Ablation for Cardiac Arrhythmias

What is a cardiac arrhythmia?

A cardiac arrhythmia, also called dysrhythmia, is an irregular or abnormal heart rhythm.

What is catheter ablation?

Catheter ablation is a type of treatment for cardiac arrhythmias. During ablation, a doctor inserts a catheter (thin, flexible tube) into the heart. A special machine delivers energy through the catheter to 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 types of rhythms are treated with this procedure?

Normally, the heart’s impulses travel down an electrical pathway through the heart. The atria and ventricles work together, alternately contracting and relaxing to pump blood through the heart. The electrical system of the heart is the power source that makes this possible. Each electrical impulse causes the heart to beat.

Catheter ablation can be used to treat:

• AV Nodal Reentrant Tachycardia (AVNRT): an extra pathway lies in or near the AV node, which causes the impulses to move in a circle and reenter areas it already passed through.
• Accessory Pathway: 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: Extra signals originating in different parts of the atrium cause the atria to beat rapidly (atrial flutter) or quiver (atrial fibrillation).
• Ventricular tachycardia: a rapid, potentially life-threatening rhythm originating 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.

How can I be evaluated for the procedure?

If you are currently being treated outside of Cleveland Clinic, please call the Miller Family Heart & Vascular Institute Information & Resource nurse toll-free at 866.289.6911 or 216.445.9288. The nurse can offer options for evaluation at Cleveland Clinic. Or call Cardiology Appointments at 216.444.6697 or toll-free at 800.223.2273 ext. 46697.

If you already are a patient of Cleveland Clinic and are receiving treatment for your arrhythmia, talk to your cardiologist about whether catheter ablation is an option for you.

Evaluation

To determine if catheter ablation is an appropriate treatment, a thorough evaluation will be performed, which may include:

• A review of your medical history
• Complete physical examination
• Electrocardiogram (ECG)
• Echocardiogram (Echo)
• Holter monitor test
• Other tests as needed

After the evaluation, the doctor will discuss your treatment options and together, you will determine if you are a candidate for this procedure.

How successful is catheter ablation in treating arrhythmia?

The success rate varies for each type of catheter ablation. Many variables also affect the potential success of the procedure. Please discuss the success rate of your proposed ablation procedure with your physician.

Are there any risks?

The catheter ablation procedure is generally very safe. However, as with any invasive procedure, there are risks. Special precautions are taken to decrease these risks. Your doctor will discuss the risks of the procedure with you.

Before the procedure:

What tests are performed?

If you take Coumadin, the results of your INR test (a blood test to evaluate blood clotting) must be within a suitable range before the procedure can be performed.

Should I take my medications?

• Usually you will be instructed to stop taking Coumadin (warfarin) three days before the procedure.
• Your doctor may also ask you to stop taking other medications, such as those that control your heart rate or aspirin products.
• Do not discontinue any of your medications without first talking to your health care provider. Ask your doctor which medications you should stop taking and when to stop taking them.
• If you have diabetes, ask the nurse how you should adjust your diabetes medications and/or insulin.

Can I eat?

• Eat a normal meal the evening before your procedure. However, DO NOT eat, drink or chew anything after 12 midnight before your procedure. This includes gum, mints, water, etc.
• If you must take medications, only take them with small sips of water. When brushing your teeth, do not swallow any water.

What should I wear?

• Remove all makeup and nail polish before coming to the hospital.
• Wear comfortable clothes. You will change into a hospital gown before the procedure.
• Please leave all jewelry (including wedding rings and watches) and other valuables at home.
• The clothing you are wearing that morning will be returned to the person who accompanies you or placed in a locker.

What should I bring?

• You will not need a robe or toiletries when you first arrive. Your family member can keep these items to give you after the procedure.
• Bring your prescription medications with you, but do not take them without first talking to your health care provider.
• You may bring guided imagery tapes or music and the appropriate player to listen to before the procedure.

What happens when I arrive?

Before the procedure begins, a nurse will help you get ready.

• You will lie on a bed and the nurse will start an IV (intravenous line) in a vein in your arm. The IV is used to deliver medications and fluids during the procedure.
• A medication will be given through your IV to make you feel drowsy. You may fall asleep at times due to the sedation.
• Your neck, upper chest, arm and groin will be cleansed with an antiseptic solution, and the catheter insertion site(s) will be shaved. Sterile drapes will be placed to cover you from your neck to your feet.

During the procedure:

Where is the procedure performed?

The catheter ablation takes place in a special room called the EP (electrophysiology) lab.

Will I be monitored?

The nurse will connect you to several monitors that will check your heart rhythm and your body’s responses to any arrhythmias during the procedure. The nurse will constantly assess you during the procedure.

How does the doctor insert the catheters?

After you become drowsy, the doctor will numb the catheter insertion site(s) by injecting a medication.

• The doctor will insert several catheters through a small incision into a large blood vessel (in your groin, neck or arm, depending on the type of ablation procedure being performed). Sometimes, it may be necessary to use both an artery and a vein.
• A transducer is inserted through one of the catheters so intracardiac ultrasound can be performed during the procedure. The ultrasound allows the doctor to view the structures of the heart on an external monitor.
• The catheters will be advanced through the blood vessels to your heart. After the catheters are in place, the doctor looks at a monitor to assess your heart’s conduction system.
• The doctor then uses a pacemaker-like device to send electrical impulses to the heart to increase the heart rate. If your arrhythmia occurs during the procedure, the nurse will ask you to describe the symptoms you feel.
• The doctor uses the catheters to locate the area or areas where the arrhythmia is originating. Once the area is located, energy is 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.

What will I feel?

• You will feel an initial burning sensation when the doctor injects medication in the catheter insertion site.
• You may feel your heart beating faster or stronger when the doctor uses the pacemaker device to increase your heart rate.
• You may feel some discomfort or a burning sensation when the energy is applied. It is important to remain quiet, keep very still and avoid taking deep breaths.
• If you are feeling pain, ask your doctor or nurse to give you more medication.
• During the procedure, you will be asked to report any symptoms, answer questions or follow instructions given by your doctor.

How long does the procedure last?

The catheter ablation procedure may last from 4 to 8 hours.

After the procedure:

What should I expect after the procedure?

• The doctor will remove the catheters and apply pressure to the insertion site to prevent bleeding.
• You will need to stay in bed from 1 to 6 hours after the procedure to prevent bleeding. You’ll need to keep your legs still during this time.
• No stitches are needed. A small sterile dressing (bandage) will cover the insertion site.
• Keep this area clean and dry. Notify your doctor or nurse right away if you have redness, swelling or drainage at the procedure site.
• You can remove the bandage after you go home.
• During your recovery, you will be placed on a special monitor, called a telemetry monitor. Telemetry consists of a small box connected by wires to your chest with sticky electrode patches. The box displays your heart rhythm on several monitors in the nursing unit. The nurses will be able to observe your heart rate and rhythm.

Will I have to stay in the hospital?

Your doctor will determine if you need to stay overnight in the hospital. Some patients are discharged the same day, while others stay overnight in the hospital after the procedure.

When will I find out the results?

After the procedure, the doctor will discuss the results of the procedure with you and your family.

How will I feel after the procedure?

• You may feel fatigue or chest discomfort during the first 48 hours after the procedure. Please tell your doctor or nurse if any of these symptoms are prolonged or severe.
• You may experience skipped heartbeats or short episodes of atrial fibrillation after the procedure. After your heart has healed, these abnormal heartbeats should subside.

What instructions will I receive before I leave the hospital?

Your doctor will discuss the results of the procedure and answer any questions you have. You will receive specific instructions about how to care for yourself after the procedure including medication guidelines, wound care, activity guidelines, pacemaker care and maintenance, and a follow-up schedule.

Will I be taking new medications?

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.

Will I be able to drive myself home?

No. For your safety, a responsible adult must drive you home. We request that your ride be ready to take you home by 10:00 a.m. on the morning of your discharge day.