WHAT IS IT?

Catheter ablation (ab-LA-shun) is a medical procedure used to treat some arrhythmias (ah-RITH-me-ahs). An arrhythmia is a problem with the speed or rhythm of the heartbeat.
During catheter ablation, a long, thin, flexible tube is put into a blood vessel in your arm, groin (upper thigh), or neck. This tube is called an ablation catheter. It’s then guided to your heart through the blood vessel. A special machine sends energy through the catheter to your heart. This energy finds and destroys small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start.

BASIC FACTS

Catheter ablation is a medical procedure used to treat some cardiac arrhythmias (irregular heartbeats). It's one of several treatments for arrhythmia.
Your doctor may recommend catheter ablation:

• To treat your arrhythmia if medicine doesn’t help or if you can’t tolerate the medicine.
• If you have certain types of arrhythmia, such as Wolff-Parkinson-White syndrome or some forms of atrial fibrillation.
• If you have abnormal electrical activity in your heart that increases your risk for ventricular fibrillation (a life-threatening arrhythmia) and sudden cardiac arrest.

Catheter ablation alone doesn’t always restore a normal heart rhythm. Other treatments may be needed as well. Also, some people who have the procedure may need to have it done again. This can happen when the first procedure doesn’t fully correct the problem.

• Your doctor can tell you how to prepare for the procedure.
• Catheter ablation is done in a hospital. Doctors who do this procedure have special training in cardiac electrophysiology (the electrical system of the heart) and ablation (destruction) of diseased heart tissue.
• During the procedure, your doctor uses a long, thin, flexible tube called an ablation catheter to find the area where abnormal heartbeats are starting. Then, with the tip of the catheter, the doctor uses one of several energy forms to find and destroy this tiny area.
• The procedure lasts 3 to 6 hours.
• After the procedure, you will need to lie still for 4 to 6 hours. Some people are able to go home the same day. Others need to stay overnight for 1 or more days.
• Recovery is usually quick. Most people return to normal activity in a few days. Talk to your doctor about signs and symptoms to watch for. Let your doctor know if you have a large amount of bleeding at the catheter insertion site or pain, swelling, redness, or other signs of infection.
• Though few, catheter ablation does have risks. Some possible complications are bleeding, infection, and pain where the catheter was inserted. More serious problems are blood clots and puncture of the heart.

A MORE DETAILED EXPLANATION

The heart’s electrical system controls the speed and rhythm of your heartbeat. With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As it travels, the electrical signal causes the heart to contract and pump blood.
The process repeats with each new heartbeat. A problem with any part of this process can cause an arrhythmia. Catheter ablation is one of several treatments for arrhythmia. Your doctor may recommend it if:

• The medicines you take don’t control your arrhythmia.
• You can’t tolerate the medicines your doctor has prescribed for your arrhythmia.
• You have certain types of arrhythmia, such as Wolff-Parkinson-White syndrome.

Though few, catheter ablation has risks. These include bleeding, infection, and pain where the catheter is inserted. More serious problems include blood clots and puncture of the heart. Your doctor will explain the risks to you.

Cardiologists (doctors who specialize in treating people with heart problems) sometimes perform ablation through open-heart surgery. But this method isn’t as common as catheter ablation, which doesn’t require surgery to open the chest cavity.

Catheter ablation alone doesn’t always restore a normal heart rate and rhythm. Other treatments may need to be used as well. Also, some people who have the procedure may need to have it done again. This can happen when the first procedure doesn’t fully correct the problem.

WHEN IS IT INDICATED?

Your doctor may recommend catheter ablation if:

• You have an arrhythmia that medicine can’t control.
• You can’t tolerate the medicines your doctor has prescribed for your arrhythmia.
• You have certain types of arrhythmia, such as Wolff-Parkinson-White syndrome or some forms of atrial fibrillation.
• You have abnormal electrical activity in your heart that raises your risk for ventricular fibrillation (a life-threatening arrhythmia) and sudden cardiac arrest

WHAT TO EXPECT BEFORE CATHETER ABLATION

Before having catheter ablation, discuss with your doctor:

• How to prepare for the procedure, including limits on eating and drinking. You will likely need to stop eating and drinking by midnight before the procedure. Your doctor will give you specific instructions.
• Any medicines you’re taking, and whether you should stop taking them before the procedure.
• Whether you have diabetes, kidney disease, or other conditions that may require taking extra steps during or after the procedure to avoid complications.

Some people go home the same day as the procedure. Others need to stay overnight for 1 or more days. Driving after the procedure may not be safe. Your doctor will let you know if you need to arrange for someone to drive you home.

WHAT TO EXPECT DURING CATHETER ABLATION

Catheter ablation is done in a hospital. Doctors who do this procedure have special training in cardiac electrophysiology (the electrical system of the heart) and ablation (destruction) of diseased heart tissue.

At the Start

Before the procedure, you're given medicine through an intravenous (IV) line inserted in a vein in your arm. The medicine will help you relax. It may make you sleepy. You're also connected to several machines that check your heart's activity during the procedure.

Once you're drowsy, your doctor numbs an area on your arm, groin (upper thigh), or neck. A needle is used to make a small hole through the skin into a blood vessel. Your doctor puts a tapered tube called a sheath through this hole.

Your doctor then puts a thin, flexible wire and an ablation catheter (a long, thin, flexible tube) through the sheath and into your blood vessel. The guide wire is threaded through your blood vessel to your heart. The wire helps your doctor place the catheter correctly.

Then, your doctor puts a special dye into the catheter. The dye makes the inside of your heart show up on special x-ray images called angiograms. The images help your doctor place the tip of the catheter in the correct spot in the heart.

During the Procedure

Electrodes at the end of the catheter are used to stimulate the heart and record its electrical activity. This helps your doctor learn where abnormal heartbeats are starting in your heart.

Your doctor aims the tip of the catheter at the small area of heart tissue where the abnormal heartbeats are starting. A special machine sends energy through the catheter to create a scar line, also called an ablation line. The types of energy used include radiofrequency (heat generated by electrodes), laser, or cryo- (very cold temperatures).

The scar line creates a barrier between the damaged heart tissue and the surrounding healthy heart tissue. This stops abnormal electrical signals from traveling to the rest of the heart and causing arrhythmias.

What You May Feel

You may sleep on and off during the procedure. You generally will not feel anything except for:

• A burning sensation when the doctor injects medicine into the area where the catheter will be inserted
• Discomfort or burning in your chest when the energy is applied
• A faster heartbeat during studies of your heart's electrical system

The procedure lasts 3 to 6 hours. When the procedure is done, your doctor will pull back the ablation catheter and take it out along with the sheath and guide wire.

The opening left in the blood vessel is closed and bandaged. Nurses apply pressure to this site to help prevent major bleeding and to help the site begin to heal.

WHAT TO EXPECT AFTER CATHETER ABLATION

After the procedure, you’re moved to a special care unit where you lie still for 4 to 6 hours of recovery. Lying still prevents bleeding at the site where the catheter was inserted.

While you’re in the special care unit, you’re connected to special devices that measure your heart’s electrical activity and blood pressure. The nurses check these monitors continuously. Nurses also check to make sure that there’s no bleeding at the catheter insertion site.

Going Home

Your doctor determines whether you need to stay overnight in the hospital. Some people go home the same day. Others need to stay overnight for 1 or more days.

Before you go home, your doctor will tell you:

• Which medicines you need to take
• How much physical activity you can do
• How to care for the area where the catheter was inserted
• When to see the doctor again

Driving after the procedure may not be safe. Your doctor will let you know if you need to arrange for someone to drive you home.

Recovery and Recuperation

Recovery from catheter ablation is usually quick. You may feel stiff and achy from lying still for 4 to 6 hours after the procedure. In addition, a small bruise may form at the site where the ablation catheter was inserted. The area may feel sore or tender for about a week. Most people are able to return to normal activity in a few days.

Talk to your doctor about signs and symptoms to watch for. Let your doctor know if you have problems such as:

• A constant or large amount of bleeding at the catheter insertion site that you can’t stop with a small bandage
• Unusual pain, swelling, redness, or other signs of infection at or near the catheter insertion site
• Strong, rapid, or other irregular heartbeats
• Fainting

WHAT ARE THE RISKS?

Though few, catheter ablation does have risks. Possible problems are:

• Bleeding, infection, and pain where the catheter was inserted.
• Damage to blood vessels. This complication is very rare. It’s caused by the catheter scraping or poking a hole in a blood vessel as it’s guided to the heart.
• Puncture of the heart.
• Damage to the heart’s electrical system. This may lead to the need for a permanent pacemaker. A pacemaker is a small device that’s placed under the skin of your chest or abdomen to help control abnormal heart rhythms.
• Blood clots, which could lead to stroke or other damage.
• Narrowing of the veins that carry blood from the lungs to the heart. This is called stenosis.

As with any heart procedure, complications can sometimes, although rarely, be fatal. The risk of complications is higher if you have diabetes or kidney disease. It also is higher if you’re 75 years old or older.

SOURCE

National Institutes of Health (U.S. Department of Health and Human Services) www.nih.gov

 

The information on this Web site is provided by Cardiology Associates of Michigan for educational purposes only. It is not a substitute for professional medical care.  If you have, or suspect you have, a health problem you should consult your physician immediately where they can diagnose and treat your symptoms.

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