Description

Cardiac ablation procedures are done in a hospital laboratory by specially trained staff. This includes cardiologists (heart doctors) trained in electrophysiology, technicians, and nurses. The setting is safe and controlled to make your risk as low as possible.

You will be given a mild sedative before the procedure to help you relax.

• The skin on your neck, arm, or groin will be cleaned well and made numb with an anesthetic.
• Next, the cardiologist will make a small cut in the skin.
• A small, flexible tube (catheter) will be inserted through this cut into one of the blood vessels in this area. The doctor uses live x-ray images to carefully guide the catheter up into your heart.

Once the catheter is in place, your doctor places small electrodes in different areas of your heart.

• These electrodes are connected to monitors that allow the cardiologist to tell what area in your heart is causing problems with your heart rhythm. Usually, there are one or more specific areas.
• Once the source of the problem has been found, one of the catheter lines is used to send electrical (or sometimes cold) energy to the problem area.
• This destroys the problem area, creating a small scar that causes the heart rhythm problem to stop.

Catheter ablation is a long procedure that can last 4 or more hours During the procedure your heart will be monitored closely. A nurse or doctor may ask you if you are having symptoms at different times during the procedure. Symptoms you may feel are:

• A brief burning when any medicines are injected
• A faster or stronger heartbeat
• Light-headedness
• Burning when the electrical energy is used

Why the Procedure is Performed

Cardiac ablation is used to treat certain heart rhythm problems that medicines are not controlling. These problems may be dangerous for you if they are not treated.

Common symptoms of heart rhythm problems may include:

• Chest pain
• Fainting
• Fast or slow heartbeat (palpitations)
• Light-headedness, dizziness
• Paleness
• Shortness of breath
• Skipping beats - changes in the pattern of the pulse
• Sweating

Some heart rhythm problems are:

• AV Nodal Reentrant Tachycardia (AVNRT)
• Accessory Pathway, such as Wolff-Parkinson-White Syndrome
• Atrial fibrillation and atrial flutter
• Ventricular tachycardia

Risks

Catheter ablation is generally safe. Talk with your doctor about these rare complications:

• Bleeding or blood pooling where the catheter is inserted
• Blood clot that goes to arteries in your leg, heart, or brain
• Damage to the artery where the catheter is inserted
• Damage to heart valves
• Damage to the coronary arteries (blood vessels that carry blood to your heart)
• Esophageal atrial fistula (a connection that forms between your esophagus and part of your heart)
• Fluid around the heart (cardiac tamponade)
• Heart attack
• Vagal or phrenic nerve damage

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

During the days before the procedure:

• Ask your doctor which drugs you should still take on the day of the surgery.
• Tell your doctor if you are taking aspirin, clopidogrel (Plavix) or warfarin (Coumadin).
• If you smoke, stop before the procedure. Ask your doctor for help.
• Tell your doctor if you have a cold, flu, fever, herpes breakout, or other illness.

On the day of the procedure:

• You will usually be asked not to drink or eat anything after midnight the night before your procedure.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Pressure to reduce bleeding is put on the area where the catheters were inserted into your body. You will be kept in bed for at least 1 hour, and maybe up to 5 or 6 hours. Your heart rhythm will be monitored during this time.

Your doctor will decide whether you can go home on the same day or if you will need to stay in the hospital overnight to continue monitoring your heart. You will need someone to drive you home after your procedure

For 2 or 3 days after your procedure, you may have these symptoms:

• You may feel tired.
• Your chest may feel achy.
• You may notice skipped heartbeats, or times when your heartbeat is very fast or irregular.

Your doctor may keep you on your medicines, or give you new ones that help control your heart rhythm.

Outlook (Prognosis)

Success rates are different depending on what type of heart rhythm problem is being treated.

Alternative Names

Catheter ablation; Radiofrequency catheter ablation

References

Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, Crijns HJ, et al. (HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2007:4(6): 816-61.

Miller JM, Zipes DP. Therapy for cardiac arrhythmias. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 33.

Updated: 4/19/2012

Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.