Understanding Catheter Ablation

If you have a problem with your heart rhythm (the speed and pattern of your heartbeat), your doctor may suggest a procedure called Catheter Ablation. This procedure destroys a few of the cells in your heart that are causing your heart rhythm to problem. This treatment may result in no more symptoms, no more heart rhythm medications and less worrying about your heart.

During catheter ablation, wires are inserted into the heart. The cells causing your rhythm problem are found. Then, energy is sent through the wires to destroy some of the electrical cess causing your heart rhythm problem. A specially trained doctor (Electrophysiologist) performs the ablation. The entire procedure takes from 2 to 6 hours. Your doctor or nurse can discuss the procedure with you and answer your questions.

Before the procedure:

•   Tell your doctor what medications you take, and ask if you should stop taking them before the procedure. Also mention if you are allergic to any medications.
•   Have any routine tests that your doctor prescribes. These may include blood tests or an electrocardiogram (ECG).
•   Don't eat or drink anything (including water) after midnight the night before your procedure.

The day of the procedure, the skin on your groin, neck, shoulder or arm will be washed and may be shaved.

The risks of catheter ablation are low. They are likely outweighed by the benefit of treating your heart rhythm problem. Once you understand the risks, you'll be asked to sign a consent form. This gives your permission to have the procedure done. The risks of catheter ablation include:

•   Bleeding
•   Blood Clots
•   Perforation of the heart muscle, blood vessel or lung
•   Heart block (requiring a permanent pacemaker)
•   Damage to a heart valve
•   Stroke or heart attack (rare)
•   Death (extremely rare)

When you're ready, you'll be taken to the electrophysiology (EP) lab. You'll receive medications through an intravenous (IV) line or in pill form. Some of these medications relax you and help you "sleep" through part or all of the procedure.

Ablation catheters (thin, soft, coated wires) are inserted into a vein or artery through a site in your groin, neck, shoulder, or arm. First, the area is numbed with a local anesthetic so you won't feel pain. Then, a small puncture is made in the vein or artery. The catheter is inserted and moved toward your heart. This movement is viewed on a video screen. After the catheters are inserted, they are used to study your heart rhythm problem. They also help pinpoint the area or areas to be destroyed.

A test called an electrophysiology study (EPS) is usually done as part of your ablation procedure. During EPS, the electrode catheters read where signals begin in the heart an how often these signals are sent. An EPS gives an electrical "map" of your heart and helps pinpoint the places in the heart where an ablation should be done.

When the exact area to be ablated is found, the ablation can be done. A special electrode catheter (called an ablating electrode catheter) is placed near the problem pathway, circuit, or node. Energy waves sent through the catheter destroy (ablate) the problem cells. The rest of your heart muscle is unharmed. Depending on your heart rhythm problem, areas to ablate may include:

•   An extra pathway or circuit
•   Part of your AV node (to slow down the signals passing through this node)
•   All of your AV node (to stop signals from passing through this node)

If all of your AV node must be ablated, signals will no longer be able to pass from your atria to your ventricles. In this event, a small electronic device called a pacemaker must be implanted in your body. The pacemaker sends signals to keep the ventricles beating at the right speed. It is placed permanently into your chest during a minor surgical procedure. This can be done during the ablation or at a later time.

After the ablation, all catheters are removed from your body. You'll need to remain lying down for 4 to 6 hours to allow the insertion site to seal. A nurse will check this site and your blood pressure often. Before you go home, you may have an x-ray and other tests. You may leave the hospital that day or you may stay one or more days, depending on your condition.

Your doctor or the electrophysiologist will discuss your ablation results with you. One ablation is usually enough to treat a heart rhythm problem. Occasionally, though, the heart rhythm problem returns or another one is found. In this case, a second ablation is needed. You can usually stop taking heart medications after a successful ablation.

Have a family member or friend drive you home from the hospital. Most people can return to normal activities a day or two after they come home. It's a good idea to avoid heavy lifting and only engage in light activities for a few days. You may find a small bruise or lump about the size of an olive under your skin at the insertion site. Also, the skin in that area will usually bruised. These are common side effects and should disappear within a few weeks.

Call your doctor if:

•   The insertion site begins to bleed or pain at the site increases
•   You feel any shortness of breath or chest pain
•   The arm or leg in which the catheter was inserted feels cold, swollen or numb
•   The bruising or swelling increases
•   You have a fever over 100 degrees Fahrenheit
•   You feel the symptoms of your heart rhythm problem return

If you have any questions or concerns, please call the Cath Lab (Little Rock - 501.202.2196; North Little Rock - 501.202.3685) or ask your doctor.

Be sure to see your doctor as recommended for follow-up visits. For a few months after your ablation, it's normal to feel your heart skipping a few beats. For a month or two, you may also feel as though your heart rhythm problem is about to return. In most cases, it won't. If you do feel it return, call your doctor.