Cardiac Ablation

Introduction

Ablation is a non-surgical procedure used to treat certain kinds of heart rhythm problems. Special kinds of energy (radio frequency waves, cryoablation) are used to burn or freeze part of your heart's electrical system, which is causing the problem.

In the past, the only way to treat some rhythm problems was to take medication to control the rhythm or to have surgery. Thanks to new advances in medicine, ablation is the preferred way to treat some of these rhythm problems. This therapy is effective in most patients in achieving a complete cure.

Risk Factors

Ablation is a safe procedure, with a very small chance of any problems developing. Like any procedure done inside the blood vessels or heart, ablation has some risks. Your doctor will discuss these with you.

You could develop a very fast heart rhythm and need an electrical shock to get it back to normal.
The ablation will cause scarring to a small part of the heart.
The ablation might not work and you might need to have it done again.
You might bleed from a puncture site.
You might develop a blood clot.
Infection is very rare.
Partly collapsed lung is very rare.
There is an approximately 1% chance of serious complications occurring e.g. stroke, permanent pacemaker, death or complications requiring emergency surgery.

What to Expect Before the Ablation

You will be given an appointment to be seen in person in the outpatient cardiology clinic, virtually or over the phone . This is to ensure the recent blood work, an echo within six (6) months and any other required tests have been completed and to answer any questions you might have about the procedure.

Before Coming to the Hospital

Your doctor may ask you to stop taking the pills for your fast heart rate up to 5 days prior to coming to the hospital for the ablation. If you are taking other pills, they are usually continued. You will be instructed what to do with your medication, specifically you anticoagulant and antiarrhythmic medications, in the Outpatient Cardiology Clinic or in the letter of instruction that will be sent to you. Do not eat or drink anything after midnight before your ablation. We may need to adjust your insulin dose if you are diabetic. You may take necessary pills with a sip of water on the day of the ablation.

The Day of the Ablation

You will be admitted the morning of your procedure and likely discharged later the same day.. You will need to wear a hospital gown. A nurse will start an intravenous (IV) in your arm. This is used to give you medications or fluids during the ablation. You will also be given sedation as needed.

Just before you go for the ablation, empty your bladder. You do not need to remove your glasses or your dentures. A porter and perhaps a nurse will take you to the EP lab on a stretcher.

What to Expect During the Ablation

The ablation is done in the EP lab. It will take from 2 to 6 hours. You will lie on your back on a narrow table. There will be a lot of equipment, nurses and doctors in the room.

The nurses will put sticky pads (electrodes) on your chest and back. These electrodes monitor your heartbeat. They will also put a blood pressure cuff on your arm. The nurses will give you some medication through your IV to help you to relax.

Ablation is not surgery, but the doctors take special care to be sure the sites(s) in your groin and left shoulder are as clean as possible. They will clean the skin of your groin and shoulder with a special solution. Then, they will cover you with sterile towels and sheets.

In most cases, patients under the age of 18 will receive a general anesthetic for the ablation.

To get the catheters to the heart for the ablation, the doctors use a vein and sometimes an artery in your leg. They may use the vein in your left shoulder too. Your skin will be numbed with medication. This may initially burn or sting a bit. When the skin is numb, 3 or 4 small wires are put into the vein. These wires can be passed through the blood vessels to the heart without discomfort.

The doctors use your ECG and x-ray to place the tip of one tube on the spot in your heart that is causing the heart rhythm problem. Sometimes it can take a lot of time for the doctors to find the right spot. They send a small amount of energy down the catheter to burn the spot. Usually, they need to repeat this a few times. While they do this, you may feel some mild discomfort inside your chest for a few seconds. This discomfort has been described as a "warm achiness" but lasts only a short period.

When the procedure is completed, the catheters will be removed. They will apply firm pressure on the site for a few minutes and then put on a band-aid. If a blood thinner has been used, the catheters will not be removed for 4 hours after the procedure.

What to Expect After the Ablation

You will be taken to a bed by stretcher from the EP lab or recovery room. You will need to lie in bed for 2 to 6 hours. You must keep your leg straight so that it doesn't bleed. You can have the head of the bed rolled up slightly.

Your nurse will check your blood pressure and pulse, look at your band-aids, and check for potential bleeding. Your nurse will also check the pulse in your foot. You can eat and drink. The nurse will remove your IV in a few hours.

Your nurse will tell you when it is time to get up. It is a good idea to sit on the side of the bed for a few minutes before you stand. Your nurse will be with you when you first get up. Please let the nurse know if you are having any dizziness or discomfort.

Going Home

The doctors or nurses will tell you when you can go home. When you get home, avoid heavy lifting (more than 10-20 lbs) and strenuous exercise for a few days. You should be able to go back to work in a week or even 2 to 3 days if you have an office job, and resume your normal activities, like walking, sports, and usual sexual activities in 2 to 7 days, depending on the nature of the procedure.

Follow-Up

You are to be seen by your own family doctor or referring heart doctor for follow-up.

If any of your symptoms of heart racing or dizziness should come back, you should see your family doctor right away. You should also report any fever, swelling or cramping in your legs, bleeding or redness at the site, or trouble breathing. It is important that you take your medications as directed by your doctor.