Ablation is a non-surgical procedure using a thin bendable wire called a therapeutic catheter. This catheter is placed through the vein of a patient and into his heart where the electrical impulses of the heart can be studied and treated.

If abnormal heart rhythms are detected, therapeutic catheters are able to emit radio frequency waves and generate enough heat to produce a small scar on a specific part of the heart tissue in order to block wayward electrical impulses.

How does ablation cure common arrhythmias?
Ablation targets the areas of the heart that are generating the wrong kinds of electrical pulses that cause rapid heartbeat. By neutralizing and blocking these areas, the pulses are controlled and a normal heartbeat returns.

Who does ablation for common heart arrhythmias?
There is a specialty of Cardiology called Electrophysiology that focuses exclusively on the electrical impulses of the heart. Such physicians are called an Electrophysiologist or EP and are often referred by Cardiologists when rate and rhythm control drugs fail to work.

What factors should I consider ablation recommended to treat common cardiac arrhythmias?
According to the American College of Cardiology, ablation is the number one recommendation for re-current and well-tolerated unstable Atrial Flutter.

Factors you’ll want to consider when choosing an optimal treatment for your common arrhythmia include safety, effectiveness, how long will it take, how much will it cost and what will my life be like afterward.

Safety: There are complications that come with managing arrythmias with drugs including non-cardiac toxicity, unreliable effectiveness with chronic cases of arrhythmia and rate control can sometimes take up to 4 hours to work. The complication rate for ablation is a comparatively low 1.6%

Efficacy: Easily measured by percentage of success rate of each type of procedure. This chart shows that rate and rhythm control drugs have a low success rate compared to ablation.

What to Expect: Catheter Ablation
More than likely, your doctor has recommended that you undergo catheter ablation because other treatments that have been prescribed for your arrhythmia have not provided the relief you need. In catheter ablation, the electrode delivers a low-voltage, high-frequency current that destroys the heart tissue responsible for the arrhythmia. The majority of 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 permanent return to normal heart rhythm

This means that medicines for controlling heart rate or rhythm may be stopped or reduced following successful catheter ablation. Do not modify your medications without consulting your doctor. Catheter ablation is considered safe and is not associated with a significant risk, so the chance of experiencing complications is very low. For example, the overall rate of complications of catheter ablation for atrial flutter is 1.2%.1 That’s comparable to the risk of tubal ligation (1-2%2) and much lower than the risk of appendectomy (18%3). The electrophysiologist will discuss any particular risks with you before the procedure. The procedure always begins with an electrophysiology (EP) study.

Preparing 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.
• You will have to sign an Informed Consent form, which details any risks or problems that may occur.
• Usually, your doctor will tell you not to eat or drink for 6 to 8 hours before the test.
• The area where the catheter will be inserted will be thoroughly cleaned and shaved. This is usually in the groin, but may be in the neck. You will receive a local anesthetic in that area.
• The catheters will then be inserted; you may initially feel some pressure at the site of insertion.
• You will be given a mild sedative.
  
  

During catheter ablation
The EP and other healthcare specialists in the lab will use a variety of imaging and monitoring systems to help them navigate the catheters to your heart, locate the precise location for the ablation, and evaluate their progress.

Also, depending on your anatomy, some specialists will take extra steps to avoid damaging tissue near your esophagus. They may ask you to drink a creamy substance to help the esophagus show up better on the x-ray.

Catheter ablation uses a series of thin, flexible wires (catheters) that are inserted through an artery or a vein (usually in the groin or neck) and guided to the heart. The position of the catheters can be seen using fluoroscopy, a special monitoring technique that uses x-rays.

Once in the heart, one or more of the catheters are used to pinpoint the source of the abnormal electrical signals.

Medications will be given to increase your heart rate. You may also be given a drug or electrical stimulation to bring on the abnormal rhythm. This will help the doctor identify the areas of the heart producing the arrhythmia.

Some people may feel some temporary chest discomfort during the procedure. If that happens to you, be sure to tell the doctor, who can give you medication to relieve it. When the EP has located the source of your arrhythmia, he or she moves another catheter to the site. That catheter delivers bursts of high-energy waves that ablate, or destroy, the abnormal areas. This creates a small scar (called a “lesion”) that electrical signals cannot pass through. After ablating the problem areas, the doctor will try to re-start your arrhythmia. If the abnormal rhythm cannot be induced in this way, then the procedure is a success. If a fast rhythm does return, further ablation may be needed.

The whole procedure (including the EP study and mapping) may take several hours.

After catheter ablation
Immediately after the procedure, the catheters will be removed and pressure will be applied to the insertion site to minimize or prevent bleeding; a bandage may be applied. It is important to remain still during this time and to not move or bend your leg.

Generally, you will stay in bed for some hours or overnight after the procedure for observation and go home the next day. Once you can 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 activity. Most people can return to their normal routine within a few days. It is common to have a small bruise or lump (about the size of a walnut) at the site of catheter insertion, but you should contact your doctor immediately if the spot becomes warm, tender, or painful, or if it swells. You should also contact your doctor immediately if you experience fever, dizziness, or any other symptoms. Be certain to carefully follow your doctor’s instructions regarding any medications and follow-up appointments.