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What is catheter ablation?

Most patients who receive catheter ablation experience a long-term reduction in the number of episodes of arrhythmia and the severity of symptoms. Many achieve a permanent return to normal heart rhythm.

Cardiac ablation is a non-surgical procedure that is performed by an electrophysiologist (EP). An EP is a cardiologist who focuses exclusively on the diagnosis and treatment of arrhythmias and determines where the abnormal tissue in your heart is located.

A 3D cardiac mapping system that acts like a navigation system is used to create a map of your heart in real time. Guided by this map, the EP places a catheter into your heart to pinpoint the source of the abnormal electrical signals.

When the source of your arrhythmia is located, therapeutic catheters transmit radiofrequency waves, generating enough heat to produce a small scar on the targeted part of your heart tissue. This process blocks the abnormal electrical impulses causing your heart rhythm disorder.

Learn what to expect, how to prepare for and what happens after your catheter ablation procedure.

Why catheter ablation?

More than likely, your doctor has recommended that you undergo catheter ablation – sometimes also called catheter or radiofrequency ablation – because other treatments for your arrhythmia have not given you the relief you want.

In catheter ablation, an electrode delivers a low voltage, high frequency current that removes the heart tissue responsible for your arrhythmia. Most people who have a catheter ablation experience either:

  • A long-term reduction in the number of episodes of arrhythmia and the severity of symptoms, or
  • A return to normal heart rhythm

This means that, after successful catheter ablation, you may be able to stop taking medication for controlling your heart rate or rhythm, or you may be able to reduce the amount you take. Do not modify your medications without consulting your doctor.

What can I expect during catheter ablation?

Cardiac ablation is considered safe and is not associated with a significant risk, so the chance of experiencing complications is very low. The electrophysiologist (EP) will discuss any risks with you before your ablation therapy. The catheter ablation procedure always begins with an electrophysiology study.

How do I prepare for catheter ablation?

Your doctor will tell you ahead of time whether to stop taking any of your medications. Do not modify your medications without consulting your doctor.

Often, your doctor will tell you not to eat or drink for six to eight hours before the test.

The area where the catheter will be inserted will be thoroughly cleaned and shaved. This is usually in your groin, but may be in your neck. You will receive a local anesthetic in that area.

You will be given a mild sedative. Your EP will then insert the catheters. You may initially feel some pressure at the site of insertion.

What happens during the catheter ablation procedure?

Cardiac ablation is a nonsurgical procedure that involves two key stages: mapping and ablation.

Mapping

First, a ‘map’ of your heart is made using catheters to identify the location of the abnormal electrical signal that is causing your arrhythmia. The catheters are thin, bendable tubes that are introduced via your circulatory system. The mapping catheter has a tiny electromagnetic sensor in its tip that communicates with a 3D electroanatomical mapping and ablation system to make a picture of your heart.

The resulting map gives your EP detailed information about how your heart looks and where the electrical circuit is broken. The technology used is almost identical to the GPS technology used in navigation systems.

Ablation

Once your EP has created a 3D map of your heart, the catheter is maneuvered to the areas identified by the map. The EP then uses radiofrequency waves to neutralize these small parts of your heart tissue that generate and conduct abnormal electrical activity. Ablation therapy blocks the faulty electrical impulses that cause your irregular heart rhythm.

The catheter ablation procedure, including the EP study and mapping, may take several hours.

What happens after my catheter ablation?

Immediately after your catheter ablation, your EP will remove the catheters and apply pressure to the insertion site to minimize or prevent bleeding. A bandage may be applied. It is important to remain still during this time.

You will most likely stay in bed for several hours, or possibly overnight, after the procedure for observation and then go home the next day. Once you are free to get up and move around, you may feel stiff from lying still for so long.

At home, you will need to limit your activity for several days and avoid all strenuous physical exertion. Most people can return to their normal routine within a few days.

It is common to have a small bruise or walnut-sized lump where the catheter was inserted. You should contact your doctor immediately if the spot becomes warm, tender, painful or swollen. You should also contact your doctor immediately if you experience fever, dizziness or any other symptoms. Be certain to follow your doctor's instructions carefully regarding any medications and follow-up appointments.

What is catheter ablation?

Cardiac ablation is a nonsurgical procedure that uses a thin bendable wire called a therapeutic catheter. This catheter is placed through your vein and into your heart where the electrical impulses of your heart can be studied and treated.

If your doctor detects abnormal heart rhythms, he or she can use therapeutic catheters that emit radiofrequency waves and generate enough heat to produce a small scar on a specific part of your heart tissue. This blocks the faulty electrical impulses that can cause heart rhythm disorders like atrial fibrillation.

How does catheter ablation cure common arrhythmias?

Cardiac ablation targets the areas of your heart that generate faulty electrical pulses that cause rapid heartbeat or Afib. By neutralizing and blocking these areas, the pulses are controlled and a normal heartbeat returns.

Who performs the catheter ablation procedure?

The ablation procedure is performed by a heart rhythm specialist called an electrophysiologist (EP). An EP is a cardiologist (heart doctor) who has had specialized training in diagnosing and treating heart arrhythmias. Your primary physician or cardiologist can refer you to an EP. Find a doctor.

Which factors should I take into account when considering catheter ablation?

Is catheter ablation safe?

Cardiac ablation is a low-risk procedure that may cure the symptoms of your heart arrhythmia. In many cases, patients who have received an ablation procedure either experience a long-term reduction in the number of symptomatic episodes and severity of symptoms, or a permanent return to normal heart rhythm.

This also means that medicines for controlling the arrhythmia can be reduced or stopped following successful catheter ablation. Complications from medicines used to manage arrhythmias can include fatigue, shortness of breath, dizziness and drug toxicity as well as more serious complications.

As with any procedure, there are catheter ablation risks that potentially include bleeding or bruising, swelling, blood clots, a slow heart rhythm or perforation of the heart muscle, blood vessel or lung.

The complication rate for catheter ablation is a comparatively low 1.6% 1.

Is catheter ablation effective?

This chart shows effectiveness by comparing two cardiac arrhythmia treatments: catheter ablation and antiarrhythmic drug therapy. Over time, patients who were treated with catheter ablation had considerably fewer recurrences of atrial fibrillation than those who were treated with drugs. This clinical study was published in JAMA, a leading medical journal, in 2010.2

Study results demonstrated that catheter ablation for paroxysmal Afib is a much more effective treatment. In fact, 66% of patients treated with catheter ablation were free of Afib one year after the procedure compared to only 16% of patients treated with antiarrhythmic drugs.

In terms of complications and adverse events, these were reported for 4.9% of catheter ablation patients vs. 8.8% for antiarrhythmic drugs patients.

Will catheter ablation improve my quality of life?

Catheter ablation improves quality of life.

A clinical study published in JAMA demonstrated that patients had greater improvements following catheter ablation than those on antiarrhythmic drug therapy.

The clinical study utilized a measurement tool, the SF-36, which is used to measure the quality of life of patients. The scores of patients treated with antiarrhythmic drugs did not significantly change from baseline (before treatment), while those treated with catheter ablation showed significant improvement.2 This group of patients felt significantly better after their catheter ablation recovery.

Improvements in quality of life result from the elimination of arrhythmia-related symptoms such as palpitations, fatigue or effort intolerance.2

What is the cost of catheter ablation?

Ablation is the most cost-effective therapy among patients with monthly episodes of common arrhythmias. Ablation has been found to reduce lifetime medical expenditures by $27,900 compared with long-term drug therapy.3

References:
1Catheter ablation for cardiac arrhythmias: A 14-year experience with 5330 consecutive patients at the Quebec Heart Institute, Laval Hospital
Gilles E O’Hara, MD, François Philippon, MD, Jean Champagne, MD, Louis Blier, MD, Franck Molin, MD, Jean-Marc Côté, MD, Isabelle Nault, MD, Jean-François Sarrazin, MD, and Marcel Gilbert, MD

2 Wilber DJ, Pappone C, Neuzil P, De Paola A, Marchlinski F, Natale A, Macle L, Daoud EG, Calkins H, Hall B, Reddy V, Augello G, Reynolds MR, Vinekar C, Liu CY, Berry SM, Berry DA (2010) Comparison of Antiarrhythmic Drug Therapy and Radiofrequency Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation: A Randomized Controlled Trial. JAMA 303 (4):333-340.

3 Ann Intern Med. 2000; 133: 864-876

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