Catheter ablation is a medical procedure used to treat some types of arrhythmia. An arrhythmia is a problem with the rate or rhythm of the heartbeat.
During catheter ablation, a series of catheters (thin, flexible wires) are put into a blood vessel in your arm, groin (upper thigh), or neck. The wires are guided into your heart through the blood vessel.
A special machine sends energy to your heart through one of the catheters. The energy destroys small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start.
Catheter ablation often involves radiofrequency (RF) energy. This type of energy uses radio waves to produce heat that destroys the heart tissue. Studies have shown that RF energy works well and is safe.
Overview
To understand catheter ablation, it helps to understand how the heart works. The heart’s electrical system controls the rate and rhythm of your heartbeat.
Normally, with each heartbeat, an electrical signal spreads from the top of your heart to the bottom. As it travels, the electrical signal causes your heart to contract and pump blood. The process repeats with each new heartbeat. (For more information, go to the Health Topics How the Heart Works article.)
A problem with any part of this process can cause an arrhythmia. Catheter ablation is one of several arrhythmia treatments. Your doctor may recommend ablation if:
The medicines you take don’t control your arrhythmia.
You can’t tolerate the medicine your doctor has prescribed for your arrhythmia.
You have certain types of arrhythmia. (Your doctor can tell you whether catheter ablation can help treat your arrhythmia.)
You have faulty electrical activity in your heart that raises your risk of ventricular fibrillation (v-fib) and sudden cardiac arrest (SCA). V-fib is a life-threatening arrhythmia. SCA is a condition in which your heart suddenly stops beating.
Catheter ablation has some risks. Bleeding, infection, and pain may occur at the catheter insertion site. More serious problems include blood clots and puncture of the heart. Your doctor will explain the risks to you.
Cardiologists (heart specialists) sometimes do ablation during open-heart surgery. This method isn’t as common as catheter ablation, which doesn’t require surgery to open the chest.
Outlook
Catheter ablation alone doesn’t always restore a normal heart rate and rhythm. You may need other treatments as well. Also, some people who have the procedure may need to have it done again. This can happen if the first procedure doesn’t fully correct the problem.
Who Needs Catheter Ablation?
Your doctor may recommend catheter ablation if:
You have an arrhythmia that medicine can’t control.
You can’t tolerate the medicine your doctor has prescribed for your arrhythmia.
You have certain types of arrhythmia. (Your doctor can tell you whether catheter ablation can help treat your arrhythmia.)
You have faulty electrical activity in your heart that raises your risk of ventricular fibrillation (v-fib) and sudden cardiac arrest (SCA). V-fib is a life-threatening arrhythmia. SCA is a condition in which your heart suddenly stops beating
What To Expect Before Catheter Ablation
Before you have catheter ablation, your doctor may review your medical history, do a physical exam, and recommend tests and procedures.
Your doctor will want to know about any medicines you’re taking. Some medicines can interfere with catheter ablation. If you take any of these medicines, your doctor may advise you to stop taking them before the procedure.
Your doctor also may ask whether you have diabetes, kidney disease, or other conditions. If so, he or she might need to take extra steps during or after the procedure to help you avoid complications.
Before catheter ablation, you may have tests such as:
An EKG (electrocardiogram). This simple, painless test records your heart’s electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart.
Echocardiography. This is a painless test that uses sound waves to create moving pictures of your heart. The pictures show the size and shape of your heart. They also show how well your heart’s chambers and valves are working.
Stress testing. Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can’t exercise, you may be given medicine to raise your heart rate.
Less often, your doctor may recommend cardiac catheterization, coronary angiography, or a test to rule out an overactive thyroid. (An arrhythmia can be a symptom of an untreated overactive thyroid.)
If you’re pregnant, let your doctor know before having catheter ablation. The procedure involves radiation, which can harm the fetus. Talk with your doctor about whether the benefits of the procedure outweigh the risks.
If you’re a woman of childbearing age, your doctor might recommend a pregnancy test before catheter ablation to make sure you’re not pregnant.
Once the procedure is scheduled, your doctor will tell you how to prepare for it. You’ll likely need to stop eating and drinking by midnight before the procedure. Your doctor will give you specific instructions.
Some people go home the same day as the procedure. Others need to stay in the hospital longer. Driving after the procedure might not be safe. Your doctor will let you know whether 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 heart’s electrical system) and ablation (destruction) of diseased heart tissue.
Before the Procedure
If you’re a woman of childbearing age, your doctor might recommend a pregnancy test before catheter ablation to make sure you’re not pregnant. The procedure involves radiation, which can harm the fetus. If you’re pregnant, talk with your doctor about whether the benefits of the procedure outweigh the risks.
Before the procedure, you’ll be given medicine through an intravenous (IV) line inserted into a vein in your arm. The medicine will help you relax and might make you sleepy. You’ll also be connected to several machines that will check your heart’s activity during the procedure.
Once you’re drowsy, your doctor will numb an area on your arm, groin (upper thigh), or neck. He or she will use a needle to make a small hole in one of your blood vessels. Your doctor will put a tapered tube called a sheath through this hole.
Next, your doctor will put a series of catheters (thin, flexible wires) through the sheath and into your blood vessel. He or she will thread the wires to the correct place in your heart.
An imaging method called fluoroscopy will help your doctor see the wires as they’re moved into your heart. Fluoroscopy uses real-time x-ray images.
During the Procedure
Electrodes at the end of the catheters will stimulate your heart and record its electrical activity. This will help your doctor learn where abnormal heartbeats are starting in your heart.
After your doctor pinpoints the source of the abnormal heartbeats, he or she will aim the tip of a special catheter at the small area of heart tissue. A machine will send energy through the catheter to create a scar line, also called an ablation line.
The scar line will create a barrier between the damaged heart tissue and the surrounding healthy heart tissue. This will stop abnormal electrical signals from traveling to the rest of the heart and causing arrhythmias.
What You Might Feel
You might sleep on and off during the procedure. You generally will not feel anything except for:
A burning sensation when your doctor injects medicine into the area where he or she will insert the catheters
Discomfort or burning in your chest when your doctor applies the energy
A faster heartbeat when your doctor stimulates your heart to find out where abnormal heartbeats are starting
The procedure lasts 3–6 hours. When it’s over, your doctor will remove the catheters and the sheath. He or she will close the opening in your blood vessel and bandage it. Pressure will be applied to the site to help prevent major bleeding.
What To Expect After Catheter Ablation
After catheter ablation, you’ll be moved to a special care unit where you’ll lie still for 4–6 hours of recovery. Lying still prevents bleeding from the catheter insertion site.
You’ll be connected to devices that measure your heart’s electrical activity and blood pressure. Nurses will regularly check these monitors. Nurses also will check to make sure that you’re not bleeding from the catheter insertion site.
Going Home
Your doctor will decide whether you need to stay overnight in the hospital. Some people go home the same day as the procedure. Others need to stay in the hospital longer.
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 catheter insertion site
When to schedule followup care
Driving after the procedure might not be safe. Your doctor will let you know whether you need to arrange for someone to drive you home.
Recovery and Recuperation
Recovery from catheter ablation usually is quick. You may feel stiff and achy from lying still after the procedure.
Also, a small bruise may form at the catheter insertion site. The area may feel sore or tender for about a week. Most people can return to their normal activities within a few days.
Your doctor will talk with you about signs and symptoms to watch for. Let your doctor know whether 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
What Are the Risks of Catheter Ablation?
Catheter ablation has some risks. The procedure may cause:
Bleeding, infection, and pain at the catheter insertion site.
Damage to blood vessels. Rarely, the catheters may scrape or poke a hole in a blood vessel as they’re threaded to the heart.
Puncture of the heart.
Damage to the heart’s electrical system, which may cause you to need a permanent pacemaker. A pacemaker is a small device that’s placed under the skin of your chest or abdomen to help control arrhythmias.
Blood clots, which could lead to a stroke or other problems.
Narrowing of the veins that carry blood from the lungs to the heart. This narrowing is called stenosis.
Also, catheter ablation involves radiation. Thus, the procedure may increase the risk of cancer, although the risk is small.
As with any procedure involving the heart, complications sometimes can be fatal. However, this is rare with catheter ablation.
