Radiofrequency Ablation - for patients with supraventricular tachycardias, atrial fibrillation and ventricular tachycardiaOther Names for Catheter Ablation
What Is Catheter Ablation?Catheter ablation (ab-LA-shun) is a medical procedure used to treat some types of arrhythmia (ah-RITH-me-ah). An 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 guided into your heart through the blood vessel. A special machine, called a generator, sends energy through the ablation catheter to your heart. The energy modifies, via heating, or less commonly, freezing, small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start. Radiofrequency (RF) energy usually is used for catheter ablation. This type of energy uses radiofrequency current to produce heat that modifies the heart tissue. Studies have shown that RF energy is safe and effective. Who Needs Catheter Ablation?To understand catheter ablation, it helps to understand how the heart works. The heart's electrical system controls the rate and rhythm of your heartbeat. Normally, with each heartbeat, an electrical signal spreads from the top of your heart to the bottom. As it travels, the electrical signal causes your heart to contract and pump blood. The process repeats with each new heartbeat. (For more information, go to the Diseases and Conditions Index How the Heart Works article.) A problem with any part of this process can cause an arrhythmia. Catheter ablation is one of several arrhythmia treatments. Your doctor may recommend it in several situations, as described in the next section:
Catheter ablation has some risks. Bleeding, infection, and pain may occur where the ablation catheter is inserted. More serious problems include blood clots and puncture of the heart. Your doctor will explain the risks to you. In general, however, catheter ablation is a safe and effective curative procedure. What To Expect Before Catheter AblationBefore you have catheter ablation, your doctor may review your medical history, do a physical exam, and recommend tests and procedures. Your doctor will want to know about any medicines you're taking. Some medicines can interfere with catheter ablation. If you take any of these medicines, your doctor may advise you to stop taking them before the procedure. Your doctor also may ask whether you have diabetes, kidney disease, or other conditions. If so, your doctor may need to take extra steps during or after the procedure to help you avoid complications. Before catheter ablation, you may have tests such as:
Less often, your doctor may recommend cardiac catheterization (KATH-e-ter-i-ZA-shun), coronary angiography (an-jee-OG-ra-fee), or a test to rule out an overactive thyroid. (An arrhythmia can be a symptom of an untreated overactive thyroid.) If you're pregnant, let your doctor know before having catheter ablation. The procedure involves the use of radiation, which can harm a fetus. Talk with your doctor about whether you should have the procedure or wait. If you're a woman of childbearing age, your doctor may recommend a pregnancy test before catheter ablation to make sure you're not pregnant. Once the procedure is scheduled, your doctor will tell you how to prepare for it. You'll likely need to stop eating and drinking by midnight before the procedure. Your doctor will give you specific instructions. Most people stay overnight following the ablation procedure. Some people go home the same day as the procedure. A few may require a longer than 1 day stay in the hospital. You will need someone to drive you home after the procedure, as driving is not recommended due to having received sedation/anesthesia. What To Expect During Catheter AblationCatheter ablation is done in a hospital. Doctors who do this procedure have special training in cardiac electrophysiology (the heart's electrical system) and ablation (modification) of diseased heart tissue. Before the ProcedureIf you're a woman of childbearing age, your doctor may recommend a pregnancy test before catheter ablation to make sure you're not pregnant. The procedure involves the use of radiation, which can harm a fetus. If you're pregnant, talk with your doctor about whether you should have the procedure or wait. Before the procedure, you'll be given medicine through an intravenous (IV) line inserted into a vein in your arm. The medicine will help you relax. It may make you sleepy. You'll also be connected to several machines that will check your heart's activity during the procedure. Once you're drowsy, your doctor will numb an area on your arm, groin (upper thigh), and/or neck. A needle will be used to make a small puncture through your skin and into a blood vessel. Your doctor will put a tapered tube called a sheath through this puncture site. Your doctor will then put thin, flexible guide tubes and catheters ( long, thin, flexible wires) into your blood vessel. These wires will be threaded through your blood vessels and into your heart. The wires have recording poles, called electrodes at the end. These are used to record electrical signals from inside the heart, similar to the way an ECG records signals from the body surface. The ablation catheter can record signals as well as be used to deliver energy through, to ablate, or modify the heart’s electrical tissue and cure the abnormal heart rhythm. During the Procedure Electrodes at the end of the catheter will be used to stimulate your heart and record its electrical activity. This will help your doctor learn where abnormal heartbeats are starting in your heart. Your doctor will aim the tip of the catheter at the small area of heart tissue where the abnormal heartbeats are starting. A special machine will send energy through the catheter to create ablation lesions. In some cases, the abnormal heart rhythm may arise from a single point, or focus, while in other cases a circuit is involved and several ablation applications along one or more lines is needed. The ablation point or line(s) will modify the abnormal electrical tissue. This will stop abnormal electrical signals from traveling to the rest of the heart and causing arrhythmias. What You May Feel You will most likely be sleeping for most of the procedure. You may be awakened if it is difficult to start your abnormal rhythm in the sedated state, or for testing to see if the abnormal rhythm is gone after the ablation. You generally will not feel anything except possibly:
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 blood vessel puncture sites will be bandaged. Nurses will apply pressure to this site to help prevent major bleeding and to help the area begin to heal.What To Expect After Catheter Ablation
While you're in the special care unit, you'll be connected to special devices that measure your heart's electrical activity and blood pressure. Nurses will check these monitors regularly. Nurses also will check to make sure that you're not bleeding from the catheter insertion site. Going Home Your doctor will decide whether you need to stay overnight in the hospital. Some people go home the same day as the procedure. Others need to stay in the hospital for 1 or more days. Before you go home, your doctor will tell you:
Driving after the procedure may not be safe, as you will have received sedation/anesthesia. You will need to have someone drive you home from the procedure. Recovery and Recuperation Recovery from catheter ablation usually is quick. You may feel stiff and achy from lying still for 4 to 6 hours after the procedure. You may receive pain medication for this following the procedure. Also, a small bruise may form at the site where the catheter was inserted. The area may feel sore or tender for about a week. Most people are able to return to normal activities in a few days. Your doctor will talk with you about signs and symptoms to watch for. Let your doctor know whether you have problems such as:
Follow-up care The doctor will see you about 1 month after the procedure for follow-up. In the interim, if you note any unusual symptoms or have questions, please contact the office. Information provided by National Heart, Lung and Blood Institute
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arrhythmia is a problem with the rate or rhythm of the heartbeat.
After catheter ablation, you'll be moved to a special care unit where you'll lie still for 4 to 6 hours of recovery. Lying still prevents bleeding at the site where the ablation catheter was inserted.
© Donna Gallik, M.D. | Los Angeles Electrophysiologist |