Overview
Catheters are placed into groin veins (and sometimes artery) and advanced into the heart to analyze the heart’s electrical system, induce the abnormal heart rhythm, identify the site responsible for the abnormal heart rhythm and cauterize (ablate) this site thus eliminating the abnormal heart rhythm.
Success rates: for many common arrhythmias this is > 90%, for atrial fibrillation and other complex arrhythmias 60 – 80%.
Potential complications
These are rare and occur in less than < 1% of patients: Bleeding and infection at the groin sites, damage to the heart (cardiac tamponade), damage to the electrical system of the heart (AV block, requiring a pacemaker). There may be other potential complications related to the specific type of ablation procedure.
What to expect
These procedures are done in the EP laboratory and typically require an overnight stay. The procedure takes about 2 – 4 hours, more complex cases up to 6 hrs.
Procedure
Patient arrives (no food that morning) to the cardiac pre-op area. Intake paperwork is being completed. ECG electrodes are attached and an i.v. line is placed. The blood pressure, heart rate and blood oxygen values are monitored. The patient is taken to the EP laboratory.
Both groins are prepped with disinfectant and the patient’s whole body is draped with a sterile drape lifted up at the head area for patient comfort.
Conscious sedation is administered. These medications make the patient very sleepy but it is not the same as anesthesia
The electrophysiologist injects a local anesthetic in both groin sites (this may sting and burn a bit similar to injections at the dentist). Small sheaths are inserted into the veins (occasionally the artery too). Several steer-able electrode catheters are inserted and under x-ray are advanced into the heart chambers. These catheters lightly touch the inside of the heart wall. The veins and inside of the heart do not signal any pain. These catheters allow pacing of the heart and record its electrical signals from each heartbeat. This information is being displayed and analyzed on a powerful computer system. The electrophysiologist performs a thorough analysis the heart’s electrical system. Next he/she induces the abnormal heart rhythm by pacing the heart, this allows identifying the site responsible for the abnormal heart rhythm. A special catheter is directed to this target site and this site is ablated by delivering energy for 60 – 180 seconds (radiofrequency = heating or cryo-energy = freezing). Often more than one ablation lesion is required to completely eliminate the abnormal heart rhythm. At the end of the procedure all catheters and sheaths are removed.
The patient will then be transferred to recovery area and eventually to a hospital bed. The patient rests for 6 hrs, and typically will be able to be up the same evening.
Recovery
The next morning we will see the patient, assess the groin sites and review overnight ECG strips. After review of the discharge instructions the patient can go home. For the next 48 hours we advise light activity (up and around in the house), then back to normal activities.
The patient will typically see his referring physician, often medications needed to control the heart rhythm before the ablation procedure can be stopped or modified. The risk of recurrence of the abnormal heart rhythm is typically less than 5%, but some heart rhythm problems have a higher potential chance of coming back.