Catheter Ablation

Since 1983, we have performed more than 2,500 ablations. Our group has more experience with this procedure than anyone else in the state of Wisconsin, and we also serve as a national leader in this area.

About Radiofrequency Catheter Ablation

In the past, supraventricular tachycardia (SVT) was treated with a lifelong regimen of drugs, surgery or, in some cases, both. Now, however, this arrhythmia can be permanently cured using radiofrequency catheter ablation. This procedure can be performed in the electrophysiolgy lab (instead of an operating room) while the patient is under light anesthesia or sedation.

Prior to the ablative procedure the patient receives a complete electrophysiologic evaluation. A special catheter is then inserted that will be used for locating the precise area causing the abnormal heart rhythm and for the ablation itself. Once the location is determined, the catheter is placed over the targeted area, destroying the tissue and restoring the normal rhythm. After the procedure, patients usually are discharged within one to two days and may resume full activities with no restrictions. Depending on the nature of the arrhythmia, the cure rate can be as high as 98%-99%.

About Your Ablation:
Your doctor has prescribed an ablation because you have an abnormal heart rhythm that requires treatment. An ablation is likely to control your abnormal rhythm, however, as no two patients (and no two arrhythmias) are alike, the specifics of your condition may not be covered here.

How Can an Ablation Help?
The normal heartbeat is caused by an electrical impulse, or signal, that follows a certain pathway in the heart muscle, similar to the wiring in a house. But some people have abnormal heartbeats caused by impulses that come from abnormal locations, or travel through an abnormal pathway.

Catheter ablation is recommended as treatment for those heart rhythm disorders in which:

• An abnormal pathway short-circuits the normal electrical system of the heart, causing a fast heartbeat.

• The heart can "race" for a few seconds to a few hours

• A person can have symptoms of palpitations, chest pounding, dizziness, lightheadedness, and even fainting.
  

Your Ablation: What to Expect
Your ablation will be performed in a special room called and electrophysiology (EP) lab, by doctors trained in the study and treatment of heart rhythms.

Long, flexible wires, called catheters, are inserted into the veins of the leg, arm and neck (and possibly into arteries in the leg) and positioned in the heart. Through these catheters, the doctor can record electrical signals that come from different parts of the heart – similar to an EKG, which records electrical activity from the body’s surface.

With a special catheter, the area of the abnormality is located inside the heart. The catheter is placed at this area and, by delivering either electrical current or heat from radiofrequency waves, the defective heart tissue is destroyed. This eliminates the source of the abnormal heart rhythm or extra pathways.

A catheter ablation can take several hours, and does involve some risks. However, the doctor recommending this procedure believes these risks are small compared to the potential benefit to you. Your doctor will explain these risks to you and answer any questions you may have.

Preparing For The Test:

• You will be admitted to the hospital the day before, or the morning of, your procedure. You may have blood tests, x-rays and an EKG (electrocardiogram). Your heart rhythm may be monitored throughout the time you are in the hospital.

• You will be asked not to eat or drink anything for six hours before the procedure. You may take sips of water with any medications the doctor advises you to continue.

• If you are taking heart rhythm medications (antiarrhythmics), they should be stopped at least 72 hours before the procedure on the advice of your doctor.

• The doctor will explain the procedure, and then ask you to sign a consent form. An intravenous (IV) line will be placed in a vein in your arm. You’ll be taken to the EP lab about 30 minutes before your scheduled procedure time.
  

During The Procedure:

In the EP lab, you will be helped onto a special table. Doctors, nurses and technicians will be present. Electrodes will be placed on your chest to monitor your heart. You may be put to sleep for the entire procedure.

Here’s a brief summary of what will happen:

• The areas where the catheters are to be inserted will be shaved and scrubbed with an antiseptic solution.

• Catheters will be inserted into veins in your neck, arm and groin (and possibly into arteries in your groin) and threaded into your heart under x-ray guidance.

• Some abnormal pathways located on the left side of the heart may need to be reached through a different technique. If this is necessary, your doctors will discuss it with you.

• After positioning the catheters in different areas of your heart, the doctors will try to start your abnormal heart rhythm. This helps them find the exact area of the defective heart tissue (where the abnormal rhythm comes from).

• The special catheter is applied to the targeted area of the heart to destroy the defective tissue. This is done with radiofrequency energy or electrical current.

• The doctors will then try to repeatedly to start your abnormal rhythm, to check the effectiveness of the procedure.
  

How long will it take?
Your catheter ablation will usually last 2-4 hours. When it is finished, the catheters will be removed and pressure will be applied to these areas to prevent bleeding. Pressure bandages will be kept on these areas for about 12 hours.

After the Procedure

You will be taken to the recovery room for about two hours if you were asleep for the procedure. Then you’ll go back to your room, where your heart rate, blood pressure and dressings will be checked often by your nurse. Tell the nurse right away if you feel any discomfort or notice any bleeding.

You’ll be asked to lie flat in bed for about six hours, and to keep your arm and leg straight to prevent any bleeding. The nurse or your family can help you with meals during this time. Your doctors will discuss the results of the procedure with you and your family.

Once the dressing is removed, tell your nurse if you notice any drainage, swelling, or tenderness at the catheter insertion site.
A thin tube may remain in your neck after the procedure. This will be used for inserting a catheter during the follow-up study that is usually done the next day.

For those patients with certain heart rhythm abnormalities (atrial fibrillation or atrial flutter) who undergo catheter ablation to regulate their heart rhythm, a permanent pacemaker may be implanted. This will be scheduled as soon as possible. If you are having a pacemaker implanted, you probably will not have a follow-up study.

About the Follow-up Study

The purpose of the follow-up electrophysiology study is to make sure that your catheter ablation was successful – in other words, if no arrhythmia can be induced after the ablation, it will be considered a success.

You will be awake for the study, which will take about an hour.

A catheter will be inserted through the IV line in your neck or arm and threaded into your heart. The doctors will try to start your abnormal heart rhythm. If an abnormal rhythm is started, your doctor will discuss these results with you and offer further recommendations. You may be able to go home the next day.

Once you have been sent home, you will be asked to keep an eye on the catheter sites, watching for redness or swelling, and asked to report any pain at these site.

You will also be asked to report palpitations, dizziness, shortness of breath, any other symptoms you have before your procedure or any new symptoms.

Your doctor may recommend that you have another electrophysiology study two to three months after your procedure, when all of the tissues are completely healed. This is to evaluate the long-term success of your procedure, and check for other arrhythmias.

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