About Ablation Therapies

Atrial fibrillation, or AF, is a quivering or irregular heartbeat. Left untreated, AF gets worse over time. Medications and procedures can reset or control the heart’s rate and rhythm to prevent irregular heartbeat and reduce risk for stroke for many people. These measures are not enough for some patients, however. When medications are not enough, patients may benefit from cardiac ablation.

Cardiac ablation destroys the tissue producing the unpredictable electrical signal. Ablation directs energy at the pulmonary vein, where it connects to the left atrium of the heart. This energy creates lesions that cause the tissue to scar over, preventing the erratic signals from ever reaching the atria.

What is Catheter Ablation?

Catheter ablation is a non-surgical procedure that is performed by an electrophysiologist (EP). A 3D cardiac mapping system that acts like a navigation system is used to create a map of your heart in real time. Guided by this map, the EP places a catheter into your heart to pinpoint the source of the abnormal electrical signals.

The procedure always begins with an electrophysiology study (EP Study).

When the source of your Afib is located, therapeutic catheters transmit radiofrequency waves, generating enough heat to produce a small scar on the targeted part of your heart tissue. This process blocks the abnormal electrical impulses causing your heart rhythm disorder.

Fluoroless Catheter Ablation

Certain EP doctors, like Dr. Moretta, have trained in cutting-edge imaging techniques such as intracardiac ultrasound to perform EP studies and ablations with no fluoroscopy. This means that the procedure is performed without any radiation. Medical testing is the number one source of radiation to patients and radiation exposure is cumulative, meaning that the more you are exposed, the higher the risk of ill-effects (such as certain types of cancer) no matter how long ago your last exposure may have been. Contact our care specialists to discuss this option for your ablation.

Why Do I Need Catheter Ablation?

The American College of Cardiology and the American Heart Association recommend catheter ablation for Afib patients when medication proves to be unsuccessful. More than likely, your doctor has recommended that you undergo catheter ablation because other treatments that have been prescribed for your cardiac arrhythmia have not provided the relief you need.

The majority of people who have a catheter ablation experience either:

  • 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. Note: Do not modify your medications without consulting your EP, cardiologist or family 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 for atrial flutter is 1.2%. That’s comparable to the risk of tubal ligation (1-2%) and much lower than the risk of appendectomy (18%). Your electrophysiologist will discuss any particular risks with you before the procedure.

Preparing for Catheter Ablation

Your EP 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

Your electrophysiologist and other healthcare specialists in the lab will use a variety of imaging and advanced monitoring systems to help them navigate the catheters to your heart, locate the precise location for the ablation, and evaluate their progress. Also, depending on your anatomy, some ablation specialists will take extra steps to avoid damaging tissue near your esophagus. They may ask you to drink a creamy substance to help the esophagus show up better on the x-ray.

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. 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. This will help the doctor identify the areas of the heart producing the arrhythmia. Some people may feel some temporary chest discomfort during the procedure. If that happens to you, be sure to tell your doctor, who can give you medication to relieve it.

When your electrophysiologist has located the source of your arrhythmia, he will move 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, your electrophysiologist will try to re-start your arrhythmia. If the abnormal rhythm cannot be induced in this way, then the procedure is a success. If a fast rhythm does return, further ablation may be needed. The whole procedure (including the EP study and mapping) may take several 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.

If you believe you may be suffering from a heart rhythm disorder, speak to your doctor about visiting cardiac electrophysiologists of Heart Rhythm Consultants for more information, testing and treatment options, including ablation therapy.

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Questions For Your Doctor

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References: Scheinman M, et al. NASPE policy statement on catheter ablation. PACE. 2003; 26:789-99. // Kulier R, et al. Minilaparotomy and endoscopic techniques for tubal sterilization. Cochrane Database Syst Rev. 2000; CD01328. // Katkhouda N, et al. Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg. 2005; 242:439-50.