. Germano is a member of Winthrop Cardiology Associates and is affiliated with Winthrop-University Hospital. Profiles of Dr. Germano and his team of arrhythmia experts can be found on the Staff Information page.

How do I schedule an appointment?

Appointments can be made by calling us. Some insurance companies require referrals from your doctor prior to making an appointment.

How do I schedule a procedure?

Procedures are scheduled in person or by calling us. In general, procedures are scheduled after we have had the opportunity to perform a full medical evaluation and appropriate testing. The details of the procedure as well as the risks, benefits, and alternatives will be discussed with you by a physician with expertise in this procedure(s).

What do I need to do before my procedure?

After a full medical evaluation has been performed and a procedure is planned, pre-admission testing as well as any necessary pre-procedural testing will be scheduled. At pre-admission testing, a physician’s assistant (PA) or nurse practitioner (NP) will obtain medical information, perform a physical examination, obtain lab work, an electrocardiogram, and possibly a chest X-ray. The PA or NP will also reiterate the details, risks, benefits, and alternatives of the procedure(s) planned by you and your physician as well as obtain informed consent. They will also help coordinate any additional testing as well as use of anticoagulation around the time of the procedure.

Anticlotting agents, such as antiplatelet medications (aspirin, plavix, etc.) are not usually stopped prior to our procedures. However, antiocoagulants such as warfarin (coumadin) is generally stopped a few days prior to invasive procedures. You may be asked to perform self-injections of enoxaparin (lovanox) before and/or after your procedure to provide “bridging anticoagulation” while warfarin is wearing off (before the procedure) and subsequently taking effect (after the procedure). Alternatively, you may be admitted to the hospital for an intravenous heparin infusion instead of receiving lovanox. Noninvasive procedures generally do not require discontinuation of coumadin. The use of anticoagulation around the time of your procedure is individualized for every patient and at the discretion of your doctor. It can be confusing and should be clear to you before your procedure. Ask questions if you are not clear on the details!

Unless otherwise instructed, normal medications can generally be taken the morning of the procedure with sips of water.

As you will be lying flat on a procedure table and receiving sedation, stomach acid secretions must be minimized to reduce the risk of inhaling irritating foreign material into the lungs, otherwise known as aspiration pneumonia. Therefore, do not drink or eat anything after midnight the night before the procedure or the morning of the procedure (NPO status) except for sips of water with your medications. Sips of juice, coffee, and chewing gum are NOT permitted as they can also stimulate the secretion of stomach acids. Any violation of the NPO status will cause a delay or rescheduling of your procedure.

How do I find out more about my medical condition(s)?

The Heart Rhyhtm Society website is an excellent resource for information about normal heart function and heart rhythm disorders, as well as signs and symptoms commonly associated with these conditions.

What testing is available to diagnose my medical condition(s)?

Information about heart testing can be found on the Heart Rhyhtm Society site.

How do I find out more about the treatment options available for my medical condition(s)?

The Heart Rhyhtm Society webiste provides information about common treatment options for arrhythmias.

Am I at risk for an arrhythmia?

Many risk factors and triggers have been linked to arrhythmias.

I have been diagnosed with a heart rhythm disorder. Do I need a blood thinner?

“Blood thinners” is a term often used to describe both anti-platelet medications (aspirin, clopidogrel or plavix, etc.) as well as anticoagulants (warfarin or coumadin). These medications are commonly used in patients with coronary artery disease, strokes, artificial heart valves and certain types of arrhythmias such as atrial fibrillation and atrial flutter. They are generally used to prevent heart attacks and strokes, but may have other indications. You may be placed on one or both of these types of medications depending on your specific medical history. Click here for more information on these medications.

What activities can I do and what should I avoid after my procedure?

After a procedure through your groin, such as an electrophysiology study or an ablation, normal activity is permitted. Brisk walking, jogging, running, and other forms of heavy exertion or straining should be avoided for approximately a week after your procedure to allow the groins to heal fully. Activities such as sex and use of hot baths, whirlpools, and jacuzzis should also be avoided during this time period.

After a device such as a pacemaker or defibrillator is implanted, normal activity is generally permitted with the exception of raising the arm on the same side the device was implanted over your head. This only applies to devices where leads (wires) were implanted or moved inside the heart, not to generator changes (battery changes) where no leads were added or moved. Please ask us if you are not sure of the specifics of your procedure and whether or not this applies to you. Avoiding arm raising does not apply to insertion of implantable loop recorders as there are no leads associated with these devices.

After any device implantation or generator change, it is important to keep the surgical site dry until you see us in the office to verify that the site has healed properly. We will ask you to see us in approximately 2 weeks after the device is implanted. At that time, we will remove the Steri-strips and possibly a single stitch. Only your doctor or one of his qualified staff members should remove the Steri-strips or the stitch. Do not do this yourself.

Not following the above guidelines can result in serious complications including the need for surgery or revision of the implanted system.

If you develop severe swelling, pain or oozing at the procedure/surgical site, fever, chills, chest pain, difficulty breathing, heart racing or any other change in your normal state of health, contact us immediately or call 9-1-1 to be evaluated at the nearest emergency room depending on the severity of the problem. Please contact us (or have a family member contact us) if you call 9-1-1 so that we can help coordinate your care or arrange transfer to our hospital if necessary.

When should I follow-up with my doctors after the procedure or hospitalization?

Follow-up with us generally takes place 2-4 weeks after your procedure or hospitalization. This information should be obtained before leaving the hospital. We ask that you call to schedule your appointment as soon as possible upon leaving the hospital so that we can help pick a convenient time for you.

Follow-up with your regular doctor or cardiologist generally occurs 1-2 weeks after the procedure or hospitalization at the ultimate discretion of your doctor.

You may be asked to see your doctor sooner to obtain outpatient testing such as lab work, especially in patients who leave the hospital on blood thinners.

Can I drive after my procedure?

Driving a motor vehicle in patients with cardiac conditions is a complicated issue.

In 1996, the American Heart Association and the North American Society of Pacing and Electrophysiology (currently the Heart Rhythm Society) published recommendations regarding personal and public safety issues related to arrhythmias that may affect consciousness. These guidelines are comprehensive and address various aspects of cardiac arrhythmias to aid physicians in assessing how they will affect the driving skills of patients.

In 2007, the American Heart Association and the Heart Rhythm Society published a scientific statement updating guidelines for physicians and patients regarding driving restrictions in patients with implantable cardioverter-defibrillators (ICDs). These guidelines clearly distinguish between primary and secondary prevention. With respect to ICDs, primary prevention refers to preventing the initial episode of sudden cardiac death; whereas secondary prevention refers to preventing sudden cardiac death following the survival of an initial event. These recommendations state that patients who receive ICDs for primary prevention should be restricted from driving a private automobile only until they can be evaluated for proper ICD function and to allow for recovery from implantation of the ICD (this period should be at least one week). Thereafter, driving privileges should not be restricted in the absence of symptoms potentially related to a life-threatening heart rhythm abnormality. These patients must be instructed that impairment of consciousness is a possible future event. If a patient subsequently receives an ICD therapy for a life-threatening heart rhythm abnormality, especially with symptoms, the patient should be treated as if the ICD was implanted for secondary prevention. Guidelines for driving in patient with ICDs implanted for secondary prevention were addressed in the 1996 guidelines and have not changed significantly. Recommendations are based on arrhythmia recurrence and associated symptoms. Some authors have suggested that patient without arrhythmic events for 6 months are considered low-risk and can safely drive. These recommendations do not apply to the licensing of commercial drivers.

Department of Motor Vehicles (DMV) rules vary by state. The New York State DMV requires that patients disclose medical conditions. If a physician reports a condition that can affect the driving skills of a patient, the DMV can suspend the driver’s license. The DMV suspends the driver license until a physician provides a certification that the condition is treated or controlled and does not affect driving skills. The DMV can require that the physician re-certify that the condition is controlled and not dangerous at a future time. If the DMV does not receive the required certification, the DMV can suspend the driver license until it receives physician certification.

Commercial drivers are regulated under federal laws due to interstate travel. The Commercial drivers fitness driver determination form (Form 649-f) discusses the physical qualifications to a commercial motor vehicle in persons with cardiovascular conditions. Federal Motor Carrier Safety Administration (FMCSA) disqualifying conditions include “myocardial infarction, angina pectoris, coronary insufficiency, thrombosis or any other cardiovascular disease” which is “not fully stabilized” and is “likely to cause syncope, dyspnea, collapse or congestive cardiac failure.” The subjective decision of whether the nature and severity of an individual's condition will likely cause symptoms is on an individual basis and “qualification rests with the medical examiner and the motor carrier.” When one of these conditions is present, “it is suggested before a driver is certified that he or she have a normal resting and stress electrocardiogram (ECG), no residual complications and no physical limitations, and is taking no medication likely to interfere with safe driving.” Coronary artery bypass surgery, pacemaker implantation, and the use of warfarin do not necessarily disqualify commercial driving. Implantable cardioverter-defibrillators are disqualifying due to risk of syncope. FMCSA can be contacted at (202) 366-1790 for additional recommendations or questions. (See also Cardiovascular Advisory Panel Guidelines for the Medical examination of Commercial Motor Vehicle Drivers)

Overall, whether or not driving is advisable should be a discussion between a physician, patients and often family members using expert consensus to guide the final decision.

When do I contact my physician after the procedure?

Some soreness at the sight of the procedure is normal; however, if you develop severe swelling, pain or oozing at the procedure/surgical site, fever, chills, chest pain, difficulty breathing, heart racing or any other change in your state of health, contact us immediately or call 9-1-1 to be evaluated at the nearest emergency room depending on the severity of the problem. Please contact us (or have a family member contact us) if you call 9-1-1 so that we can help coordinate your care or arrange transfer to our hospital if necessary.

How do I find out more information about my pacemaker and defibrillator from the manufacturer?

Refer to device manufacturer information.

What do I do if my defibrillator delivers a shock?

ICD shocks fall into two major categories. The first category is appropriate shocks; that is, when an ICD delivers a shock for its intended purpose of stopping a dangerous heart rhythm called ventricular tachycardia or ventricular fibrillation. The second major category is called inappropriate shocks. These shocks can occur for a variety of reasons, including arrhythmias that are not life threatening, external electromagnetic interference, and even noise from within the ICD itself or one of the leads (wires) connected to the ICD. An important consideration when evaluating ICD shocks is the presence or absence of symptoms that may develop immediately before or at the time of the shock. These symptoms include dizziness and lightheadedness, loss of consciousness, heart racing or palpitations, chest pain, and shortness of breath. Regardless of the cause of the shock, an isolated ICD shock without symptoms usually only requires an outpatient ICD evaluation to determine the cause for the shock. Multiple shocks within a 24-hour period and/or symptoms associated with even a single shock generally require hospitalization to evaluate. Your medical team will then determine the cause and type of ICD shock(s) delivered, as well as any adjustments to your ICD or medical regimen that are necessary.