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What is Catheter-Based Cardiac Ablation?

Catheter-based cardiac ablation is a minimally invasive procedure to treat abnormal heart rhythms (arrhythmias).

An arrhythmia is a disorder characterized by an abnormal heartbeat such as beating too fast, too slowly, or irregularly. When this happens, your heart may not pump blood effectively, and you may feel faint, short of breath, and weak. You may also feel your heart pounding.

Catheter-based cardiac ablation involves passing a thin, flexible tube called a catheter through a blood vessel into your heart to ablate (destroy) small areas of tissue that may be causing your abnormal heartbeat. In other words, ablation is a method utilized to strategically destroy abnormal tissue and restore proper function to your heart. The procedure utilizes either heat (radiofrequency ablation) or cold (cryoablation) energy to create scars in your heart tissue where the arrhythmia is occurring. The scars help block abnormal electrical impulses and prevent abnormal rhythms.

Indications for Catheter-Based Cardiac Ablation

Catheter-based cardiac ablation is a procedure to treat heart rhythm problems known as cardiac arrhythmias. Some of these include:

  • Atrial fibrillation
  • Ventricular tachycardia
  • Supraventricular tachycardia (SVT)
  • Atrial flutter
  • AV nodal re-entrant tachycardia (AVNRT)
  • An accessory pathway, such as Wolff-Parkinson-White (WPW) syndrome

In general, your physician may recommend cardiac ablation if you:

  • Have tried medications to manage an arrhythmia but without much success
  • Have had major side effects from medications used to treat arrhythmias
  • Have a high possibility of problems from arrhythmias, such as sudden cardiac arrest
  • Have certain forms of arrhythmias that respond well to ablation like SVT and WPW syndrome

Preparation for Catheter-Based Cardiac Ablation

Preoperative preparation for a catheter-based cardiac ablation procedure may involve the following:

  • A review of your medical history and a thorough physical examination
  • Routine blood work, imaging, and other tests specific to your condition
  • Informing your doctor of any allergies to medications, anesthesia, or latex
  • A review of your medications and the need to refrain from certain medications for a specific period
  • Refraining from solids or liquids at least 8 hours prior to the procedure
  • Signing an informed consent form after the pros and cons of the procedure have been explained

Procedure for Catheter-Based Cardiac Ablation

Catheter-Based cardiac ablation can be performed by two methods:

  • Radiofrequency ablation: This method utilizes catheters to convey radiofrequency (RF) energy (similar to microwave heat) to destroy problematic heart tissue.
  • Cryoablation: This method utilizes a single catheter to deliver a balloon tipped with a freezing material to cause a scar in the problematic heart tissue.

Your physician will decide the method most suitable for you based on your cardiac history.

In general, catheter-based cardiac ablation involves the following steps:

  • You will be administered a sedative drug just before the procedure to keep you relaxed.
  • The skin on the groin, shoulder, or neck area is thoroughly cleaned and numbed with an anesthetic.
  • A small incision is made in the area where the catheter is to be inserted.
  • Next, a catheter is inserted through the incision into one of the blood vessels in the area.
  • Your physician may inject a contrast medium (dye) through the catheter so that the blood vessels are clearly visible on X-ray images.
  • Under live X-ray guidance, your physician carefully passes the catheter through the vessel up into your heart. Often, more than one catheter is required.
  • Electrodes at the tip of the catheter convey electrical signals and document your heart's electrical activity.
  • Your physician uses this information to determine where to apply the ablation.
  • Once the source of the problem has been identified, your physician will use electrical (or sometimes cold) energy to destroy the faulty area in the heart, eliminating the heart rhythm problem.

Post-Procedure Care and Recovery

Catheter-based cardiac ablation usually takes about 4 hours or more. After the procedure, you will be transferred to the recovery area where your vital signs are closely monitored. Based on your condition, you may be discharged home the same day, or you may need an overnight stay in the hospital. Arrange for someone to drive you home after the procedure. You may experience some soreness at the incision site for a few days. Medications and the use of a cold pack can help relieve discomfort. Instructions on incision site care and bathing will be provided to keep the site clean and dry. You should avoid strenuous activities and lifting weights for a defined period. Most patients can resume their normal activities within a few days. A follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Catheter-based cardiac ablation is a relatively safe procedure; however, as with any procedure some risks and complications may occur such as:

  • Bleeding
  • Infection
  • Damage to heart valves
  • Damage to blood vessels
  • Blood clots or deep vein thrombosis (DVT)
  • Slow heart rate
  • Stroke
  • Heart attack
  • Death, in rare instances
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