Ablation is a medical procedure used to correct many types of fast heart rhythms. It restores the normal regular rhythm of the heart by scarring the tissue in the heart that triggers the abnormal rhythm, allowing it to return to a normal, regular rhythm. If the procedure is successful, this prevents the arrhythmia from reoccurring.
In CVSKL, two modalities are used:
- Radiofrequency ablation employs heat energy to scar the tissue.
- Cryoablation damages the tissue by freezing.
Catheter ablation can be used to treat many arrhythmias that cause fast heartbeats. Catheter ablation may be recommended for:
- Paroxysmal supraventricular tachycardia, which includes:
- Wolff-Parkinson-White syndrome
- AV nodal re-entrant tachycardia
- Atrial tachycardia
- Atrial flutter
- Atrial fibrillation
- Inappropriate sinus tachycardia
- Ventricular tachycardia and premature ventricular contractions
The success rate depends on the type of arrhythmia and how long has it been present. Cardiac ablation can restore normal heart rhythm in over 95% of patients.
- You will be asked to fast for at least 6 to 8 hours before the procedure.
- Inform your doctor about any medication you are on. Don’t stop taking your medicine until your doctor tells you to.
- Leave all your jewellery at home.
- Arrange for someone to drive you home after your procedure the next day.
- You will have an intravenous line (IV) inserted in your arms, which will be used to administer pain medication (anaesthesia).
- The nurse will shave and disinfect the area where the catheter is inserted, usually in the groin.
Ablation is typically done by a trained electrophysiologist along with a team of nurses and technicians. The procedure is done in an EP or cath lab.
- The doctor will administer a local anaesthetic to numb the needle puncture site.
- The doctor will make a needle puncture through your skin into the blood vessel (typically a vein, but sometimes an artery) in your groin. A small straw-sized tube (called a sheath) will be inserted into the blood vessel. The doctor will gently guide a catheter (a long, thin tube) into your vessel through the sheath. A video screen will show the position of the catheter/s. You may feel some pressure in your groin, but you shouldn’t feel any pain.
- The doctor inserts several long, thin tubes with wires, called electrode catheters, through the sheath and feeds these tubes into your heart.
- To locate the abnormal tissue causing arrhythmia, small electrical impulses are sent through the electrode catheter. This activates the abnormal tissue that is causing your arrhythmia.
- Ablation is relatively painless but you may feel a very distinct heartbeat every time it is stimulated. However, this sensation rapidly disappears.
- A catheter is placed at the exact site inside your heart where the abnormal cells are. Then, a mild, painless, radiofrequency energy (similar to microwave heat) is sent to the tissue. This destroys heart muscle cells in a very small area that are responsible for the extra impulses causing your rapid heartbeats.
- Catheter ablation usually takes between 1 to 4 hours. If you have more than one area of abnormal tissue, the procedure will take longer. You will have to stay overnight to be observed.
A side effect is an unintended consequence of the procedure and it is not necessarily the same as a complication. A possible side effect that occurs is chest discomfort during the first few days after an ablation due to inflammation around the heart (pericardial inflammation), from the ablation burns. This is not unexpected as it is a natural consequence of the treatment, usually mild in nature and disappears after a few days of treatment with painkillers. Another commonly noted side effect is mild bruising noted at the groin puncture site.
After the procedure, you will be taken to a recovery room where you will be monitored for a few hours. You are also advised to lie flat on your back for 6 hours to ensure that the bleeding has stopped and the incision (cuts) are healing well. Most patients will require an overnight stay for further observation. Your doctor may give you new medication before you leave the hospital. Bruising, soreness and some swelling around the insertion site are normal and heal with time.
Risk
- Bleeding around the heart (tamponade)
- Spasm of the coronary vessel
- Formation of blood clots
- Bleeding at the site where a catheter is introduced
- Bruising
- Stroke
Risk
If you were taking an anticoagulant before the procedure you will need to continue this for a period of time afterwards, depending on your doctor’s guidance. Even if your heart remains in sinus rhythm, you may still be advised to continue the anticoagulant to reduce your risk of stroke in the future. The circumstances for each patient are different and you will need to discuss this with your doctor.
Risk
Your doctor will give 1-week hospitalisation leave following the procedure. Allow yourself plenty of time to recover before resuming any work or physical activity that may stress the body.
Follow-up visits after the procedure will generally involve the same tests as before the procedure, such as:
- Electrocardiogram (ECG)
- Echocardiogram
- Transoesophageal Echocardiogram (TEE)
