Catheter Ablations are a treatment to selectively destroy “short circuits” within the heart that cause abnormal rhythms.
A Catheter ablation is a non-surgical technique used to eliminate alternate pathways present in the heart that interfere with the normal electrical functioning of the heart that results in and causes abnormal beats. This is a fancy way of saying a catheter ablation is a way to stop short circuits in the heart.
Most people know that the heart is the pump that pushes blood through the body to carry nutrients and oxygen where it is needed, but people are not always conscious of the fact that the “pump” depends on an electrical system to set the heart rate and stimulate the pump.
The heart is made up of four main cavities–the right and left atriums are the top two chambers of the heart and the right and left ventricles are the bottom chambers of the heart.
In a normal heart, the left and right sides of the heart beat together to maintain a steady supply of blood and oxygen to the rest of the body.
A typical heart beat begins with the sinoatrial node, a cluster of specialized cells located in your right upper chamber, firing an electrical impulse that spreads through the walls of the right and left chambers, causing them to contract, thus forcing blood into the lower chambers.
The impulse then travels to the atrioventricular node, another center of special cells located in the lower part of the right atrium. After a short pause, the pulses travels into the lower chambers, causing them to contract, forcing blood out of the heart to the lungs and body.
Who is a candidate for a catheter ablation?
Sometimes, however, all does not work normally. As explained, normally, the heart’s impulses travel down an electrical pathway through the heart. There are a variety of conditions that interrupt or impede this process, the most common being:
- AV Nodal Reentrant Tachycardia (AVNRT): In this condition, an extra pathway lies in or near the AV node, causing the impulses to move in a circle and reenter areas it has already passed through.
- Accessory Pathway: In this condition, extra pathways can exist from birth that connect the atrium and ventricles. The extra pathway causes signals to travel back to the atrium, making it beat faster.
- Atrial fibrillation and atrial flutter: In this condition, extra signals originating in different parts of the upper chambers causing the heart to beat rapidly or quiver.
- Ventricular tachycardia: In this condition, a rapid, potentially life-threatening rhythm originates from impulses in the lower chambers of the heart. The rapid rate prevents the heart from filling adequately with blood so that less blood is able to circulate through the body.
To address these conditions, a doctor inserts a thin, flexible tube into the heart through a big I.V. in the leg, and then uses a special machine to deliver heat or cold to the tiny areas of the heart muscle that cause the abnormal heart rhythm. This energy “disconnects” the pathway of the abnormal rhythm.
The ablation procedure also can be used to disconnect the electrical pathway between the upper chambers (atria) and lower chambers (ventricles) of the heart.
The type of ablation performed depends upon the type of arrhythmia.
What can I expect as a catheter ablation recipient?
After you are diagnosed as a candidate for an ablation, you may be asked to stop taking certain medications several days before your procedure. Blood thinners, heart rate medications and aspirin, for example, can all cause difficulty during the procedure and you will often be told to stop taking them five days prior to the procedure. If you have diabetes, ask the nurse how you should adjust your diabetes medications and/or insulin.
Do not eat or drink anything after midnight the night before the procedure. If you must take medications, drink only small sips of water to help you swallow your pills.
When you get to the hospital you will change into a hospital gown for the procedure, which will be performed in the Electrophysiology Lab. You will lie on a bed and the nurse will start an intravenous line to deliver medications and fluids.
You will receive a medication through your IV to make you very drowsy. The medication will NOT put you completely to sleep so if you are uncomfortable or need anything during the procedure you will be able to communicate that to the nurse. During the procedure, you will be asked to report any symptoms, answer questions or follow instructions given by your doctor. However, due to the medications you may not recall the procedure afterwards.
This is completely normal.
Prior to the procedure, the nurse will connect you to several monitors that will allow the medical staff to monitor your condition at all times during the procedure. Sterile drapes will be placed to cover you from your neck to your feet.
The staff will clean and shave the area of the puncture, after which the doctor will numb your skin by injecting a local anesthetic in the groin area. You will feel a slight pinching or burning feeling at first and then the area will become numb.
Where the doctor inserts the catheters depends on the type of ablation being performed. The doctor will insert several catheters through a small incision or puncture into a large blood vessel in your groin, and possibly neck . Sometimes, it may be necessary to use both an artery and a vein.
During the procedure, the doctor will use a fluoroscopy machine (a special x-ray machine that allows the doctor to see your heart and blood vessels), to guide the catheters into the heart. After the catheters are in place, the doctor looks at a monitor to assess your heart’s conduction system.
The doctor will then use a pacemaker-like device to send electrical impulses to the heart to increase the heart rate. You may feel your heart beating faster or stronger when the doctor uses the pacemaker device to increase your heart rate. This is normal. If your hearth beats erratically during the procedure, the nurse or technician will ask you to describe the symptoms you feel.
The doctor will use the catheters to locate the area or areas that is causing the erratic heartbeat and, once the area is located, heat or cold will be applied through the catheter to stop the abnormal impulses.
Once the ablation is complete, the electrophysiologist uses monitoring devices to observe the electrical signals in the heart to ensure that the abnormal rhythm was corrected. You may feel some discomfort or a burning sensation when the energy is applied. Again, this is normal.
It is important to remain quiet, keep still and avoid taking deep breaths. If you are feeling pain, ask your doctor or nurse to give you more medication.
The catheter ablation procedure may last from 2 to 4 hours and varies with the location of the short circuit pathway.
After the ablation?
After the ablation is complete, the doctor will remove the catheters and apply pressure to the insertion site to prevent bleeding. You will need to stay in bed at least 4 hours to prevent bleeding. You’ll also need to keep your legs still during this time. No stitches are needed. A small sterile bandage will cover the insertion site.
Let your doctor or nurse know right away if you notice redness, swelling or drainage at the procedure site.
When you’re feeling more awake, the doctor will discuss the results of the procedure with you and your family. Your doctor will also determine if you need to stay overnight in the hospital. Many patients go home the same day, but some stay overnight in the hospital.
You may feel tired or some discomfort in the chest following a catheter ablation. This is normal. However, please tell your doctor or nurse if any of these symptoms are prolonged or severe. You may also experience “skipped heartbeats” or short periods of time where your heart beats faster or quivers. After your heart has healed, these abnormal heartbeats should go away.
You will receive specific instructions about how to care for yourself after the procedure including medication guidelines, wound care, activity guidelines and a follow-up schedule.
You may need to take an antiarrhythmic medication to control abnormal heartbeats. You will receive the necessary prescriptions and medication instructions from your doctor. Ask your doctor if you can continue taking your previous medications.
About four weeks after the procedure, you should see your doctor for a check up.Catheter Ablation