What to Expect: Catheter Ablation

In catheter ablation, a soft, thin tube is placed through vein of the leg and passed to the heart. The catheter delivers a low-voltage, high-frequency current that destroys the heart tissue responsible for the arrhythmia.

The goals of catheter ablation include:

• A long-term reduction in the number of episodes of arrhythmia and the severity of symptoms, or
• A permanent return to normal heart rhythm

This means that medicines for controlling heart rate or rhythm may be stopped or reduced following successful catheter ablation. Do not modify your medications without consulting your doctor.

Catheter ablation is considered safe and is not associated with a significant risk, so the chance of experiencing complications is very low. For example, the overall rate of complications of catheter ablation ranges from 0.5-1.5%. This is dependent on the type of arrhythmia that is ablated and also may change depending on other illness you may have. That’s comparable to the risk of tubal ligation (1-2%) and much lower than the risk of appendectomy (18%). The electrophysiologist will discuss any particular risks with you before the procedure.

The procedure always begins with an electrophysiology study.

Preparing for catheter ablation

• Your doctor will tell you ahead of time whether to stop taking any of your medications. Do not modify your medications without consulting your doctor
• You will have to sign an Informed Consent form, which details any risks or problems that may occur
• Usually, your doctor will tell you not to eat or drink for 6 to 8 hours before the test
• The area where the catheter will be inserted will be thoroughly cleaned and shaved. This is usually in the groin, but may be in the neck. You will receive a local anesthetic in that area
• The catheters will then be inserted; you may initially feel some pressure at the site of insertion
• You will be given a mild sedative

During catheter ablation

The EP and other healthcare specialists in the lab will use a variety of imaging and monitoring systems to help them navigate the catheters to your heart, locate the precise location for the ablation, and evaluate their progress.

Catheter ablation uses a series of thin, flexible wires (catheters) that are inserted through an artery or a vein (usually in the groin or neck) and guided to the heart. Typically you are given medication through an IV to make you comfortable and drowsy for the procedure.

The position of the catheters can be seen using fluoroscopy, a special monitoring technique that uses x-rays.

Once in the heart, one or more of the catheters are used to pinpoint the source of the abnormal electrical signals.

Medications will be given to increase your heart rate. You may also be given a drug or electrical stimulation to bring on the abnormal rhythm.

When the EP has located the source of your arrhythmia, he or she moves another catheter to the site. That catheter delivers bursts of high-energy waves that ablate, or destroy, the abnormal areas. This creates a small scar (called a “lesion”) that electrical signals cannot pass through.

After ablating the problem areas, the doctor will try to re-start your arrhythmia and look for other heart arrhythmia problems

The whole procedure (including the EP study and mapping) may take 1-2 hours.

After catheter ablation

Immediately after the procedure, the catheters will be removed and pressure will be applied to the insertion site to minimize or prevent bleeding; a bandage may be applied.

It is important to remain still during this time and to not move or bend your leg.

Generally, you will stay in bed for some hours or overnight after the procedure for observation and go home the next day. Once you can get up and move around, you may feel stiff from lying still for so long.

At home, you will need to limit your activity for several days and avoid all strenuous physical activity. Most people can return to their normal routine within a few days.

It is common to have a small bruise or lump (about the size of a walnut) at the site of catheter insertion, but you should contact your doctor immediately if the spot becomes warm, tender, or painful, or if it swells. You should also contact your doctor immediately if you experience fever, dizziness, or any other symptoms.

Be certain to carefully follow your doctor’s instructions regarding any medications and follow-up appointments.