Catheter Ablation
Catheter ablation is a procedure that destroys abnormal tissue in the heart wall by directly cauterizing—or heating—the muscle tissue that causes arrhythmias. This procedure is conducted in a hospital setting.
The procedure is used to:
Treat abnormal rhythms such as AV nodal rentrant tachycardia, atrial fibrillation, atrial flutter, ventricular tachycardia and accessory pathway.
Preparing for the test:
Do not eat the morning of the procedure.
Prepare for an overnight stay, as this procedure is done in the EP laboratory at the hospital and requires a night in the hospital. Wear comfortable clothes and leave all jewelry or valuables at home. You will change into a hospital gown for the procedure.
Ask your doctor what medications you are allowed to take. Your doctor may ask you to stop certain medications one to five days before your test (such as aspirin products). If you are diabetic, ask your doctor how you should adjust your diabetic medications.
Please arrange for someone to drive you home.
What to expect during the test:
These procedures are done in the EP laboratory at a hospital and typically require an overnight stay. It typically takes about 2 – 4 hours to complete, but more complex cases can take up to 6 hours.
ECG electrodes are attached, and an intravenous line is placed. The blood pressure, heart rate and blood oxygen values will be monitored throughout the procedure.
The patient is taken to the EP laboratory where both groins are prepped with disinfectant, and the patient's whole body is draped with a sterile drape lifted up at the head area for comfort.
Conscious sedation is administered. These medications make the patient very sleepy but are not the same as anesthesia. The electrophysiologist injects a local anesthetic in both groin sites (this may sting and burn slightly, similarly to injections at the dentist).
During catheter ablation, your physician will insert several special long, flexible tubes with wires – called electrode catheters – into the veins or artery of the groin in both legs. These catheters are then positioned inside the heart in specific locations that allow recording of the electrical signals.
Some of these electrode catheters are used to study your arrhythmia. However, one of the catheters will be used for the actual ablation. Your physician will position the ablation catheter so that it lies on or very close to the abnormal tissue.
It is amazing how one can see inside the heart. We do so using a variety of methods. We use X-rays to guide where to place the catheters, and we can reconstruct an image of the heart just from the electrical signals themselves. Sometimes we also use sound waves – echocardiography – from inside the heart.
Tachycardia is then induced, and the result is analyzed to show how the heart is electrically activated to determine the areas of the heart that are responsible for starting or perpetuating the abnormal rhythm.
High-frequency electrical energy is then delivered to the small area of heart tissue under the tip of the ablation catheter to destroy the muscle tissue that is responsible for the abnormal rhythm. As a result, this tissue is no longer capable of conducting or sustaining the arrhythmia.
At the end of the procedure you will be transferred to a recovery area and eventually to a hospital bed.
What to expect after the test:
You will rest for six hours and typically will be able to be up the same evening. The next morning, medical staff will assess the groin sites and review overnight ECG strips. After review of the discharge instructions, you can go home. Over the next 48 hours we advise only light activity (up and around in the house) then back to normal activities. You will typically see your referring physician, as medications needed to control the heart rhythm before the ablation procedure can often be stopped or modified. The risk of the fast heart rhythm returning is usually less than 5% but depends on the type of heart rhythm problem.