Having Catheter Ablation

A heart rhythm problem (arrhythmia) can make your heart beat too fast or in an irregular pattern. The problem is often caused by cells in your heart that aren’t working as they should. Or it may be the result of an abnormal electric circuit. It may cause other problems, such as an irregular heartbeat, dizziness, shortness of breath, chest pain, or fainting. Your doctor has recommended catheter ablation to treat your arrhythmia. This non-surgical procedure destroys the cells that are causing the problem.

What will happen before the procedure?

Doctor visits:

• Before your catheter ablation, you will meet with a specially trained heart doctor (called a cardiac electrophysiologist) who will do the procedure. This doctor will tell you how to get ready. 

• Have any routine tests, such as blood tests, as recommended.

Medicines:

• Tell the doctor about all prescription and over-the-counter medicines you take. This includes herbs, supplements, and vitamins. It also includes daily medicines, such as insulin or blood thinners. If you are allergic to any medicines, tell the doctor.

• You may need to stop taking your rhythm medicines and blood thinners before this procedure. Follow the doctor's orders.

Getting ready:

• We will call you the day before your procedure. We will let you know when you need to arrive and check in.

• Arrange to have someone drive you here and back home. You will not be able to drive for 24 hours after the procedure. 

• Take a shower or bath the night before and the morning of the procedure. Use an antibacterial soap. Examples include name brands like Dial and Zest.

• Don’t eat or drink anything after midnight the night before the procedure. You may take your morning medicine with a sip of water.

• Tell your family and friends about who can visit you. You may have 2 visitors at a time. Visitors must be 12 years old or older.

What to bring:

• Bring all your medicines to your procedure in their original containers. 

• You should bring a small overnight bag with you. This is in case you need to spend the night at the hospital. Include a robe, hair brush, tooth brush, and tooth paste.

• Leave your valuables at home. You may wear your wedding band.

How is catheter ablation done?

Catheter ablation uses thin, flexible wires (electrode catheters) to find and destroy (ablate) problem cells. Here’s how the procedure is done:

• The heart’s signals are mapped. To find the problem, an electrophysiology study (EPS) is done. During this study, the doctor tries to start (induce) your arrhythmia. An electrical map of the heart is then created. This shows the type of arrhythmia you have and where the problem is. Using the map as a guide, the doctor knows where to ablate.

• Problem areas are destroyed using heat or cold therapy. Once the EPS shows where the problem is, the doctor threads an electrode catheter through a blood vessel to that area in the heart. Energy is sent through the catheter to destroy the problem cells.

• The heart’s rhythm is tested again. After ablating the problem cells, the doctor tries to restart (reinduce) your arrhythmia. If a fast rhythm can’t be induced, the ablation is a success. But if a fast rhythm does start again, you may need more ablation.

What happens during catheter ablation?

In most cases, catheter ablation is done in an electrophysiology (EP) lab. It often takes 2 to 4 hours, and sometimes longer. You’ll receive medicine to prevent pain. Medicine will also help you relax or sleep during the procedure. If you feel uncomfortable during the procedure, tell the doctor or nurse:

• Getting started. The healthcare team washes the skin on your groin (or rarely, the neck). Any hair in that area may be removed. This is where the catheters will be inserted. An IV (intravenous) line is started in your arm. Medicines and fluids are given through this IV. To help keep the insertion site germ-free (sterile), your body is draped with sheets. Only the area where the catheters will be inserted is exposed.

• Inserting the catheters. The healthcare provider numbs the skin where the catheters will be inserted with pain medicine (local anesthetic). Then the provider uses a small needle to make punctures in your vein or artery. He or she puts catheters through these punctures and guides them to your heart. The provider uses X-ray monitors to help guide the catheters.

• Placing the wires. The provider then puts wires in several places in the heart to map the electrical signals. The wires also stimulate the heart.

• Finishing up. When the procedure is finished, the provider takes the catheters out of your body. He or she puts pressure on the puncture sites to stop any bleeding. No stitches are needed. You’re then taken to a recovery room to rest. You'll need to remain lying down for 2 to 6 hours. You'll also be asked not to move the leg where the catheters were inserted for a few hours. This is to make sure the insertion sites don't bleed.

What are the risks?

The risks of catheter ablation are fairly low compared to the benefits you receive. Discuss these risks with your doctor before the procedure. Possible risks and complications include:

• Bleeding or bruising at the catheter insertion site

• Blood clots

• A slow heart rhythm (requiring a permanent pacemaker)

• Perforation of the heart muscle, blood vessel, or lung (may require an emergency procedure)

• Damage to a heart valve (rare)

• Stroke or heart attack, also known as acute myocardial infarction, or AMI (rare)

• Infection, which is a risk after any invasive procedure. This may be indicated by a fever of 100.4°F (38.0°C) or higher, drainage, or redness and pain at the catheter insertion site.

• Death (extremely rare)