Catheter Ablation

Catheter ablation is an invasive procedure used to treat cardiac arrhythmias (heart beat irregularities). It is done after a comprehensive electrophysiolgic study. Today these procedures are performed in the electrophysiology laboratory where small tubes called catheters are placed into the veins and arteries in the legs, and sometimes arm or neck and passed to the heart. Most catheter ablations utilize radiofrequency energy to heat the tip of a special catheter. This catheter is placed in the heart near the area causing the arrhythmia (often an accessory pathway or fiber) and ablates or destroys this abnormal pathway.

The procedure is done with the patient lying on their back and in general with the patient in a sleep like sedated state.

The key to performing catheter ablation is mapping of the cardiac arrhythmia. This allows the electrophysiologist to determine where in the heart the arrhythmia arises and allows for placement of the ablation catheter at that location. The ablation procedure needs to be preceded by a comprehensive electrophysiologic study (EPS). The EPS procedure is often done just before the ablation procedure at the same sitting. This allows most patients to have their arrhythmia diagnosed and treated with one procedure.

In general there is little pain associated with an ablation procedure. There is discomfort with the placement of local anesthesia and catheter placement. There may also be a warm sensation in the chest during the ablation itself.

Most ablation procedures and the EPS done before them can be done in four hours or less; occasionally the procedure may take more time.

Before the ablation you will need to have preprocedure testing including blood tests, chest X-ray, and ECG. You should not eat the day of your procedure. You will have an IV started before the procedure.

Catheter ablation is performed for a variety of arrhythmias. The most common are the supraventricular arrhythmias such as WPW, AV Node Reentry and atrial flutter. Ablation is also combined with a pacemaker to treat Atrial fibrillation. Catheter ablation can also be used the treat ventricular arrhythmias, but this is done less commonly than supraventricluar arrhythmias.

Catheter ablation patients are usually monitored overnight after the procedure. If there are no complications, you can be discharged the next day and return to normal activities with a few more days.

The success of catheter ablation procedures varies depending on the arrhythmia. There are also a number of potential complications and you need to discuss these with your doctor before the procedure.

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