Cardiac ablation procedures

Definition

Ablate means "to destroy." Cardiac ablation is a procedure that is used to destroy areas in your heart that may be causing your heart rhythm problems. During the procedure, small wires called electrodes are placed inside your heart to measure your heart’s electrical activity. These electrodes are also be used to destroy the bad areas of your heart.

Alternative Names

Catheter ablation; Radiofrequency catheter ablation

Description

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

You will be given a mild sedative before the procedure to help you relax. Then, the skin on your neck, arm, or groin will be cleaned well and made numb with an anesthetic. Next, a surgeon will make a small cut into one of the blood vessels in this area. Then, a catheter (a small, flexible tube) will be inserted through this cut. The doctor uses live x-ray images to carefully guide the catheter up into your heart.

Once the catheter is in place, your doctor runs several flexible tubes that contain electrodes through it. These are placed in different small blood vessels in your heart. They are connected to monitors that tell what area in your heart muscle is causing problems with your heart rhythm.

One of the catheter lines sends electrical energy to the problem area to create a scar. The scarring 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
• Lightheadedness
• A 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. Some problems are:

• AV Nodal Reentrant Tachycardia (AVNRT)
• Accessory Pathway
• Atrial fibrillation and atrial flutter
• Ventricular tachycardia

Risks

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

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

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 surgery:

• 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, try to stop. 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 surgery:

• 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.

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.

You will need someone to drive you home after your procedure.

Outlook (Prognosis)

Success rates are different for each type of catheter ablation and what type of heart rhythm problem is being treated.

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.