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Simple and Complex Ablation

Catheter Ablation

Catheter ablation is a medical procedure used to treat some arrhythmias. An arrhythmia is a problem with the speed or rhythm of the heartbeat.

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 then guided to your heart through the blood vessel. A special machine sends energy through the catheter to your heart. This energy finds and destroys small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start.

The heart’s electrical system controls the speed and rhythm of your heartbeat. With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As it travels, the electrical signal causes the heart to contract and pump blood.

The process repeats with each new heartbeat. A problem with any part of this process can cause an arrhythmia. Catheter ablation is one of several treatments for arrhythmia. Your doctor may recommend it if:

  • The medicines you take don’t control your arrhythmia.
  • You can’t tolerate the medicines your doctor has prescribed for your arrhythmia.
  • You have certain types of arrhythmia, such as Wolff-Parkinson-White syndrome.

Though few, catheter ablation has risks. These include bleeding, infection, and pain where the catheter is inserted. More serious problems include blood clots and puncture of the heart. Your doctor will explain the risks to you.

What to Expect Before Catheter Ablation

Before having catheter ablation, discuss with your doctor:

How to prepare for the procedure, including limits on eating and drinking. You will likely need to stop eating and drinking by midnight before the procedure. Your doctor will give you specific instructions.

Any medicines you’re taking, and whether you should stop taking them before the procedure.

Whether you have diabetes, kidney disease, or other conditions that may require taking extra steps during or after the procedure to avoid complications.

Some people go home the same day as the procedure. Others need to stay overnight for 1 or more days. Driving after the procedure may not be safe. Your doctor will let you know if you need to arrange for someone to drive you home.

What to Expect During Catheter Ablation

Catheter ablation is done in a hospital. Doctors who do this procedure have special training in cardiac electrophysiology (the electrical system of the heart) and ablation (destruction) of diseased heart tissue.

At the Start

Before the procedure, you're given medicine through an intravenous (IV) line inserted in a vein in your arm. The medicine will help you relax. It may make you sleepy. You're also connected to several machines that check your heart's activity during the procedure.

Once you're drowsy, your doctor numbs an area on your arm, groin (upper thigh), or neck. A needle is used to make a small hole through the skin into a blood vessel. Your doctor puts a tapered tube called a sheath through this hole.

Your doctor then puts a thin, flexible wire and an ablation catheter (a long, thin, flexible tube) through the sheath and into your blood vessel. The guide wire is threaded through your blood vessel to your heart. The wire helps your doctor place the catheter correctly.

Then, your doctor puts a special dye into the catheter. The dye makes the inside of your heart show up on special x-ray images called angiograms. The images help your doctor place the tip of the catheter in the correct spot in the heart.

During the Procedure

Electrodes at the end of the catheter are used to stimulate the heart and record its electrical activity. This helps your doctor learn where abnormal heartbeats are starting in your heart.

Your doctor aims the tip of the catheter at the small area of heart tissue where the abnormal heartbeats are starting. A special machine sends energy through the catheter to create a scar line, also called an ablation line. The types of energy used include radiofrequency (heat generated by electrodes), laser, or cryo- (very cold temperatures).

The scar line creates a barrier between the damaged heart tissue and the surrounding healthy heart tissue. This stops abnormal electrical signals from traveling to the rest of the heart and causing arrhythmias.

What You May Feel

You may sleep on and off during the procedure. You generally will not feel anything except for:

  • A burning sensation when the doctor injects medicine into the area where the catheter will be inserted
  • Discomfort or burning in your chest when the energy is applied
  • A faster heartbeat during studies of your heart's electrical system

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 opening left in the blood vessel is closed and bandaged. Nurses apply pressure to this site to help prevent major bleeding and to help the site begin to heal.

What to Expect After Catheter Ablation

After the procedure, you’re moved to a special care unit where you lie still for 4 to 6 hours of recovery. Lying still prevents bleeding at the site where the catheter was inserted.

While you’re in the special care unit, you’re connected to special devices that measure your heart’s electrical activity and blood pressure. The nurses check these monitors continuously. Nurses also check to make sure that there’s no bleeding at the catheter insertion site.

Going Home

Your doctor determines whether you need to stay overnight in the hospital. Some people go home the same day. Others need to stay overnight for 1 or more days.

Before you go home, your doctor will tell you:

  • Which medicines you need to take
  • How much physical activity you can do
  • How to care for the area where the catheter was inserted
  • When to see the doctor again

Driving after the procedure may not be safe. Your doctor will let you know if you need to arrange for someone to drive you home.

Recovery and Recuperation

Recovery from catheter ablation is usually quick. You may feel stiff and achy from lying still for 4 to 6 hours after the procedure. In addition, a small bruise may form at the site where the ablation catheter was inserted. The area may feel sore or tender for about a week. Most people are able to return to normal activity in a few days.

Talk to your doctor about signs and symptoms to watch for. Let your doctor know if you have problems such as:

  • A constant or large amount of bleeding at the catheter insertion site that you can’t stop with a small bandage
  • Unusual pain, swelling, redness, or other signs of infection at or near the catheter insertion site
  • Strong, rapid, or other irregular heartbeats
  • Fainting